Sonjay-- yes, that was the most severe bronchospasm that immediately preceded Israel being placed on ECMO. (Crashed onto ECMO?) Basically, it's not simply a matter of blowing air into the lungs during status asthmaticus. There is no gas exchange at the alveolar or tissue level, due to the severe bronchospasm, severe swelling, and other effects within the lungs. No oxygen getting into the blood, no carbon dioxide being exchanged. When the bronchospasm is that severe, even the usual strong bronchodilator meds don't work. Respiratory arrest always leads to cardiac arrest, if the respiratory problem isn't "fixed" promptly.
IMO, after 40 min of cardio respiratory arrest, they had few to no other options. (Back in the old days before ECMO, we used to try to save these kids by putting them on our anesthesia machines and using the anesthetic agents to try to bronchodilate the lungs.) Israel was going to die imminently, and so ECMO was a "hail Mary" last ditch effort to save Israel, IMO.
From the testimony of Dr. Myette, it appears Israel was on ECMO for about 48 hours (or less), which is a rather short time given the circumstances of his arrest, and the severe condition of his lungs. It's my opinion from the testimony and other media sources, that ECMO was likely discontinued when docs determined that his neurological status was devastated-- as opposed to his status "improving", and then ECMO being discontinued. Clearly his heart and lungs were functioning well enough that he came off ECMO (still on the ventilator, and with levophed and vasopressin to keep him somewhat stable), and the brain death evaluations were going on at that time, too. So, to me it's clear that the 40 min arrest produced the devastating hypoxic encephalopathy. Dr. Myette described the brain stem herniation they saw on imaging in his testimony.
It's lucky he was at UC Davis-- the only hospital in the area with a high level PICU and ECMO. Truly, this little one was given every possible chance to survive. He was simply too sick.
We also don’t know how things were going with Israel's health, and Jonee's compliance, prior to January, which would be interesting to know. And now from the court documents and statement of Dr. Myette, we also know the transfer to Kaiser Roseville was a compassionate move after UCSF Benioff refused the transfer—so Kaiser Roseville had absolutely nothing to do with Jonee’s insurance, as she said publicly. That was definitely a lie. I admit I was really, really puzzled why Israel was transferred from a tertiary care University medical center, to the Roseville Kaiser-- that made no sense at all to me. UC Davis is clearly the higher level of care, and Kaiser could not provide any type of care Israel wasn't already getting. No way would a university med center "dump" an ICU level pediatric patient onto Kaiser to avoid costs-- that would be an enormous violation of lots of laws and policies beyond EMTALA, and huge fines for UC Davis. So I knew there had to be much more to that part of the story.
Anyway, this sad case will not have any kind of a happy ending. My guess is that no criminal charges of child abuse or neglect will be filed against Jonee, but it sure looks like she and her attorneys were/ are worried about that. She has another little girl, about one year old, so she has to be worried she could lose custody of her, too. And the Judge invoking Dority says she is pretty suspicious about Jonee's actions/ negligence leading to this current admission and Israel's death, too. Could be that part of Jonee and Nate's motivation in going to the media was to head off criticism and deflect attention from the CPS investigation and guardianship request, or try to avoid criminal charges-- who knows. Poor Israel is dead, just the same. No happy endings here.
ETA: I just re-read the doc's testimony-- ECMO was continued for 4 days, not 48 hours. He was taken off ECMO on April 6, and immediately on Apr 7 the first radionuclide flow test was done (that looks at blood flow to the brain, and is done usually as a confirmatory test when other clinical exams and tests are indicating brain death.) So, docs definitely believed Israel was already meeting brain death criteria on Apr 6-7.
He was decannulated, which is to say taken off
13· ·of the ECMO circuit on April 6th.
14· · · · · · On April 7th, he had a procedure, a nuclear
15· ·medicine procedure at U.C. Davis, called radionuclide.
16· ·It's spelled r-a-d-i-o-n-u-c-l-i-d-e, I believe.
Radionuclide scan, which is a scan which
18· ·measures uptake of oxygen and nutrients, glucose and
19· ·such, into the brain.· That is often used as an ancillary
20· ·test.· It is not a test that you can use to determine
21· ·brain death in and of itself.· It doesn't substitute for
22· ·a brain death exam.· But in cases where a complete brain
23· ·death exam is not -- is not able to be done, it can be an
24· ·ancillary piece of information.· That's why I bring it up
25· ·because it's supporting information.
http://thaddeuspope.com/images/Stinson_v_UC_Davis_Placer_Cty_docs_.pdf
