Doctors from San Antonio Military Medical Center here saved a young mother's life last month using cutting-edge technology historically reserved for infants and young children.
The 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 in 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 a few months ago, while he was in the midst of a surgery. He had asked to be paged whenever a patient in the hospital develops severe lung injury so he could assess them for ECMO treatment.
The patient, Jane*, a mother of two young children, woke up several days earlier 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. She was sent via chopper from her south Texas hometown to the U.S. Army Institute of Surgical Research Burn Center, the Defense Department's only burn center, which is located in the medical center here.
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. 15 and initially was stabilized. However, when her condition worsened, Cannon was alerted.
Cannon and his ECMO team members 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 Defense Department 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 newborns with lung issues such as meconium aspiration, a medical condition that occurs when infants ingest their first stool before or during delivery. However, 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 he had ongoing exposure to the technology. Along with its experts, the neonatal 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 involved in ECMO cases for 15 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. "It 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 transitioned her from ECMO to a standard 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.