IOWA CITY, Iowa — Mike Meyer, a 23-year-old Marine from Pensacola, Fla., remembers being sick and going to the hospital in March in Okinawa, Japan, where he was stationed with the military, and he remembers waking up two months later at University of Iowa Hospitals and Clinics, in a state where he'd never before set foot.
What happened in between tells the story of a growing medical program at University Hospitals, a procedure used regularly for adults at so few hospitals that a gravely ill Marine was flown from Japan to Hawaii to Iowa so his life could be saved.
"That's totally the reason I'm here right now," Meyer said from Pensacola, where he's been recuperating since his June 22 release from UI Hospitals and Clinics. "There's no possible way I would have survived otherwise. Iowa, by keeping me on (the machine) for that long, longer than anybody else would have, made the difference."
Meyer spent about three months at the Iowa City hospital, and for 54 of those days he was hooked up to an Extracorporeal Membrane Oxygenation machine, or ECMO. It's a prolonged heart-lung bypass for critically ill patients with severe, but reversible, respiratory failure or cardiac disease who have failed other intensive care therapies.
The machine basically does the job of the lungs — draining blood through a closed circuit, removing carbon dioxide and then putting oxygen into the bloodstream — when a patient's lungs are too sick to do the job.
It's technology that for decades has been used to treat babies and children, but it's becoming more popular for hospitals to use the treatment on adults as well, said Dr. William Lynch, a cardiothoracic surgeon who directs the UI hospital's ECMO program. The UI program started in 1996 for babies and children, and Lynch was recruited in 2005 to launch the adult ECMO program, to support the hospital's lung transplant program.
Early use of ECMO when it was invented in the 1970s did not show promising survival rates with adult patients, so few doctors used it for that population, Lynch said. But more recent studies show a higher survival rate for adults, as the technology and training have improved, he said. And more hospitals began using ECMO on adults after it proved a successful treatment during the H1N1 flu outbreak several years ago, Lynch said.
"I think all of ECMO will start to shift in that direction," he said.
The survival rate of adult patients with respiratory failure who are put on ECMO at UI Hospitals and Clinics is about 54 percent, Lynch said, but patients who require the treatment are "usually the sickest of the sick."
Because the UI hospital has a strong and growing adult ECMO program, it draws patients from across the Midwest and sometimes from across the country. University Hospitals see about 10 ECMO cases with babies and children per year, and about 15 adults, program coordinator Elizabeth Moore said. That's out of about 200 to 300 adults treated with ECMO each year in the United States, Lynch said. The H1N1 outbreak of several years ago put UI on the radar for adult ECMO treatment, Moore said.
"People found out we had this ability to treat patients with respiratory failure," she said. "Maybe some patients who are struggling on a ventilator, we're getting referrals for those patients now."
Meyer was the second patient flown to the UI hospital from Hawaii for treatment, Moore said. ECMO is a "pretty small community," and doctors and medical professionals get to know what programs can offer, she said. Lynch has advised hospitals around the world on the treatment, including helping a hospital in South Africa launch an adult ECMO program, so those ties play a role in patient referrals, Moore said.
"Even though it seems kind of crazy that a patient would get sick in Japan and somehow end up in Iowa, the community is so tightly connected," Moore said. "For Mike, the stars were aligned and the right phone calls were made."
Meyer, while stationed with the 31st Marine Expeditionary Unit in Japan, got what he thought was a cold or the flu, nothing that alarmed him at first. But after days of worsening symptoms and a persistent cough, he got to the point where he didn't have the strength to stand up. He was on a beach during a training mission with his unit, and told his commanding officer he needed to go to the hospital.
A helicopter took him to the hospital in Okinawa, where he was sedated and put on an ECMO machine. His parents were flown to Japan because his condition was so grave. But he was not getting better, so he was flown to Tripler Army Medical Center in Honolulu, and continued his ECMO treatment there. But after a week, he kept getting sicker, and the staff didn't have the resources to support the 24/7 needs of ECMO care.
The doctor at Tripler knows Lynch and is familiar with the UI program, so Meyer was again loaded onto a C-17 and this time flown to Iowa.
"It was just lucky that they knew all these people, all the right people," Meyer said.
During his illness, Meyer lost 50 pounds and had five surgeries while in Iowa City, including one to remove his gallbladder due to the rapid weight loss and another to remove dead lung tissue. Now back in Florida, Meyer goes to physical rehab three times a week, and works on administrative and paperwork tasks on the military base in Pensacola. But his doctor there doubts he can return to physical training with his Marine unit, and is seeking a medical discharge for Meyer.
He returned to Iowa City in early August, for a picnic for former ECMO patients and UI doctors, nurses and staff. Meyer credits all of the medical personnel and military resources that helped save him. His mother and family were helped with travel expenses by several groups, including the Marine Corps League in Cedar Rapids, the Semper Fi Fund and the Fisher House Foundation, which provides help to military families.
"I can't say thank you enough to everybody," Meyer said. "I've never heard of ECMO before until now. And now I act like everybody should know what it is."
For Lynch, it's an ECMO success story. It shows keeping patients on the costly and staff-heavy treatment, even for weeks, can pay off.
"The logistics of ECMO are hard for a lot of centers," Lynch said. "But if you just wait long enough, the lungs can get better."