DOD’s first dual-patient ECMO C-17 transport

JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas — The Department of Defense’s only Extracorporeal Membrane Oxygenation (ECMO) team travelled to El Paso, Texas, on Oct. 23, 2023, to support a civilian patient with acute respiratory distress syndrome.

The ECMO team, located at Brooke Army Medical Center possesses the capability for global transports of all service members. Additionally, the team may also transport civilian patients through the Secretarial Designee program or with the Secretary of the Air Force’s approval. Once approval is granted, the medics use any means necessary to quickly reach the patient.

“We need to get there as fast as we can because, without ECMO support, this patient, is dying,” said Capt. Sarah Juhasz, 959th Inpatient Operations Squadron, ECMO transport primer. “Within a few hours we got our team together and were able to fly commercially, with all of our equipment, to El Paso.”

Juhasz highlighted that within an hour after reaching the patient, they were on the ECMO machine, which positively contributed to their response and overall condition, even as the patient remained unconscious.

“ECMO is a life-saving effort that uses a machine to bypass organs for a specific period of time,” said Juhasz. “While it doesn’t heal anything; it provides crucial time to help save the patient.”

While awaiting a C-17 Globemaster III to transport the patient to BAMC, ECMO team members alternated shifts to care for the patient. During this time, doctors approached them and asked if they could consult on a second patient who also had acute respiratory distress syndrome.

After obtaining SECAF approval, they worked with the En Route Critical Care Pilot Unit manager, U.S. Air Force Maj. Alex Wilson, and coordinator, U.S. Air Force Maj. Amber Hadjis. Collaborating with the 99th Flying Training Squadron, Joint Base San Antonio-Randolph, Texas, they utilized a plane from the student training program, to provide back-up ECMO supplies for the flight to BAMC. With supplementary equipment en route, the medics initiated ECMO for the second patient.

“They were able to take a training plane to El Paso with our equipment on it,” Juhasz explained. “We received our equipment within three to four hours of requesting it, ensuring this flight was safe for our patients, and that was a fantastic joint effort on everyone’s part.”

After receiving the necessary ECMO equipment, the patients were moved into ambulances to transport to the C-17.

“Fortunately, on this mission we took extra personnel for training,” said U.S. Army Capt. Matt Wood, Institute of Surgical Research Burn Intensive Care Unit ECMO transport coordinator and lead. “We had a critical care nurse, [U.S. Army] Capt. Keith Bartolome, two CCATT nurses, [U.S. Air Force] 1st Lt. Alaina Doyle and [U.S. Air Force] Capt. Chad Lee, a respiratory therapist, [U.S. Air Force] Senior Airman Ricardo Soler and a few physicians on the mission with us.”

Wood noted that both CCATT nurses had recently completed the ECMO course.

“I thought this would be the perfect time for the two CCATT nurses to train for future CCATT and ECMO missions,” said Wood. “With the additional personnel, we were able to flex into two teams and safely transport these patients.”

Juhasz acknowledged the rarity of having two ECMO consults at the same time, from the same facility.

“It was the first time in DOD history that we have done an air transport of dual-patients on ECMO simultaneously,” said Juhasz.

While the medics had not anticipated to care for a second patient, they were willing and prepared when called upon. This mission undoubtedly illustrates their medical readiness and skills, ultimately resulting in saving lives.

“This ECMO program proves that military medicine is, by far, the best in the world,” said Wood. “We can adapt and overcome any situation showcasing the capabilities and readiness of all DOD medicine. This is made possible because we become one team, regardless of the service we belong to.”