The Critical Care Transport Service at the University of Alabama at Birmingham has added another first to its lengthy list of accomplishments during its more than 30-year history of transporting critically ill patients by air or ground. The program recently transported a patient on a portable ECMO machine to UAB for the first time.
ECMO, or extra corporeal membrane oxygenation, is a technology developed for heart/lung bypass. ECMO takes on the function of the heart and lungs by routing the patient’s blood into the machine, where carbon dioxide is removed and oxygen is added. The blood is then pumped back into the body.
The original machines, cumbersome and complicated, could be used only in the operating room. In the past several years, UAB has added portable ECMO machines, which has opened up myriad new uses for the devices. UAB now uses them as a bridge to lung transplant, or in cases of severe lung injury from flu, carbon monoxide poisoning or other causes.
Feb. 3, the CCT team flew their Cessna Citation Bravo jet aircraft — their flying intensive-care unit — to the University of Kentucky Hospital in Lexington to pick up a patient in need of a lung transplant. The patient had gone on ECMO at Kentucky, and the process of moving her to UAB was complicated.
“This was the most clinically and logistically challenging type of transport we had ever undertaken,” said Laura Lee Demmons, director of CCT. “We had to anticipate and plan for every possible contingency because, at 30,000 feet, there is no margin for error.”
ECMO is difficult and not without risk even in the controlled environment of a hospital intensive-care unit. The process of gearing up for an ECMO transport took months.
“It took a great deal of effort from a lot of people to make this happen,” said John Doriety, R.N., a CCT team member. “We had to establish policies, conduct planning sessions, organize supplies, medications and equipment, and above all, practice.”
Doriety is a veteran of 12 years with CCT. He has done more than 1,800 patient transports. This one was unlike any that had come before.
“We spent a lot of time thinking this one through — asking ourselves what could go wrong, and how would we respond if it did,” Doriety said. “We were as prepared as possible for any eventuality, but I’m happy to say that the flight was very routine.”
The team, consisting of Doriety, physician Chris Bellot, M.D., perfusionists Bobby Reed and Britt McIlwain, respiratory therapist Regena Bragwell, and pilots Justin Koenig and Mike Huston, flew to Lexington on Feb. 3. They spent about two hours on the ground in the hospital, switching from the UK equipment to UAB’s portable ECMO machine and prepping the patient.
“The collaboration and cooperation with the staff at the University of Kentucky and the ground transport to the airport were outstanding,” Doriety said. “Everything went as smoothly as possible.”
The flight back to Birmingham took just over an hour. At one point, the team had to request a change in altitude — the patient, who was on oxygen, was having difficulty with oxygen saturation. A drop of 6,000 feet solved the problem. CCT ground transport driver Ahmed Saeed was waiting for the team at Shuttlesworth International Airport to complete the successful, and remarkably trouble-free, transport.
“There are only a handful of medical transport programs in the nation who can do a patient transport of this complexity,” said Demmons. “As UAB’s ECMO program expands, CCT stands ready to provide our services whenever needed.”
The team completed its second ECMO transport just one week later. The second went as smoothly as the first.
UAB’s CCT program has been providing local, national and international patient-transport services for more than 30 years. It has transported more than 42,000 patients using both jet aircraft and mobile intensive-care vehicles. CCT is one of four services accredited in Alabama by the Commission on Accreditation of Medical Transport Systems and the only accredited critical-care ground service in the state.