A 5,000-mile journey to recovery

An active-duty Air Force crew aboard a C-17 Globemaster made history July 10 while flying specialized medical teams and a patient requiring equipment never before used on board a transatlantic mission.

The spouse of an active-duty Army service member, who wishes to remain anonymous, was being treated with extracorporeal membrane oxygenation at a local German hospital prior to being temporarily transferred to Landstuhl Regional Medical Center for movement back to the U.S.

ECMO teams from San Antonio Military Medical Center, a 24-person staffed hub officially recognized as an ECMO center in May, flew to Germany to coordinate and fly the specialized mission alongside LRMC medical staff for the 5,000-mile journey back to SAMMC in Texas.

The patient had been receiving ECMO in veno-venous mode by German medical staff for approximately a week prior to arriving at LRMC.

ECMO is the process of removing blood through a large vein, placing it through an oxygenator to remove carbon dioxide, and depositing the blood back into the body through another large vein — a medical process similar to dialysis treatment.

“ECMO is designed to replace the heart and lung function as a temporary measure to give the body the ability to recover,” said Lt. Col. David Zonies, LRMC medical director of the ECMO program. “Today’s mission is to bring the team that is similarly developing in the states our experience and fly together as a validation, so the next step for the San Antonio team will be to stand alone to perform the long-range strategic evacuations.”

In order for something of this magnitude to be successful in flight, there are several things that need to happen. Whether recognizing an issue with the patient or grabbing a piece of equipment, teamwork is essential.

“We need to make sure the equipment and patient are secure while in flight,” said Maj. Michelle Langdon, U.S. Air Forces in Europe and Air Force Africa critical care air-transport team leader. “It is important that the team knows their equipment and the other people on the team and what roles they are good at.”

The LRMC team first purchased its ECMO equipment in 2010, using it primarily to transport patients back from Afghanistan. This trip was the first opportunity for the SAMMC and LRMC ECMO teams to transport a patient such a far distance.

“We have practiced this type of movement in short chunks,” Langdon said. “We anticipate what could happen and practice our responses, but there is more to consider while transporting someone this far.”

The challenges increase for medical teams when a patient is in the aircraft for an extended period of time.

“We could have equipment failure, where we would then hand-crank the machine until we were able to trouble shoot and get the device running again,” Langdon said. “We have little control over the environment in the back of the aircraft; it could be hot or cold and sometimes dry, but we do our best to keep the patient as comfortable as possible.”

This capability is a breakthrough on many levels for the medical field.

“This is a huge milestone from technology application to team development to standing up ECMO capabilities both in Germany and San Antonio,” said Lt. Col. Jeremy Cannon, SAMMC chief of trauma and ECMO medical director. “The original vision was to maintain this capability for our combat wounded, but everyone in the (Department of Defense) community benefits.”

This program not only touches the patient but their family as well.

“We’re excited that this technology is available for Soldiers and spouses alike and that they care as much for family members as they do for (active duty),” said the patient’s husband. “It makes me excited and happy that this capability is there and they’re willing to do it in such a quick fashion. We were thinking the transport (back to the U.S.) would take months, not days, for everything to happen.”

Last year alone, the LRMC ECMO team made 18 trips to Afghanistan. Of those, six warriors were put on ECMO treatment prior to being taken back to Germany.

One of the Air Force’s key capabilities is global reach, and this mission solidifies that concept. Both Zonies and Cannon said the idea is to create teams in Europe, the U.S. and in the Pacific so there is the ability to strategically move patients anywhere around the globe to the central ECMO center in San Antonio.

“This team truly gives these (patients) one more chance to survive so we can return them back to their families,” Langdon said.