The ECMO ambulance team helping a patient
The ECMO ambulance team helping a patientAmerican Friends of Magen David Adom

A 45-year-old man in Israel didn’t merely have a near-death experience last month. He technically died — twice. And he lived to tell the tale thanks to a joint lifesaving initiative by Magen David Adom (MDA) and Shamir Medical Center that put a heart-lung bypass machine on an ambulance.

On June 27, the man went into cardiac arrest while in an art gallery in Bnei Brak. Key to his survival was the fact that he received initial CPR from a civilian and that EMTs arrived in minutes, ensuring his organs received oxygen despite his heart not beating.

Within one minute and 50 seconds of the patient’s collapse, the person who’d called MDA, Israel’s national emergency services system, was performing CPR under the MDA dispatcher’s direction. Within three minutes of the call, MDA first responders were at the scene administering cardiac shocks from a defibrillator, restarting the man’s heart.

And within five minutes, an MDA MICU unit was at the scene, initiating the patient’s transfer. At the same time, a second ambulance, a special ECMO (extracorporeal membrane oxygenation) unit equipped with the heart-lung bypass machine that MDA and Shamir Medical Center launched several months ago, also raced to the scene.

Soon after the MDA MICU team initiated the transfer, the patient’s heart stopped a second time and MDA made the decision to transfer him to the ECMO ambulance, providing him with a better chance of arriving to the hospital alive, with his brain and organs fully oxygenated.

The MDA team pulled the man from the MICU ambulance and, seeking ample space to hook him to the ECMO machine, took him to a nearby ceramics store, whose owner acquiesced to closing his shop while they used his floor space as a medical staging area.

After the patient was put on the ECMO machine, which was now acting in lieu of the patient’s heart and lungs, he was loaded into the ECMO ambulance and rushed to the catheter lab at Shamir Medical Center, where he underwent angioplasty.

He regained consciousness the next day, looking shockingly well and recorded a thank-you video to MDA for saving his life.

“I remember going to work and then waking up in the hospital and I didn't understand what I was doing there,” said the patient, who asked that his name not be used. “I was told I was actually already in the next world, and thanks to the angels of MDA who arrived very quickly and, in combination with the ECMO ambulance and the Shamir Asaf Harofeh Hospital team, I was rescued in the field and my life was saved.”

The ECMO unit is the only one based on an ambulance in Israel. It’s a game-changer, according to Dr. Shafir Botner, senior paramedic and head of MDA’s paramedic training. This now makes Israel one of the few countries in the world — along with the United States, Britain, France, Australia, and the Netherlands — using ECMO technology outside a hospital setting.

“It buys the paramedic time, enabling you to work smartly and without the sense that time is ticking away, because you know you don’t have to worry about the patient’s brain and other organs being deprived of oxygen,” Dr. Botner said.

“It has been a great privilege for me to be a part of leading the revolution in the field of CPR in Israel,” said Dr. Gal Pachys, director of the Department of Emergency Medicine at Shamir Medical Center. “Although changes and updates have been made in this field in recent decades in Israel and throughout the world, the rate of survival for out-of-hospital cardiac arrest is persistently low and remains below 5% in Israel.”

Innovations like the ECMO ambulance could make survival rates for cardiac events appreciably higher.

Since that incident in Bnei Brak, several other patients also have been saved with the ECMO ambulance — all with seemingly good outcomes so far.

“Magen David Adom is looking at designing an even more advanced vehicle that can perform even more complex procedures outside hospital walls to save even more lives,” said Gil Moscowitz, MDA’s Deputy Director-General for Operations.