Thanks to Martinique link
By Robert Luckock
St. Martin's Louis-Constant Fleming Hospital recently announced that three lives were saved using extra-corporeal membrane oxygenation (ECMO), a cardiopulmonary bypass technique, thanks to a privileged partnership with the Fort-de-France Academic Hospital specialists in Martinique.
ECMO is a last-chance treatment used in intractable hypoxemia when, despite the most sophisticated mechanical ventilation, lungs are no longer able to provide enough oxygen to support life.
"In such drastic situations, the intensive care unit of our hospital reaches the very limits of its capabilities," explained Anaesthesiologist Dr. Xavier Ledoux. "Until very recently patients used to die here as nothing could be done for them. But now it is possible to determine, from a distance, whether this exceptional technique needs to be or must be carried out. This life support is the cardiopulmonary equivalent of an artificial kidney."
The treatment process begins with a cardiac surgeon and team coming to St. Martin from Fort-de-France, accompanied by a flight doctor and highly specialised ECMO equipment. Louis-Constant Fleming Hospital physicians and nursing team are in charge of establishing the diagnosis that requires performing a cardiac ultrasonography. At this point the patient's life is hanging "on a knife edge", Dr. Ledoux notes.
The most recent case was a 35-year-old woman from St. Barths who was admitted on January 18.
"She was continuously monitored by an intensive care physician from 6:00am to 10:30pm, 16-hours of non-stop struggle to keep her alive," Dr. Ledoux recalled. "Once she was connected to the ECMO machine in our operating room we were able to restore an efficient cardiac output and a proper oxygenation. She was then flown to the Martinique hospital on the PJIA-based Jet Budget air ambulance (the hospital's newly-chosen medivac contractor) for specialised follow up. Her condition improved dramatically and she is expected to be well soon."
The first patient treated with ECMO was in 2009, also a 35-year-old lady, but suffering from complications after contracting H1N1 Bird flu.
"We struggled to keep her alive until the Martinique team arrived in the evening. She was kept overnight and flown next morning to Martinique on Melmik Aviation's Lear Jet. This fast and pressurised aircraft is equipped with AC plugs necessary to keep the machines functioning. Because of the patient's condition and the complex medical equipment it took us 75 minutes to board the aircraft. But this young mother of three went back home after a few days with no permanent damage and enjoys a normal life."
Today, thanks to the Martinique specialist's experience, the whole process is now perfectly coordinated and patient and intensive care equipment can be loaded aboard the plane in 15 minutes.
"We're getting much better at it," admits Dr. Ledoux. "Thanks to this chain we can save lives and keep a patient alive long enough for the team to get here. These are cases of young people with acute cardiopulmonary failure which is likely to be reversible. Our goal now is to reduce decision time and transportation time."
The second case occurred in August 2011 involving a 25-year-old lady suffering from a severe amniotic fluid embolism in the lungs after delivering a baby, but she had a full recovery.
Dr. Ledoux describes the partnership between the St. Martin hospital, Martinique hospital, and the crucial involvement of the air ambulance, as "a vital human medical chain."
"We have a dynamic and motivated medical and nursing team in our hospital and with the strong partnership with Fort-de-France's medical teams the success of these cases has major implications for health care of the population of St. Martin and St. Barths. A huge amount of credit also goes to the air ambulance companies for their efficiency."
According to Dr. Ledoux, the Martinique team has the most experience worldwide of long distance flights with ECMO equipment. It has carried out 60 ECMO procedures in the past two and a half years, 15 of which have been on long distance flights from St. Martin, Guadeloupe, and French Guiana to Martinique.
"To our knowledge we are aware of only two plane transfers in Italy and one or two in New Zealand. Within one or two years we hope to have a congress on critical care air ambulance methods and this particular therapy is one of the most amazing in the world."
