To Treat Rural Americans, a Health Funder Seeks to Bring Life-Saving Technology Outside the Hospital
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an extracorporeal membrane oxygenation (ECMO) machine. Photo: PIJITRA PHOMKHAM/shutterstock
Health is a priority for philanthropic funders with their eyes on the rural U.S., and for good reason. Rural Americans face a number of significant barriers to accessing healthcare, ranging from financial difficulties, workforce shortages and lack of transportation. Among the biggest issues, however, is the ongoing closure of rural healthcare facilities. According to data from the University of North Carolina's Cecil G. Sheps Center for Health Services Research, since 2005, 191 rural hospitals have either closed completely or no longer provide inpatient services.
As a result, many rural Americans have to travel long distances to access critical care. Coupled with limited transportation in emergency situations — many rural areas lack ambulatory services and public transportation — that could mean death.
The Leona M. and Harry B. Helmsley Charitable Trust is a global funder that emphasizes health causes in its grantmaking, including Crohn's disease and type 1 diabetes. Another one of its priorities is rural health in the U.S., where its work spans eight states — North Dakota, South Dakota, Nebraska, Wyoming, Minnesota, Iowa, Montana and Nevada.
Last year, we wrote about some of the ways Helmsley is backing rural mental healthcare through its Rural Healthcare Program, including with funding for telemedicine and Emergency Psychiatry Assessment, Treatment and Healing (EmPATH) Units. But mental health isn’t the fund’s only focus. Seeking to tackle the problem of rural healthcare access from an additional angle, Helmsley has also awarded a spate of grants to bring extracorporeal membrane oxygenation, or ECMO, to underserved rural communities.
ECMO is administered to critical patients whose hearts and lungs cannot function on their own, ensuring that a patient's blood remains oxygenated. The ECMO machine can provide long-term support to give the patient's organs time to heal on their own or for doctors to address the issue. It can be used by patients suffering from conditions like heart attacks, acute respiratory distress, pulmonary embolisms, respiratory failure and COVID-19, among others.
However, ECMO is not available in many hospitals, especially in rural areas. To increase access, Helmsley has awarded $19.7 million to the University of Minnesota for its Mobile ECMO program, which brings the technology outside the hospital, giving patients a greater chance at survival.
In addition, Helmsley recently announced a $12 million grant to Billings Clinic to expand its ECMO services, establish Montana's first surgical intensive care unit, and create a state-of-the-art transfer center. In Nevada, meanwhile, Helmsley gave $11.6 million to three health systems to expand ECMO availability, more than doubling the number of ECMO beds in the state.
"It became an equity issue, " said trustee Walter Panzirer. "I always truly believe it doesn't matter what zip code you're in. Your zip code should not determine your health outcomes and health equity, but unfortunately, in the United States, it does. And at the Helmsley Charitable Trust, we're trying to level that playing field.”
"An ultimate chance at life"
Helmsley's support for ECMO began when Panzirer's team introduced him to Dr. Demetris Yannopoulos, director of resuscitation medicine, research director of interventional cardiology and professor of medicine at the University of Minnesota Medical School. Yannopoulos is credited with creating the first comprehensive ECPR program in the United States. ECPR — extracorporeal cardiopulmonary resuscitation — is the name for the procedure performed using ECMO.
Every second counts when it comes to patients experiencing heart attacks. Thanks to Helmsley's grant, Yannopoulos brought ECMO to patients outside the hospital in a specially equipped ECPR truck that houses an ECMO machine.
"It just seems like a very good risk for the Helmsley Charitable Trust to make and to invest in something where nobody's ever really done this successfully to that level,” Panzirer said. “So we became really excited thinking we could bring his idea to reality and actually see if this thing will work."
According to Panzirer, Yannopoulos has a 50% successful resuscitation rate with patients exiting the hospital, which might sound lackluster, but is 50% better than the alternative. "These patients that Mobile ECMO is responding to — 100% of these patients would have been declared dead in the field or dead in the hospital," Panzirer said. "We're giving patients an ultimate chance at life."
Right now, Yannopoulos’ program primarily serves the Minnesota suburbs, but Helmsley hopes it can be expanded into rural areas of the state. "This is a total game changer, and with his success rate, it's more than likely this is going to be the standard of care in the future, especially in larger metropolitan cities. And hopefully, once we work through the issues, we can do it more remotely," Panzirer said.
In other states, Helmsley has already expanded its ECMO support to rural regions. In Billings, Montana, the Mobile ECMO program looks a little different. When a patient is in critical need, a team of physicians and the ECMO machine are transported by air to a rural health facility. The patient is placed on ECMO and then flown back to Billings for further treatment.
This is the first time that ECMO will be available anywhere in the states of Montana and Wyoming. "It became apparent that we needed to increase in-hospital capacity of ECMO during COVID," Panzirer said. "It really came to light during COVID… that patients were dying in rural areas and not being able to get ECMO."
In Nevada, ECMO was only available in the southern parts of the state prior to Helmsley’s support, concentrated mainly in the Las Vegas area. Many patients who needed ECMO were sent outside the state to California, Utah or Arizona. With Helmsley's grant, ECMO will now be available in northern Nevada. "It's really bringing technology to places where it hasn't been and expanding it to have it [at] full capacity," Panzirer said.
Equipping first responders for cardiac care
Helmsley’s recent grants to expand the availability of ECMO are part of its overall support for cardiac care, which is one of the pillars of its Rural Healthcare Program, along with telemedicine and behavioral healthcare. Those grants include $32.9 million to purchase and distribute 2,000 LUCAS mechanical CPR devices to hospitals and EMS in South Dakota, North Dakota, Montana, Wyoming and Nebraska.
Helmsley has also provided $60 million to place 25,000 automated external defibrillators in law enforcement vehicles and train officers and other first responders to provide care before EMS arrive on scene.
“Some people say, ‘Why do you do that?’ Well, in rural America, the sheriff or the highway patrolman, the game warden, they’re out patrolling around,” Panzirer said. “When someone does have a cardiac arrest, they are the first ones on the scene, generally, because in rural America, they rely on volunteer ambulance services so often, and it takes quite a bit of time for people to go to the ambulance station [and] get the ambulance. They’re not just sitting there. They’re working regular jobs, so they respond as local volunteers to the emergency.” According to Panzirer, there have been 400 documented cases of people who have survived cardiac arrest thanks to the initiative.
Helmsley has also partnered with the American Heart Association's Mission: Lifeline program and expanded cardiac services in St. James Healthcare in Butte, Montana. “Cardiac has always been a huge focus,” Panzirer said. “And so [these ECMO grants] fit perfectly in… bringing the latest technology to rural areas where they've never had it or giving them an opportunity to have the same type of technology as our urban counterparts.”
