The Care Conference

The hospital gives a patient's parents the option to call a "care conference."  I do not know if this can be done at any time.  It is most definitely available after a patient has experienced an emergent situation, as Ayden did three weeks ago.  Allison and I requested such a conference, which occurred on Tuesday.  It was attended by us, our social worker, Ayden's nurse from that day, and six doctors (including the director of pediatric cardiology).  At least two of these doctors were in the room with Ayden when he arrived to the PCCU and were involved in saving his life (including performing CPR).  Here is what we learned (or didn't learn):

• Ayden was "stable" when he started his trip down to the PCCU.  His heart rate was acceptable (a little over 100), but still low by his standards.  He was awake and crying.
• Upon his arrival to the PCCU, he received some adrenaline to help with his heart rate.  It helped, but only for a brief period.
• His heart rate started to slow again.  Dr. Fish attempted to use an external pacemaker to keep the rate up, but it was not able to "capture" Ayden's rhythm.
• His slowing heart rate was dropping his oxygen levels.  His lower oxygen levels, in turn, were slowing his heart rate.  This effectively created a downward spiral from which Ayden could not free himself.
• Within 15 minutes of his arrival in the PCCU, the decision had been made that Ayden could not produce a heart rate on his own that was sufficient to sustain his life.  Thus, within 15 minutes of his arrival, the decision was made to use ECMO.
• His heart never stopped.
• CPR was performed while the ECMO connection was being made.  One person was "bagging" him and providing breaths while another did the compressions.  Many people helped with this over the 48 or so minutes he got CPR (performing CPR, even on an infant, is very tiring).
• During CPR, his body temperature was quite low.  As odd as it sounds, this actually worked to his benefit.  The colder temperature helped to "preserve" his tissues while they were receiving less oxygen.
• Once the ECMO connection was made, the doctors were very encouraged to see Ayden open his eyes and start to move around.
• They continued to be encouraged over the subsequent days as he continued to try to wake up.
• There were no signs of an infection.  There was no indication he received an accidental overdose of any medication.  No test results showed a dangerous level of any medication in his bloodstream.
• It appears he had an unusually sensitive reaction to a relatively low dose of one of the anti-SVT medications.  That, when combined with the other two anti-SVT meds, may have simply slowed his heart rate down too much.  This seems to be the best theory.
• It is still only a theory.
• No one can say for sure what caused Ayden's arrest.
• We will probably never know.
• Any number of random and otherwise innocuous events can send a child with HLHS into a downward spiral from which they cannot recover without help.
• Sometimes, they cannot recover at all.
• With help - both from the doctors and from God - Ayden recovered.