TAMC staff teams with local medical community to save patient, set record

| December 10, 2010 | 0 Comments

Nick Spinelli
Tripler Army Medical Center Public Affairs

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HONOLULU — A team of health care professionals, including local civilian and military doctors, set a world record while providing life-saving care to a 56-year-old patient.

They transported her 4,051 miles while performing Extracorporeal Membrane Oxygenation.

ECMO is an extracorporeal technique that provides both cardiac- and respiratory-support oxygen to patients when their heart and lungs no longer function. Essentially, ECMO is a machine that circulates and oxygenates the blood.

“ECMO is a form of cardiopulmonary bypass that has been used successfully in neonates — infants less than 30 days old — for (more than) 30 years,” explained Lt. Col. Erik Osborn, pulmonary critical care physician, Tripler Army Medical Center.

Osborn said the procedure, while normally performed on infants, now has a higher success rate among adults due to technological advancements. However, the combination of the procedure and the circumstances surrounding it made the life-saving situation unique.

“There have been adult ECMO patients, and there have been ECMO patients who have had to be transported great distances, but this is the first time an adult patient has been transported this far,” Osborn said.

A patient at Straub Hospital in Honolulu was suffering from pneumonia, when the patient’s doctors and family decided that ECMO was the best option.

Dr. Mark Grattan, cardiothurasic surgeon at Straub, approached Pete May, senior director, Operations-Hawaii Specialty Care, perfusion support, since the perfusion team had adult ECMO experience, personnel and equipment.

Calls were made to Air Force Lt. Col. Dr. Melissa Tyree, TAMC’s ECMO medical director, and Len Tanaka, director and co-director of the Hawaii Hanuola Neonatal and Pediatric ECMO program, to explore ECMO physician support from the Pediatric ECMO team.

During the next two days, doctors and staff from Straub, TAMC and Kapiolani Medical Center worked in conjunction to set up the procedure.

“It took enormous efforts from the local medical community leadership, as well as the leadership at Tripler, to put all of this together, and I can’t say enough about how well they made it happen,” Gratten said. “It was a multi-hospital team, and the health care provided was excellent.”

Osborn performed the procedure.

“Initially, Tripler was only contacted for logistical advice and possibly for equipment,” Tyree said; “however, it became apparent that we not only had the equipment, but also the expertise, and Dr. Osborn was willing to participate.”

Once the procedure was completed, there was still concern about monitoring the patient’s recovery.

“Patients on ECMO require constant maintenance,” said Melody Kilcommons, Kapiolani Medical Center’s ECMO/transport clinical supervisor. “Someone needs to be with the patient all the time.”

The patient needed to be transported to a facility on the mainland to receive necessary care and attention.

The team decided to send the patient to Iowa City, Iowa, more than 4,000 miles away.

Currently, Osborn and Tyree are working to start a permanent adult ECMO program at TAMC.

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