Lt. Col. (Dr.) Jeremy Cannon, right, and Dr. Jeremy Pamplin place a patient on extracorporeal membrane oxygenation, or ECMO, in September 2012 at San Antonio Military Medical Center in Texas. ECMO is a heart-lung bypass system that circulates blood through an external artificial lung and sends it back into the patient’s bloodstream. (Photo courtesy of U.S. Army Institute of Surgical Research)
JBSA-FORT SAM HOUSTON —
Doctors from San Antonio Military Medical Center saved a young mother's life last month using cutting-edge technology typically reserved for infants and young children.
This case marks the first time the medical center has treated an adult with extracorporeal membrane oxygenation, or ECMO, a heart-lung bypass system that circulates blood through an external artificial lung and sends it back into the patient's bloodstream.
"This is a true success story," said Lt. Col. (Dr.) Jeremy Cannon, the hospital's trauma chief and a key player on the case. "I firmly believe this patient would not be here if it wasn't for ECMO and a tremendous team effort."
Cannon first heard of the case about a month ago, while he was in the midst of a surgery. He had asked to be paged whenever a patient with severe lung trauma arrived at the hospital so he could assess them for ECMO treatment.
The patient, Jane*, a mother of two young children, had woken up that morning with itchy, irritated eyes, but she and her doctor chalked it up to an eye infection or virus. It wasn't until her symptoms spread and worsened that she decided an emergency room visit was in order.
A few hours later, she was diagnosed with severe Toxic Epidermal Necrolysis, or TENS, an autoimmune reaction to medication, and was sent via chopper from her south Texas hometown to the Institute of Surgical Research Burn Center located in San Antonio Military Medical Center.
The TENS progressed quickly and by the time she reached the hospital, Jane's skin was sloughing off, her lungs were filling with fluid and tissue, and her vital organs were failing. She was admitted to the Burn Center on Sept. 25 and, shortly after, Cannon was alerted.
Cannon had one thought after assessing Jane: "She's going to die if we don't use ECMO."
Cannon and a select team of specialists here had been training for this moment for more than a year, thanks to a Department of Defense grant that provided ECMO supplies, training funds and equipment to explore the use of ECMO on adults.
ECMO is commonly used in neonatal intensive care units around the world on infants with lung issues such as meconium aspiration, but adult applications are much less common, mainly due to a lack of recent patient data.
Cannon, however, had been observing ECMO successes since his residency and strongly believed in its outcomes for adults, particularly for patients on the brink of death. He had transferred to SAMMC from the Air Force's Wilford Hall Medical Center, which contained the military's only infant and child ECMO center, so had ongoing exposure to the technology. Along with its experts, the ECMO center transferred to SAMMC last year.
Cannon brought his strong convictions about the lifesaving potential of the technology to his leadership and requested for Jane to be SAMMC's first adult ECMO patient. "I've been doing ECMO for 20 years," he said. "I saw the benefit and felt confident we had the team structure and protocols in place."
The same day she checked in, Jane was put on ECMO, and stayed on it for 23 days.
It was touch and go at first, Cannon noted.
"I was agonizing for 22 of those 23 days," he recalled.
Finally, on Day 21, Jane's lungs started to clear and, two days later, staff took her off the treatment and onto a ventilator. "Within a day and a half, she went from profoundly ill to greatly improved," he said, noting the team effort of experts across the hospital.
"It was exhilarating to see her get better, thanks to a concerted effort," he added.
A few weeks later, Jane is now an outpatient, staying with her mother in town until she gains enough strength to return home. "It's been tough, but I'm not going to give up," Jane said in a recent interview at the hospital. "I can't say enough about the care I've received here."
Jane's lungs and skin are still healing, but Cannon has high hopes for Jane, as well as for other SAMMC patients who can be helped through ECMO.
Cannon also hopes to see an increased use of adult ECMO in the war zone, where it's already proved lifesaving for several troops. In 2010, an ECMO-trained team picked up a Soldier in Kandahar, Afghanistan, who had been shot in the chest. His right lung had to be removed, a procedure that typically carries a 100 percent mortality rate. However, the lung team placed him on ECMO and he quickly recovered in a hospital in Germany.
Cannon recalled meeting this patient a few weeks after he arrived at Wilford Hall. "He's married now and enjoying life," he said. Since then, there have been about six ECMO transports from the battlefield to Germany, he added.
Cannon's long-term vision is to see ECMO patients transported directly from the battlefield to a stateside location, such as the medical center here, for their recovery.
"We've proven we can very safely take care of even most critically ill patients and I'm very optimistic will be able to offer these services to wounded warriors throughout their continuum of care," he said.
Based on recent successes around the nation, Cannon said he expects to see resurgence in ECMO research around the world, which will help to build confidence in the technology for adults. A trial with strict research protocols based in France is set to begin soon, he added.
Whatever the future holds, Cannon said he'll never forget the lifesaving impact of ECMO for Jane. "All of this came together beautifully and it worked," he said. "She's alive because of an amazing team effort."
The day she improved, he added, "was the pinnacle day in my medical career."
*Patient's name was changed to protect her privacy.