M Health Fairview launches airborne life-support treatment to save cardiac arrest patients

M Health Fairview has expanded its emergency life-support program for cardiac arrests, flying a cardiologist and an artificial heart pump to north-central Minnesota when patients’ hearts have stopped.

Statistics show most people who experience cardiac arrest outside a hospital don’t survive. But starting this month, paramedics have been instructed to call for the emergency life support if they can transport patients to M Health Fairview Northland Medical Center in Princeton, Minn., within 30 minutes of sudden cardiac arrest.

The life support is called ECMO, or extracorporeal membrane oxygenation, which mechanically circulates the blood, buying time for patients’ defective hearts and lungs to heal.

The first-in-the-nation air ECMO program brings the cardiac technology to a region surrounding Princeton that hasn’t had access in the past — spanning east to the Wisconsin border and north to Mille Lacs. Cardiac arrests are rare enough in that rural region to make it wasteful to base a specially trained cardiologist and ECMO machine at Northland, but a helicopter from the University of Minnesota Medical Center in Minneapolis can get them to the hospital in time, said Dr. Jason Bartos, an interventional cardiologist and leader of the program.

“Our goal is to have everybody on-pump within an hour,” said Bartos, who at the outset is the only cardiologist flying to emergencies in Princeton. “If we get patients on-pump within 30 minutes of their call to 911, we still have nearly 100% survival, but with every minute that goes by, it’s an extra 2.5% [chance of] mortality.”

Rapid response is crucial because cardiac arrest halts blood flow to the brain and organs. Cardiac arrests can be triggered by traumatic injuries, drug overdoses, irregular heartbeats and by heart attacks — blood vessel blockages that decrease or cut off blood flow.

An ECMO device pumps blood outside the body, where it is reoxygenated and warmed before being pumped back in. Mobile ECMO was unthinkable two decades ago, because the original pumps were larger than pianos and fixed in surgical suites.

The U even created a super ambulance with its own procedural suite in the back, designed to meet paramedics in remote locations such as parking lots and provide ECMO before sending patients to hospitals.

That vision created licensing and logistical concerns, though. So instead, the ambulance dispatches from a fire station in Edina to Southdale Hospital or to North Memorial Health in Robbinsdale when needed. The approach still shaves minutes off ECMO time compared to wheeling the patients into hospitals first.

Eligible patients have a 40% better chance at survival if they receive ECMO from one of the mobile teams, Bartos said.

The air ECMO program has been active for two weeks but has yet to respond to a call in Princeton. M Health Fairview is nonetheless looking to expand the program to Lakes Medical Center in Wyoming, Minn., which would provide ECMO access to more remote areas in Minnesota and western Wisconsin. The air medical transport service Life Link III provides the helicopters and emergency transport for the program.

Northland ER nurse manager Jason White said he leapt at the opportunity to bring the program to his community. ER workers are trained to prepare patients so they can be immediately tethered to ECMO when the helicopter arrives.

The option is only available for adults in cardiac arrest who show signs that their heartbeats can be shocked back into rhythm with defibrillators once the underlying blockages or defects in their hearts or blood vessels are fixed. Medics also must provide CPR continuously to keep blood flowing until the patients are placed on the pumps.

An annual CARES registry tracked outcomes of 3,478 sudden cardiac arrests that occurred outside hospitals in Minnesota last year, including some cases that received ECMO or would have benefitted from it had it been available. Only about 12% survived and recovered to the point they could be discharged from hospital care, underscoring the need for more treatment options, according to the registry data, released in late July.

Sending an ECMO team by helicopter while a patient is en route to Princeton is usually faster than sending a helicopter to Princeton and bringing the patient back to Minneapolis, he added. The ECMO team is only dispatched when cardiac arrests have been witnessed, which provides an accurate timeframe to suggest whether lifesaving efforts are possible.

EMS agencies in England and the Netherlands have used similar approaches, and medical helicopters have flown U.S. patients in cardiac arrest to hospitals equipped with ECMO. But Bartos said this program “is breaking new ground in the United States” by flying ECMO technology to remote hospital locations.