WWW.JEMS.COM DECEMBER 2017 | JEMS 35
My personal experience with ED ECMO
By Joseph P. Ornato, MD, FACP, FACC, FACEP
What does it take to save the life of someone who’s in shock and suffering from an acute massive
pulmonary embolism? The answer is a comprehensive system of medical care that starts
in the field with well-trained providers and
is seamlessly backed up by hospitals that can
provide highly sophisticated treatments that
can now be started in the ED.
As a cardiologist and the operational medical director for the city of Richmond, Va., and
the surrounding Henrico County, I’ve had the
privilege of helping to develop a comprehensive, regional system of care.
In this article, I’m going to use my own
personal, near-death experience to illustrate
how an integrated emergency healthcare delivery system can dramatically change the odds
In Fall 2014, despite a lifelong uneventful
medical history, a large stone was found in my
left kidney on a routine X-ray. Laboratory tests
showed it was beginning to affect my kidney
function, so a plan was devised to remove it
gradually by monthly, one-hour lithotripsy
treatments that use shock waves to break up
kidney stones without surgery.
After the procedure, the tiny pieces of
stones pass out of your body in your urine.
The procedure is performed under light anesthesia and is generally quite safe. However, like
many surgical procedures or traumatic injuries,
there’s a small risk of blood clot formation in
large leg veins.
My first five procedures were totally
uneventful with the stone gradually becoming
smaller and smaller. However, three days after
the sixth procedure, I began to feel increasingly short of breath on exertion.
Initial tests, including a CT scan, were negative. However, the following morning while
alone at home (my wife, who’s also a physician,
had already gone into work at the hospital),
I suddenly became breathless and felt like I
was going to pass out.
As I got myself safely to the floor, my immediate self-diagnosis was that I’d just suffered a
massive pulmonary embolism, since I was only
mildly tachycardic, had no chest discomfort,
but simply couldn’t breathe.
My first thought was to dial 9-1-1, which
would get one of my Henrico Fire crews to my
house within minutes. I quickly realized, how-
ever, that although 9-1-1 was the immediate
priority, the odds of surviving a massive pul-
monary embolism with conventional treat-
ment (i.e., heparin, clot-buster drugs like tPA)
provided in the nearest community hospital
ED would be slim. I thought my only chance
for survival would be to get transported to
the ED at Virginia Commonwealth Univer-
sity (VCU), where I work, so I could be put
on extracorporeal membrane oxygenation
(ECMO) life-support immediately and then
brought to the operating room to have the
At the time, VCU—the tertiary academic
medical center for the region—was the only
facility capable of, and experienced in, providing this level of care. The problem was that
VCU was 25 minutes away, with several community hospitals reachable in half that time.
Without hesitation, I speed-dialed my wife
on the cellphone in my pocket and managed to
communicate what I needed. She dialed 9-1-1
in the city and got transferred to Henrico
County 9-1-1, which dispatched a fire paramedic crew. She also arranged for ECMO to
be set up in the ED and blocked a cardiac OR.
A few minutes later, the paramedic crew was
Cardiologist and operational medical director for
the city of Richmond, Va., Joseph Ornato, MD, experienced first-hand what it’s like to be treated with
ECMO in the ED after he suffered a massive pulmonary embolism. Photo courtesy Joseph Ornato