I Am Diagnosed as a Medical Titan

Chapter 396: Chapter 257: A Rescue Ahead of Its Time (2)

But without ECMO, this was the only way to improve the ventilation/perfusion mismatch in her dorsal alveoli.

”Nurse on bed one, secure the endotracheal tube. Nurse on bed two, watch the central venous catheter and arterial sheath. Director Liu, you’re on the monitor.”

”On my count. One, two, three... flip!”

With perfectly synchronized movements, they turned the girl onto her stomach and positioned soft pillows under her.

Liu Jianbang said, ”Her O2 saturation isn’t rising, and her blood pressure is dropping.”

Jiang He walked over to the ventilator and glanced at the settings.

He immediately decided to implement a lung-protective ventilation strategy.

”Drop the tidal volume to the absolute minimum: 4 milliliters per kilogram of body weight. Increase the respiratory rate to 35 breaths per minute. Set PEEP—positive end-expiratory pressure—to 18.”

These settings were counterintuitive.

Such a low tidal volume would cause carbon dioxide retention, leading to respiratory acidosis.

”Jiang He, her CO2 partial pressure will skyrocket! Her pH will crash,” Liu Jianbang warned.

”Permissive hypercapnia. We need to preserve oxygenation right now. IV push 50 milliliters of tromethamine. Set the norepinephrine drip to 0.8 micrograms per kilogram per minute. Start an epinephrine drip at 0.05 micrograms per kilogram per minute to maintain cerebral perfusion.”

”Right!”

The seconds and minutes ticked by.

The precise titration of the drugs was like walking a tightrope...

One milligram too much, and her heart would give out.

One milligram too little, and her blood pressure would instantly crash.

Jiang He stood by the bed, his eyes glued to the monitor, controlling everything based on his immense experience.

Yang Xu, of course, was right there assisting him.

The seamless teamwork between the master and his apprentice left everyone stunned.

Fifteen minutes passed.

The girl’s oxygen saturation clung precariously to the life-or-death line of 75%.

Just as everyone began to breathe a small sigh of relief...

The monitor suddenly let out a long, piercing tone.

The ECG waveform flatlined, and the blood pressure reading vanished.

Hypoxic cardiac arrest.

”Supine! Flip her back over!” Jiang He commanded sharply.

The team immediately flipped the girl back onto her back.

Jiang He vaulted onto the bed, kneeling with one leg and straddling the girl’s side. He clasped his hands, placing the heel of his palm on the lower half of her sternum.

He began CPR.

”One, two, three, four...”

Each of Jiang He’s compressions was five to six centimeters deep.

He allowed for full chest recoil, and his rate was a steady 110 compressions per minute.

Jiang He rapidly ordered, ”Push one milligram of epinephrine! Get a cooling cap on her, and place ice packs on her carotid arteries and groin. We need to lower her cerebral metabolism as much as possible.”

The nurses immediately split up to administer the drugs and apply the ice packs.

”Asystole! It’s a non-shockable rhythm. Continue epinephrine, one milligram every three minutes!”

CPR is incredibly physically demanding.

The guidelines require switching out the person doing compressions every two minutes to ensure their quality.

So Jiang He said, ”Director Liu, organize everyone into a rotation. We switch every two minutes. The depth and rate of compressions must be identical to mine. If you’re getting tired, shout out immediately!”

The doctors in the room quickly formed a line.

Jiang He was first, followed by Yang Xu, Liu Jianbang, and two other junior doctors.

They all took turns.

During a break in the rotation, Liu Jianbang watched Jiang He’s resuscitation efforts with a hint of shock.

’Jiang He’s compression depth seems deeper than what’s required by the current national CPR guidelines.’

’But,’ he keenly observed, ’the femoral pulse generated by the compressions is surprisingly strong. The cerebral perfusion is clearly better this way.’

In fact, this was another detail that would one day rewrite the medical guidelines.

In 2008, international CPR guidelines still stipulated a compression depth of only four to five centimeters.

Most clinicians of that era were afraid of using too much force, fearing they would break the patient’s ribs and trigger a lawsuit or cause secondary injury.

This subconscious holding back meant that the actual compression depth often didn’t even reach four centimeters.

The five to six centimeter depth and high-frequency 110 compressions per minute that Jiang He was now using were a more advanced method, far ahead of its time.

This entire concept,

would not be formally incorporated into the new international medical guidelines by the AHA (American Heart Association) for several more years.

But tonight, at Affiliated Hospital No. 1,

Jiang He couldn’t worry about that. He would use it now and deal with the consequences later.

Outside the glass doors, Gu Yizhou was trembling.

The members of his project team surrounded him, offering support, but their own hearts were gripped with anxiety.

’You have to save her, Boss!’

Forty minutes...

Fifty minutes...

An hour.

The compressions continued. The resuscitation continued.

Jiang He’s and Yang Xu’s backs were completely soaked with sweat. Every switch required precise coordination to ensure the pumping of the heart was never interrupted.

”Where’s the vehicle from the Respiratory Research Institute?” Jiang He gasped during a break in the rotation.

Liu Jianbang’s expression was grim. ”They’re stuck on the overpass. A few private cars are blocking the emergency lane. Traffic police are on their way to clear it.”

”How much longer?”

”I don’t know. All they could say was as soon as possible...”

Jiang He gritted his teeth. ”Keep going! Don’t stop! She’s at her limit—her pupils are starting to dilate! Hang in there!”

Despair.

It began to creep into the room.

A bitter feeling washed over Liu Jianbang. He had seen this scene play out too many times.

There’s a limit to what one can do. Medicine isn’t omnipotent.

They had already pushed themselves to the limit, done everything humanly possible.

”Director Jiang... maybe we should stop,” a nurse whispered, her eyes red.

”Quiet.”

Jiang He’s voice sounded perfectly calm.

But those who knew him understood that at times like this, he was bordering on obsessive.

’I have to save her.’

Just then, the airtight doors to the ICU finally slid open!

Two doctors from the Respiratory Research Institute burst in, sweating profusely, pushing a wheeled ECMO console and its membrane oxygenator supplies.

Leading them was Director Li, his face flushed as he spoke: