Every second counts
With timely intervention from his wife and a first-of-its-kind ER-on-wheels, John Sauer survives one of medicine’s most dire scenarios
On August 11, 2022, John Sauer and his wife, Kris Waters, had just wrapped up a leisurely three-mile hike around the scenic greenspace near the home they’ve shared in Chanhassen for almost a decade. Sauer stayed outside to mow the lawn and then came indoors to cool down with a glass of water on the couch in the living room.
Seconds later, he was on the brink of death.
The 61-year-old Sauer, who had no signiﬁcant heart health concerns, was experiencing a sudden cardiac arrest.
In less than a minute, his eyes became shaky and unfocused, and his breathing became labored. Then his heart stopped. Miles away from the nearest hospital, Sauer was clinging to life in the face of a medical emergency that’s fatal for nine out of every 10 victims.
Sauer doesn’t remember what happened next, but Waters does. And so do the experts at the University of Minnesota’s Center for Resuscitation Medicine, whose innovative ideas to save more people suffering from cardiac arrest—like Sauer—were about to be put to the test.
Waters, who now works as a case manager for adults with disabilities, is a registered nurse. While she has taken CPR training and still actively trains others as part of her job, she was never called upon to use it until she felt her husband’s pulse falter in their living room.
Waters asked her adult daughter, Lauren, who was also in the room, to call 911, and to help her drag Sauer’s sizable 6-foot-3 frame onto the ﬂoor so she could begin chest compressions, a vital ﬁrst step in helping someone survive cardiac arrest.
“I felt his ribs crunch on the very ﬁrst compression, just like I used to teach,” she recalls.
First responders from Ridgeview EMS arrived quickly, taking over CPR duties. As the crew quickly whisked Sauer away into an ambulance bound for M Health Fairview Southdale Hospital, Waters noticed that her husband’s toenails had turned blue.
It was visual evidence of the grim reality that deﬁnes cardiac arrest, even if CPR has been performed, says Demetris Yannopoulos, MD, director of the U’s Center for Resuscitation Medicine and an M Health Fairview cardiologist.
“During cardiac arrest, the ability of CPR to maintain blood ﬂow and oxygen delivery to organs is quite limited,” he says. “Especially after 35 minutes of CPR, the chances of surviving are almost zero.”
Yannopoulos and his fellow Center for Resuscitation Medicine co-director, Jason Bartos, MD, PhD, have made it their mission to turn the tables on cardiac arrest. The linchpin of their plan is a lifesaving technology called extracorporeal membrane oxygenation, or ECMO.
ECMO, which is normally used for severely ill or injured patients in the hospital, takes over the duties of a person’s heart and lungs by pumping blood out of their body through a garden hose–sized tube and into an oxygenator, before returning that oxygen-enriched blood back into the patient. This allows the patient’s organs, especially their brain, to function normally, while buying time for doctors to treat them.
Since Yannopoulos founded the Center for Resuscitation Medicine in late 2014, the University of Minnesota has become a global leader in using ECMO as a bridge to survival for people experiencing cardiac arrest. He estimates that he and his colleagues at the University and M Health Fairview have used ECMO in more than 1,000 instances of cardiac arrest since the program’s inception—and signiﬁcantly boosted survival rates.
A problem remained, however. Many hospitals aren’t equipped with ECMO technology. And most cardiac arrests happen far away from hospitals that are.
“When we looked at our data from the patients that we had taken care of, we saw that if people got to us within 30 minutes, we had nearly 100% survival rates,” Bartos says. “But every 10 minutes after that, that rate went down by 25%. With cardiac arrest, not just every minute counts, every second counts.”
With support from the Leona M. and Harry B. Helmsley Charitable Trust, Yannopoulos, Bartos, and their collaborators launched the Minnesota Mobile Resuscitation Consortium (MMRC) and devised a plan to put ECMO on the road. They created a ﬁrst-of-its-kind ECMO vehicle, a ﬁre truck–sized, emergency-room-on-wheels equipped with ECMO technology that can meet cardiac arrest patients in the ﬁeld.
And on August 11, that big maroon-and-white truck was hurtling toward M Health Fairview Southdale Hospital to save Sauer’s life.
‘So, so lucky’
The MMRC team has identiﬁed several locations across the greater Twin Cities area, including Southdale Hospital, where the mobile ECMO truck can rendezvous with ambulances carrying cardiac arrest victims and then begin treatment.
Yannopoulos, Bartos, and the rest of the ECMO truck’s ﬁve-person care team met the ambulance carrying Sauer at Southdale Hospital’s emergency department vehicle bay. They transferred Sauer to the truck and began the complex procedure of connecting Sauer to the onboard ECMO machine.
“The truck is essentially a mobile version of a cardiac catheterization lab,” Bartos explains. “It has all the tools we would need to be able to put somebody on ECMO and even do some initial diagnostic testing—all those things that are traditionally only in a hospital, but now they’re on wheels.”
Once Sauer was successfully hooked up to ECMO, the truck took him to M Health Fairview University of Minnesota Medical Center, where heart experts continued to care for him as his body recovered. Sauer regained consciousness ﬁve days later and left the hospital 12 days after his cardiac arrest.
Sauer’s recovery was slow and painful at times, but he’s had plenty of help from Waters. The two of them have spent the ensuing year enjoying life with their family, including their young grandchild. In February, they’re planning a trip to Hawaii to celebrate their 10th anniversary.
“I can never pay that back, can never thank enough, there’s just no way,” says Sauer in gratitude to his care team. “So many people had to do their jobs perfectly for me to be here. I know that. This doesn’t happen all the time, and I’m so lucky. So, so lucky.”
The work continues
Sauer was the second person whose life was saved in the mobile ECMO truck. Yannopoulos, Bartos, and their colleagues have repeated that success, treating more than 10 patients in their ﬁrst year of duty.
Now Yannopoulos is leading another Helmsley-funded effort to expand the University of Minnesota Medical Center’s emergency facilities to include dedicated space for ECMO patients, which will allow the MMRC team to care for even more people.
While the ECMO truck is unique in its capabilities, Bartos is quick to note that this whole lifesaving system hinges on the quick action of everyday heroes like Waters, whose timely application of CPR make it all possible.
“These are people who jump into action to help their partner, or their friend, or their neighbor, or a random person on the street, in such a profound way,” Bartos says. “Through this work, I get to see the best in society.”
Find out how your gift can make a difference by contacting Korinne Gerhart of the University of Minnesota Foundation at firstname.lastname@example.org or 612-624-6453, or make a gift to support the Center for Resuscitation Medicine today.