Ms. X, a young healthy woman and preschool volunteer, who suffered a massive pulmonary embolism with a stuttering cardiac arrest at the Northcrest ED, was called to our shock line early Sunday morning for ECMO. She received aggressive resuscitation and thrombolytics from their ED physician, which saved her life in the immediate, but was markedly unstable on three over-max pressors and close to re-arresting, and would not survive the morning. The ED physician had been turned down by Vanderbilt for ECMO due to instability for transport. DeNene was the AOC and helped push for the patient to come despite staffing and capacity constraints. Dr. Bock and I spoke with the ED physician, and at 4:50am, we woke up Dr. Ann Gage, Jamie Jarzembowski, Dr. Rob Castiglia, perfusionist Ryan Wysocki, and ICC NP Grace Denney for help. Every person answered the phone immediately and got in their cars. Dr. Castiglia came in 2 hours early to cover the ICU so I could leave with Jamie, meeting Dr. Gage, Ryan, and Grace at the patient's bedside with all our gear in the ED at Northcrest. Grace spoke with the patient's father and helped the ED team resuscitate while waiting for us. Dr. Gage and Grace performed a smooth cannulation, and we were on ECMO by 6:20 am. The patient had severe bleeding complications from the lytics she had gotten and required another 2 hours of active resuscitation with severe hypotension at Northcrest before finding a window to safely transport her.

The entire ED team and Northcrest were outstanding, as well as their blood bank and pharmacist. Due to weather and the EC-145 being out of service, Skylife could not fly, and unfortunately, they had no ground transport option in service. We arranged with Robertson County EMS to bring us back, having to borrow multiple battery-run IV pumps and a travel monitor from Northcrest that could transduce an arterial line. The EMS crew was fantastic. Grace and Ryan transported back actively transfusing blood products and struggling with ECMO flow and high pressors, but made it back home with the patient around 9:30am. As we came down the hall we were greeted by the amazing sight of multiple fresh CICU and ICC physicians and APPs, multiple ICU nurses, ECMO specialists, including night specialists who stayed late to help, perfusionists, pharmacists, a massive transfusion cooler full of product, rapid transfuser, echo, an entire team ready to absorb the patient. When I left at 10:30 am that entire crew was still actively working on her. Twelve hours later, she was awake and neurologically intact and almost completely off pressors.