Madison, Wisconsin - It started with meeting a friend for drinks. The next thing the 21-year-old-man knew, he was in University Hospital.
"I had no idea what was going on," said the man, who wants to remain anonymous. "I don't have any memory of that night."
What he doesn't remember about the early March morning is that he was spotted floating on melting ice on a local lake. The person who saw the man called 9-1-1 and Madison Fire Department and Emergency Medical Service (EMS) responded. What followed was a patient save that no one expected.
"When we got there, the man was lying on the ice with his head in a crater. His head was totally submerged in water," said Madison Fire Department Emergency Medical Technician (EMT) Dustin Hermanson.
After Hermanson dragged him from the ice, they checked his vitals. He had no respiration or pulse. When he was hooked up to a monitor, they found that his heart was weak but still working. The EMS/paramedic team began chest compressions. They contacted University Hospital's emergency department for guidance.
"It didn't look good," said Hermanson.
Dr. Brian Patterson, an emergency medicine physician, was attending that early morning in the Level I trauma center. He told EMS to continue compressions and get the patient to the ED as quickly as possible. He knew that even a pulseless patient who is cold can be warmed up and revived. But the health care professionals in the ED thought it was a long shot.
Patterson had a plan that involved activating a new protocol that had been tested in the emergency department less than 72 hours before the man's accident. When the call came in, Patterson just happened to be sitting in front of a laminated card that gives step-by-step directions on the life-saving protocol.
Patterson called a thoracic surgeon and together they activated the extracorporeal membrane oxygenation (ECMO) plan even before the patient arrived. ECMO takes over the functions of the heart and lungs and pushes warm blood through the body. When it was activated, a team of many physicians and other health care professionals had to be summoned. Level I trauma centers are required to have specialists in the hospital 24/7.
When the patient arrived at the ED, he was hooked up to ECMO by a thoracic surgeon who placed a cannula (a thin tube) into the inferior vena cava, a large vein that carries deoxygenated blood into the heart. A second catheter is inserted into the aorta, a large artery that carries oxygenated blood away from the heart. The machine is run by a perfusionist who has been trained for these specialized procedures. ECMO began warming the patient's body while circulating oxygenated blood.
Following a round of mechanical chest compressions and shocks, the man started coming around.
"Before ECMO, this would have almost certainly been a futile case," said Patterson. "While we do everything in these situations, I was pretty sure that I would have to tell his family that he didn't make it."
Patterson said that even though ECMO was successful in this case, it only works for highly selective cases; most patients who go into cardiac arrest are not candidates for the therapy. And this just happened to be the perfect one. Patterson said the timing of the training was fortuitous.
"It was such a coincidence that we did the procedure in a simulation less than 72 hours before this patient came in," said Patterson. "It's a race against time to mobilize all of the resources necessary to start this therapy before the patient suffers irreversible damage, but we had prepared for this type of case and were able to make it happen for this patient."
"We planned the unannounced simulation for roughly six months," said Erick Przybylski, who is one of the educators working at the UW Health Clinical Simulation Program involved with this training event.
"The timing was perfect. To have such a great outcome is one of the proudest moments of my career."
Przybylski pointed out that it is not common to have the ECMO protocol in emergency departments.
The patient, who was placed in the trauma and life support center (TLC), said he didn't know for a few days what had happened on the scene and in the ED.
"When they told me about everything they had to do to save my life, it blew my mind," said the patient.
He spent two weeks in the TLC and then was transferred to the UW Health Rehabilitation Hospital. He has no neurological deficits even though he was pulseless before he was found.
"I'm thankful to be alive and want to thank the first responders and the hospital staff for their life-saving efforts."