title: Closing the "care in the air" capability gap for severe lung injury: the Landstuhl Acute Lung Rescue Team and extracorporeal lung support.
abstract: BACKGROUND
  The success of US Air Force Critical Care Air Transport Teams (CCATT) in transporting critically ill and injured patients enabled changes in military medical force deployment and casualty care practice. Even so, a subset of casualties remains who exceed even CCATT capabilities for movement. These patients led to the creation of the Landstuhl Acute Lung Rescue Team (ALeRT) to close the "care in the air" capability gap.
  
  
  METHODS
  The ALeRT Registry was queried for the period between November 1, 2005, and June 30, 2010. Additionally, Landstuhl Regional Medical Center critical care patient transfers to host nation medical centers were reviewed for cases using extracorporeal lung support systems.
  
  
  RESULTS
  For the review period, US Central Command activated the ALeRT on 40 occasions. The ALeRT successfully evacuated patients on 24 of 27 missions launched (89%). Three patients were too unstable for ALeRT evacuation. Of the 13 remaining activations, four patients died and nine patients improved sufficiently for standard CCATT movement. The ALeRT initiated pumpless extracorporeal lung assistance six times, but only once to facilitate evacuation. Two patients were supported with full extracorporeal membrane oxygenation support after evacuation due to progressive respiratory failure.
  
  
  CONCLUSIONS
  ALeRT successfully transported 24 casualties from the combat zones to Germany. Without the ALeRT, these patients would have remained in the combat theater as significant consumers of limited deployed medical resources. Pumpless extracorporeal lung assistance is already within the ALeRT armamentarium, but has only been used for one aeromedical evacuation. Modern extracorporeal membrane oxygenation systems hold promise as a feasible capability for aeromedical evacuation.
authors.affiliation: Landstuhl Regional Medical Center, Landstuhl, Germany. Raymond.Fang@us.af.mil
authors.forename: Raymond
authors.initials: R
authors.lastname: Fang
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Allan
authors.forename: Shannon G
authors.initials: SG
authors.lastname: Womble
authors.forename: Morris T
authors.initials: MT
authors.lastname: Porter
authors.forename: Johana
authors.initials: J
authors.lastname: Sierra-Nunez
authors.forename: Richard S
authors.initials: RS
authors.lastname: Russ
authors.forename: Gina R
authors.initials: GR
authors.lastname: Dorlac
authors.forename: Clayne
authors.initials: C
authors.lastname: Benson
authors.forename: John S
authors.initials: JS
authors.lastname: Oh
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Wanek
authors.forename: Erik C
authors.initials: EC
authors.lastname: Osborn
authors.forename: Stephen V
authors.initials: SV
authors.lastname: Silvey
authors.forename: Warren C
authors.initials: WC
authors.lastname: Dorlac
mesh_terms: D055371:Acute Lung Injury / Q000628:therapy*; D055826:Afghan Campaign 2001-; D004632:Emergency Medical Services; D015199:Extracorporeal Membrane Oxygenation; D005858:Germany; D006772:Hospitals, Military; D006801:Humans; D054542:Iraq War, 2003-2011; D008887:Military Medicine; D014187:Transportation of Patients