Caring for an ECMO patient is a balancing act. From heart rate and blood pressure to oxygen levels, blood gases, and anticoagulants – every aspect of the patient’s heart and lung function must be carefully monitored and controlled. To move a Covid-19 patient on ECMO is even more of a balancing act – especially when it’s a 30-hour journey across five countries in the middle of a global pandemic, when there are shortages of medical supplies and oxygen, international travel restrictions, and space limitations due to the size of the aircraft.
Planning the transport took two weeks. In July of 2021, Dr Djaoued Bedjaoui, a senior officer at the UAE Embassy in Washington, D.C., contacted AirMed International to inquire about their abilities to transport a patient from the West Coast to Dubai. Brandon Bates, Senior Director of Global Strategy for AirMed would take the challenge along with the entire AirMed team on planning the logistics of the transport. Bates immediately connected with Dr Bedjaoui to review the complexities of the case and the needs for the transport.
“The patient presented an extremely challenging clinical case, which included Covid-19, pneumonia, acute respiratory distress syndrome, pulmonary embolism and pulmonary hypertension as well as bilateral pneumothorax,” said Bates. “In addition to the clinical presentation, we were facing a whole host of other challenges related to the pandemic and the amount of equipment the transport would require.”
Mapping out the journey meticulously Oxygen was a primary concern. The patient’s Covid diagnosis and the ECMO device and ventilator dependency meant that oxygen usage would be high. Additionally, resupply along the route would be especially challenging due to Covid-19 restrictions, oxygen shortages and limited cabin space in the aircraft.
“As we planned the logistics of this transport, it quickly became apparent that space was going to be a challenge,” said Bradford Anderson, Lead Perfusionist for ECMO Transport, LLC. “We flexed and downsized our equipment as much as safely possible. We also developed a plan to stage our bags in a way that would allow the medical teams to quickly deploy additional equipment if needed.”
The AirMed team worked through every detail of the transport while the embassy made final preparations of their own. Within 48 hours of receiving confirmation from the embassy that they were ready to proceed with the transport, every piece of the puzzle fell right into place. The AirMed team had all necessary plans, briefings, and travel approvals completed.
Preparing the patient
One day in early August, the AirMed flight crew departed Birmingham, Alabama, and headed for San Antonio, Texas. In the lone star state, they picked up Dr DellaVolpe and his team and continued their journey westward to pick up their patient.
After a crew rest period upon arrival on the west coast, the team conducted a pre-transport visit to the hospital to ensure the patient was stable enough for transport and that they were prepared for what the next day and a half would bring.
As soon as the wheels were up, the AirMed Global Operations Center began the meticulous process of tracking every aspect of the flight. “Our global operations team was responsible for monitoring all aircraft movements, reporting all take-offs and landings, technical stops, and providing patient updates to our customer,” said Bates. “Their constant communication ensured that the embassy remained informed, and the clinical and medical operations departments could provide remote monitoring and reporting on the patient’s condition to the receiving hospital.”
Refuelling and refilling oxygen tanks
The team planned the journey in four legs. At each stop along the route, they refueled, refilled needed oxygen supplies, provided critical patient updates to the global operations team as well as the clinical coordination team, completed necessary pilot rotations and have meals. From Minnesota, the crew headed to Newfoundland, Canada – and then on to Ireland and Greece – before arriving in Dubai. In total, they completed three pilot rotations and 30.5 hours of continuous patient care.
The complexities of planning this transport meant that the AirMed and ECMO transport teams were prepared for any possible scenario and that resulted in a completely unproblematic transport. After nearly 31 hours of travel time, they touched down in Dubai where they accompanied the patient to the receiving facility and successfully transitioned care to the hospital providers.
The pandemic has added several complex layers to what was already considered a detailed and intensive process. AirMed must now account for travel restrictions, Covid-19 testing, supply shortages, oversaturation at hospitals and a whole host of other issues. However, with comprehensive planning, complex and long-distance transports can be completed safely and successfully, even during a global pandemic.