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ECMO transport Japan to Australia

Joint efforts in a flight for life

10/11/2015

What should have been a dream trip to celebrate a snowy Christmas in Japan turned into a near-fatal nightmare for Brett Goodban. But thanks to a special collaboration, Brett could be flown to Australia for further care, hooked up to an ECMO system borrowed from Maquet.
“I am extremely grateful to everyone who helped safe my life,” he says.

Brett's wife, Ami, is Japanese and the family, who lives in Queensland, Australia, has travelled to Japan several times. But never in the winter. “Christmas 2014 should have been very special. My wife and I, and our three young sons, were going to celebrate a white Christmas in Japan together with my sister and her family.” But Brett soon developed a cough and began suffering from shortness of breath. Despite taking medication, his condition did not improve. “On Christmas Day, I was starting throwing up blood. We went back to the hospital and I don’t remember anything after that."

He fell unconscious and would stay that way for more than six weeks. At the intensive care unit at Chiba University Hospital outside Tokyo, Brett was treated for pneumonia and inflammation of the heart muscle (myocarditis) caused by an aggressive flu bug. His heart was working only at 5–10 percent of its normal capacity. His liver and kidneys were also affected. “The doctors said I needed a heart transplant, but that it would be difficult to find a donor. My family thought I was going to die. But Brett’s Japanese doctors started looking for solutions elsewhere. “I got a call from Alfred Hospital in Melbourne, which had been contacted by the doctors in Japan, asking if we could help Brett Goodban,” explains Marc Ziegenfuss, Director of Intensive Care at Prince Charles Hospital in Brisbane, Australia.
“Since Brett’s sister said that he had cried when she spoke to him and the doctors’ examinations showed no indication of brain damage, I said, ‘Let’s go for it!’”

But there was one major challenge: Brett needed to be hooked up to an ECMO machine constantly – even during transportation. The hospital didn’t own such a small, transportable machine. The problem was quickly solved with a phone call to Maquet, which immediately agreed to lend the hospital a demo version of its portable Cardiohelp system. “The most important thing for us is the well-being of the patient,” says Mat Reid, ECLS Specialist and National Clinical Applications Manager at Maquet in Australia. “Of course we let them borrow the machine!” CareFlight, an aeromedical retrieval service, was contacted and, as luck would have it, the company had recently procured a large, converted plane for transporting Ebola patients, which had enough space for all of the equipment Brett needed.

Marc Ziegenfuss coordinated the transportation, in close cooperation with the hospital in Melbourne, the doctors in Japan and representatives from Medical Systems. On January 18, two doctors and a nurse from Alfred Hospital boarded the plane and flew to Tokyo, where Brett was hooked up to the Cardiohelp machine and transferred onto the aircraft.
There were essentially no complications during the flight. After ten hours in the air, Brett arrived at Prince Charles Hospital in Brisbane, where he remained hooked up to the Cardiohelp machine for a while. Mat Reid went to the hospital and taught the staff exactly how the machine works. “Brett was later transferred to our normal life-support system,” explains Marc Ziegenfuss. “He was put on dialysis, underwent surgery to remove blood clots from his lungs and received treatment for his pneumonia. But it all went well!”

Brett came out of his coma in February and was able to return home to his wife and three sons a few weeks later. But his rehabilitation is expected to take at least a year. “I’m so incredibly grateful to all of the amazing people who made such a huge effort to save my life,” he says. “I can’t possibly thank them enough! I’m also so grateful that I had travel insurance that covered all the costs.”

According to Marc Ziegenfuss, it was the outstanding cooperation of the people involved that made it possible for Brett’s story to have a happy ending. “There were several factors at play: the fact that we were able to borrow the machine from Maquet, that all of these people were willing to help, that the plane was available and that Brett Goodban has such a good attitude. This type of aeromedical retrieval – where the patient is hooked up to an ECMO machine and transported such a long distance – has never been performed in Australia before or perhaps anywhere in the world. It just goes to show that you can move mountains if you really try. Thanks to this effort, three little boys still have their father!”

Marc explains that it’s not clear why flu bugs can sometimes become so aggressive and have such devastating consequences. Myocarditis after a case of the flu is often fatal. “But with the help of a heart-lung machine, many patients can be helped through the worst of it and survive, especially if they are otherwise healthy and strong.”