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New lung bypass center could bring wounded home faster

Aug. 19, 2013 - 06:00AM   |  
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JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, TEXAS — Spc. Eric Griego was on patrol in Afghanistan’s Kandahar province when his unit was ambushed and an enemy bullet tore into his neck.

“I stumbled to the ground. I wasn’t even sure what happened,” Griego said. “I fired off a few shots and my left arm, from shoulder to fingertips, was completely numb.”

Griego, of 1st Squadron, 75th Cavalry Regiment, 2nd Brigade Combat Team, 101st Airborne Division, then began having trouble breathing.

The bullet had entered the lower left side of his neck, damaged part of his left lung, ricocheted off the third vertebra in his spine, and then destroyed all of his right lung.

It was Oct. 18, 2010.

Days earlier, the military in Afghanistan received the equipment and specialists required to give patients a process called extracorporeal member oxygenation.

ECMO is a lifesaving heart-lung bypass system that circulates blood through an external artificial lung before sending the blood back into the patient’s bloodstream. ECMO does what severely damaged lungs cannot do, and the treatment allows a critically ill patient’s lungs or heart time to heal.

Griego, 25, was the first soldier to receive ECMO in Afghanistan.

“I don’t know the specific details on when I was put on the ECMO machine, but I know the respirator they had me on wasn’t helping,” Griego said. “I’m the first soldier to be transported [out of Afghanistan] with the ECMO machine. It definitely saved my life. I wouldn’t be alive without it.”

But Griego’s journey wasn’t over. Before he could be flown home to San Antonio Military Medical Center, he had to spend almost two months at a civilian hospital in Germany because Landstuhl Regional Medical Center could not provide the sustained care he needed, and there was no way to transport him across the Atlantic while he was still on the ECMO pump.

Air Force Lt. Col. (Dr.) Jeremy Cannon hopes to change that.

Cannon is director of the newly created Adult Extracorporeal Life Support Center at SAMMC.

The center is the Defense Department’s only facility to provide and sustain ECMO for adults.

Cannon, who is also SAMMC’s chief of trauma surgery, is working to enable ECMO patients to be transported from the battlefield back to the U.S. for recovery, similar to what the U.S. Army Institute of Surgical Research Burn Center, also here at SAMMC, does with its burn flight team.

The burn flight team is made up of a rotating roster of burn specialists — doctors, nurses and respiratory therapists — who are always on call.

When a patient suffers burns on more than 40 percent of his body, severe inhalation injuries or multiple traumatic injuries, the team is called to respond and help treat and manage the patient’s care during transport.

Most often, in recent years, the team has evacuated burn casualties from the wars in Iraq and Afghanistan, flying to Landstuhl to meet the medevac and accompanying the patient on the flight back to SAMMC.

Before the U.S. military had ECMO capability in Afghanistan, “people were marooned in theater with severe injuries but with potentially survivable wounds,” Cannon said. “They were getting stuck in theater or dying.”

Since October 2010, at least five American troops and a number of NATO troops have received ECMO in theater, he said.

ECMO patients, like Griego, who are medically evacuated from Afghanistan are flown to Germany and taken to University Hospital Regensburg, a civilian hospital. The patients stay there until they are well enough to be taken off ECMO and flown to the States.

If Cannon can build a deep enough team of specialists and work out the logistics, ECMO patients from Afghanistan, like most other wounded warriors, would be flown to Landstuhl. There, the team of specialists would meet the patient and immediately transport him back to SAMMC.

At the German hospital, Griego said he remembers waking up, disoriented and hearing the medical staff speaking in German.

“I started to panic because I couldn’t understand what they were saying, and my last memory was being in combat,” he said.

After he was weaned off the ECMO pump, Griego was flown to SAMMC for further care.

He was medically retired in September 2012.

Today, Griego lives a normal life and functions off of 68 percent of his left lung.

He believes things would have been easier for him and his family if he had been able to return to the States more quickly.

“They flew my whole family out to Germany, and they were there almost as long as I was,” he said. “I feel if you could go home sooner, it would benefit your family. After seeing what it did to my family, having that support at home would make things better.”

Cannon said he is continuing to work on his vision to be able to transport ECMO patients home more quickly from the war.

“We can do the trauma stuff very well, but if you add ECMO, it really complicates things,” he said.

The staff at the Adult Extracorporeal Life Support Center has conducted two fixed-wing transports and one ground transport to test their capabilities, Cannon said.

“If we get a call tomorrow, there’s a 90 percent chance we can go get a patient from Germany,” he said. “We’ve laid the groundwork, we’ve proven we can do long-range transport, and we’ve identified a need. There’s no point in having a center if we can’t bring the wounded in.”

One of the test flights brought Jolene Moore, an Army wife, to SAMMC from Germany.

Moore, 31, is at the top of the list for a lung transplant. While she waits, she is on ECMO and being cared for at SAMMC.

“I thought I had asthma, but my lungs were in worse shape than I thought,” said Moore, who has been on ECMO since June 30.

With ECMO, “I can breathe easier, and I don’t have as many bad days as I used to.”

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