November 22, 2023

Gracie was with her mom and grandmother on a road trip. A medical emergency brought the Angel 7 ambulance to her rescue.

Angel 7 is the first pediatric transport team in Tennessee to offer extracorporeal membrane oxygenation — ECMO — for its patients. It was the difference in life and death.

Gracie smiling from her hospital bed.

Ashley Zombik never considered that angels could come in the form of a nearly 20,000-pound ambulance.

But she is forever grateful to Angel 7 and the team members who transported her daughter, Gracie Conlon, from an East Tennessee hospital to Monroe Carell Jr. Children’s Hospital at Vanderbilt in October.

Zombik, her mother and Gracie were on a road trip from their home in Indiana to Pigeon Forge when Gracie began vomiting.

Gracie, 5, was born with atrioventricular septal defect or AVSD, a congenital heart defect in which there are holes between the chambers of the heart, and the valves that control blood flow between the chambers may not form correctly.

By age 3 months, Gracie had undergone three open-heart surgeries to repair the defect and replace her mitral valve.

After a few hours of Gracie’s vomiting, Zombik decided to go to the closest emergency room for help.

Gracie’s condition continued to worsen. It was decided that she needed a higher level of care — one that was nearly 200 miles away.

“We recognize that we have so many specialties that other children’s hospitals don’t offer. We want to work together to provide the absolute best care for these critically ill kids.”

She not only needed to be intubated, but she required a more advanced level of care called ECMO or extracorporeal membrane oxygenation. Thankfully, Angel 7, the first pediatric transport team in the state to offer ECMO transport for its patients, was called to help.

“She was in heart failure and her valve was not working like it needed to,” said Zombik. “She needed to be put on ECMO. I had not heard of ECMO before.

“If you guys were not able to come help her, I don’t think she would have made it. The hospital where we were didn’t have this service.”

Immediate difference

Once placed Gracie was placed on ECMO, Zombik noticed an immediate difference in her numbers and breathing.

The life-sustaining mechanical system temporarily takes over for the heart and lungs of critically ill patients, allowing their organs to rest and recover by removing carbon dioxide from the blood, replacing it with lifesaving oxygen, and returning it to the patient’s circulatory system.

The technology was first introduced at Vanderbilt in 1989, making it the first ECMO program in Tennessee and propelling it to one of the largest and most successful programs in the world.

Advancements have allowed for smaller, transportable pumps that are compatible to an ambulance. The care team consists of two ECMO specialists, a transport nurse, transport respiratory therapist, and advanced EMT and a physician.

“Time was of the essence,” said Jessie Manco, RT, neonatal pediatric transport team. “If we did not have this service, it would have definitely delayed her care. It was essential that we were able to put her on the ECMO pump and provide the higher level of care before she hit the doors of Monroe Carell.”

Anna Parks, RN, CCRN, pediatric neonatal transport team, said the collaborative nature of the teams involved makes all the difference.

“We recognize that we have so many specialties that other children’s hospitals don’t offer. We want to work together to provide the absolute best care for these critically ill kids. It feels really good to be a part of such a team.”

Looking toward home

Monroe Carell was the closest pediatric cardiac ECMO center from East Tennessee Children’s Hospital.

“Having the ability to collaborate with all the teams involved to ensure she was placed on ECMO and safely transported to our hospital saved her life,” said Daphne Hardison, RN, MSN, CES-P, manager of ECMO at Monroe Carell.

Gracie arrived at Monroe Carell on Oct. 31 and was prepped for surgery on Nov. 1 to replace the malfunctioning valve.

“There was a lot of scar tissue and clots causing the mechanical valve to jam, so her hearts and lungs were filling with fluid,” said Zombik. “ECMO saved her life and got her ready to have the mitral valve replacement.”

Gracie, who also has mosaic Down Syndrome, a type of Down Syndrome with a mixture of cells with trisomy 21 and cells without trisomy 21, was signing for milk and water a few days post-surgery.

“She is mostly nonverbal but says a few words. She ate her entire dinner on Saturday night, and she was waving hi and signing ‘I love you’ to me.”

Gracie is well on her way to recovery and awaiting discharge home.