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Transplant cases are the cases that require the most technical proficiency for our team. While we do specialize in ECMO and are accustomed to a number of moving parts to be planned and coordinated for "the dance," moving a transplant patient does not afford the same amount of pre-mission planning. However this last weekend we were contacted to move a patient with a temporary left ventricular assist device who was up against a clock, straining the capabilities of other aeromedical providers.

A RN demonstrates an Impella device. 

A RN demonstrates an Impella device. 

Our patient presented to us with an Impella pump that had been implanted for 6 days and who had not been able to make transport two previous times. Castle Medflight was contacted as the final option by the sending case manager after discovering our history in critical care air transport. An Impella device is a type of temporary heart assist pump that is typically only viable for 7 days before a patient needs to either receive a transplant or be transitioned to a more permanent LVAD platform. What complicated this case was that a heart had already been located for our patient but the previous 2 flight companies were not comfortable with transporting the patient once they discovered that they had suffered from an additional 2 cardiac events and was on the assist device still.

Reassurring the patient, patients family, as well as working alongside the case manager we quickly identified options to move the patient within the rapidly closing window until transplant. We put a countdown timer on the wall and got to work. I still am amazed at how rapidly our team can be ready to roll once tasks are divided among the team. An airframe and crew were alerted and ready to fly within 30 minutes, receiving hospital was notified, transport on both ends was coordinated, landing permissions secured, and when we called the sending case manager back 60 minutes later we informed her all we were awaiting was approval from the insurance company. 

An Impella device implanted in the left ventricle. 

An Impella device implanted in the left ventricle. 

To say the case manager was shocked is an understatement. We settled in for the wait while the bureaucratic processes turned. We were delayed overnight awaiting approval but once we received the approval first thing the next morning our plane was airborne and team was beds in 130 minutes, or the length of an average feature film. Delivering the patient and family member to the transplant hospital another member of our team met the entire crew on ground to ensure that the family was taken care of with a warm meal and care basket waiting completing another successful mission that others said could not be done.

For our patients and their family members we pride ourselves on providing the best critical care, anywhere, especially when working within a narrow window to save a life. 

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