With the GSCACEP Career Development Grant, I attended RE-ANIMATE 11, a two-day immersive conference centered on extracorporeal membrane oxygenation (ECMO) cannulation. While the conference delved into ECMO physiology, the focus was to develop the hands-on skills needed for emergent ECMO cannulations, including performing cannulation for ECPR, and to learn how to train a team, hospital, and healthcare system to effectively implement an ECPR program.
Currently, the military’s healthcare system has the capacity to cannulate for ECMO and transport patients on ECMO, which is housed at Joint Base San Antonio. In 2024, the ECMO team completed the first ever double ECMO patient transport on a C-17. From 2012 – 2019, there were an average of 10 – 12 ECMO transports per year with an impressive survival rate to discharge of 73%. In part due to COVID-19 and accepting ECMO consults for civilian patients, the numbers have continued to increase and the program has grown.
The key lessons I learned from RE-ANIMATE about creating and sustaining a high-performance ECMO program centered on team and system development. These insights included how to implement nurse-led codes, which allows the physicians to determine ECMO candidacy and focus on cannulating and other procedures, how to work with local EMS systems to change local protocols to identify cardiac arrest patients eligible for ECPR to transport them immediately instead of the typical “stay and play” approach, and the changes required within the hospital system to support and take care of these patients after they were cannulated. Many of the mavericks who brought ECPR to their emergency departments shared inspiring stories of their first ECPR cannulations and fearlessly implementing this life saving treatment despite obstacles and hesitation of their local hospital leadership.
Servicemembers benefit from the military maintaining a strong ECMO program. ECMO can stabilize and save those with severe acute respiratory distress syndrome, severe obstructive shock from pulmonary embolism, and cardiogenic shock from multiple etiologies. However, ECMO has a growing role in supporting trauma and burn patients, which are indications directly applicable to military servicemembers.
In my view, the military healthcare system has an obligation to provide ECMO to our servicemembers and civilian populations. The ECMO Team at Joint Base San Antonio illustrates that we can be highly successful due to several advantages: an integrated health system, high performing teams, and an unparalleled transportation ability. For the military healthcare system to expand our ECMO program, we must consider establishing other ECMO centers within the United States and globally to expand the footprint of the program, cannulate and transport more patients on ECMO, and continue to hone our expertise. Fundamentally, the Defense Health Agency should be committed to developing and providing this life saving intervention to our servicemembers who have committed their lives to service.