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Closing the “Care in the Air” Capability Gap for Severe Lung Injury: The Landstuhl Acute Lung Rescue Team and Extracorporeal Lung Support

Fang, Raymond MD, FACS; Allan, Patrick F. MD; Womble, Shannon G. RN, MSN, CCNS, ACNP; Porter, Morris T. RRT; Sierra-Nunez, Johana RN, CCRN; Russ, Richard S. RN; Dorlac, Gina R. MD, FACP; Benson, Clayne MD; Oh, John S. MD; Wanek, Sandra M. MD; Osborn, Erik C. MD; Silvey, Stephen V. MD; Dorlac, Warren C. MD, FACS

Journal of Trauma and Acute Care Surgery: July 2011 - Volume 71 - Issue 1 - p S91-S97
doi: 10.1097/TA.0b013e3182218f97
Original Article

Background: The success of US Air Force Critical Care Air Transport Teams (CCATT) in transporting critically ill and injured patients enabled changes in military medical force deployment and casualty care practice. Even so, a subset of casualties remains who exceed even CCATT capabilities for movement. These patients led to the creation of the Landstuhl Acute Lung Rescue Team (ALeRT) to close the “care in the air” capability gap.

Methods: The ALeRT Registry was queried for the period between November 1, 2005, and June 30, 2010. Additionally, Landstuhl Regional Medical Center critical care patient transfers to host nation medical centers were reviewed for cases using extracorporeal lung support systems.

Results: For the review period, US Central Command activated the ALeRT on 40 occasions. The ALeRT successfully evacuated patients on 24 of 27 missions launched (89%). Three patients were too unstable for ALeRT evacuation. Of the 13 remaining activations, four patients died and nine patients improved sufficiently for standard CCATT movement. The ALeRT initiated pumpless extracorporeal lung assistance six times, but only once to facilitate evacuation. Two patients were supported with full extracorporeal membrane oxygenation support after evacuation due to progressive respiratory failure.

Conclusions: ALeRT successfully transported 24 casualties from the combat zones to Germany. Without the ALeRT, these patients would have remained in the combat theater as significant consumers of limited deployed medical resources. Pumpless extracorporeal lung assistance is already within the ALeRT armamentarium, but has only been used for one aeromedical evacuation. Modern extracorporeal membrane oxygenation systems hold promise as a feasible capability for aeromedical evacuation.

From the Landstuhl Regional Medical Center (R.F., S.G.W., M.T.P., J.S., R.S.R., C.B., J.S.O., S.M.W., S.V.S.), Landstuhl, Germany; Wright-Patterson Medical Center (P.F.A.), Wright-Patterson AFB, Ohio; US Air Force Center for the Sustainment of Trauma and Readiness Skills at the University of Cincinnati (G.R.D., W.C.D.), Cincinnati, Ohio; and Tripler Army Medical Center (E.C.O.), Honolulu, Hawaii.

Submitted for publication March 10, 2011.

Accepted for publication April 26, 2011.

The views and opinions expressed in this manuscript are those of the authors and do not reflect the official policy or position of the United States Air Force, the United States Army, the Department of Defense or the US Government.

The authors have no financial interests or conflicts of interest to disclose regarding the contents of this paper. Reprints are not available from the authors.

Presented at a Plenary Session of Advanced Technology Applications for Combat Casualty Care 2010, August 16–19, 2010, St. Pete Beach, FL.

Address for reprints: Raymond Fang, MD, FACS, Landstuhl Regional Medical Center, Landstuhl, Germany; email:

© 2011 Lippincott Williams & Wilkins, Inc.