Spring 2021
The ECMO truck team includes a cardiologist and critical care nurses. Here, cardiologist Demetri Yannopoulos (in gray cap) and his crew do a test run using a manikin. Photography: University Relations

Every minute counts

A U of M team is harnessing a special tool and a state-of-the-art vehicle to save people whose hearts stop beating

Demetri Yannopoulos isn’t a gambler, but he’s obsessed with beating the odds.

During his career, Yannopoulos, a cardiologist and the Robert K. Eddy Endowed Chair in Cardiovascular Resuscitation at the University of Minnesota Medical School, has stood up against one of medicine’s most dire emergencies: cardiac arrest, a condition that typically kills nine out of every 10 people who experience it. 

Cardiac arrest occurs when a person’s heart unexpectedly stops beating. Standard treatment involves a combination of CPR to keep the person’s blood flowing, defibrillation to restart their heart, intubation to help them breathe, and intravenous medication to regulate their heart’s rhythm. But too often, those treatments aren’t enough. 

Enter extracorporeal membrane oxygenation, or ECMO, a life-preserving pump that temporarily does the work of the heart and lungs. It delivers oxygenated blood throughout the body, keeping the person alive and giving doctors more time to perform lifesaving interventions. 

“It buys us more time to figure out why the cardiac arrest happened and how we can treat it,” Yannopoulos says.

Promising results

Yannopoulos and his team at the U of M’s Center for Resuscitation Medicine began using ECMO more than five years ago when cardiac arrest patients were brought to the emergency room. Results were promising, and Yannopoulos began to work with emergency medical directors across the Twin Cities to incorporate ECMO into emergency response protocols. 

Creighton Clemens experienced cardiac arrest in the middle of the night. His spouse performed CPR and called 911. Within minutes, paramedics arrived and rushed him to the M Health Fairview University of Minnesota Medical Center, where he was placed on ECMO. That was in 2016. “All my stars aligned,” says Clemens. "My life is fantastic.”
Courtesy of Creighton Clemens

The protocol overhaul resulted in better survival rates for people like Creighton Clemens, whose life was saved after he was brought to the M Health Fairview University of Minnesota Medical Center where he was placed on ECMO. 

Armed with promising evidence and success stories like Clemens’, Yannopoulos led the world’s first clinical trial to prove ECMO’s lifesaving impact. The results of the study, which were published in The Lancet in November 2020, indicated survival rate that is six times higher for patients who received prompt life support using ECMO compared with those who did not receive ECMO. 

“After the last five years of studying ECMO at the University, we knew it would be very effective but just not how effective in comparison with current treatments,” Yannopoulos says. “The next question is, how do we make this translational for other communities?” 

Taking ECMO on the road

Although ECMO’s life-saving capabilities are clear, the technology and the experts who know how to use it aren’t available everywhere.

That’s why in 2019, Yannopoulos, his team, and emergency medicine personnel from across the Twin Cities launched the Minnesota Mobile Resuscitation Consortium (MMRC), an initiative designed to bring ECMO to wherever patients are. The MMRC is funded by an $18.6 million grant from the Leona M. and Harry B. Helmsley Charitable Trust.

“Our goal has been to improve cardiac arrest survival, and the early results from the MMRC's efforts show more people are alive today because of the hard work of all involved,” says Walter Panzirer, a trustee of the Helmsley Charitable Trust. The initiative received additional support and equipment donations from Zoll Medical, Stryker Emergency Care, Getinge Incorporated, and General Electric.

MMRC’s first phase, which started in 2020, involved deploying four SUVs that carry ECMO equipment and a specially trained team of physicians, critical care nurses, and paramedics to emergency departments across the Twin Cities.

Later this year, the fleet will grow when a larger truck—an emergency room on wheels—hits the road, expanding the availability of ECMO beyond the Twin Cities metro region. Twice as long as a normal ambulance and about two feet longer than a city bus, the mobile emergency department is designed to allow experts to provide specialized care, including ECMO, inside the vehicle, shortening the time to treatment and giving patients a much better chance of survival.

In addition to ECMO equipment, the truck is outfitted with virtual reality technology that allows interventional cardiologists to attend to patients remotely while they are placed on ECMO on their way to the hospital.

Thus far, the MMRC SUVs have been called into action to treat 58 patients. More than 40 percent were discharged from the hospital and either returned to normal daily living or experienced only minimal disruption to their lives. Yannopoulos says the MMRC provides a blueprint for other health systems and communities who want to change how cardiac arrest is treated. 

“We want to show the rest of the world that this is doable,” he says.

Justin Harris is a contributor to Legacy magazine.