I Am Diagnosed as a Medical Titan

Chapter 397: Chapter 257: A Rescue Ahead of Its Time (3)

”The traffic was a total standstill... We had to unload the wheeled cart from the vehicle... and push it all the way here! For two whole kilometers!”

Director Li was gasping for air, and the perfusionists behind him were soaked through with sweat. The frantic dash had clearly exhausted them.

Jiang He immediately ordered, ”Heparinize. Give 5,000 units of sodium heparin IV. Prepare for VA-ECMO! Initiate ECPR—Extracorporeal Cardiopulmonary Resuscitation—now!”

Despite their exhaustion, the perfusionist team immediately began priming the circuit.

Normal saline rapidly filled the entire extracorporeal circuit, purging it of air bubbles.

”Puncture kit.”

Jiang He took over for the final, critical steps.

He swiftly disinfected and draped the girl’s right inguinal region.

At this point, the patient had no spontaneous pulse whatsoever.

Pressing his index and middle fingers together, he gently palpated the femoral triangle, pinpointing the location by feeling the faint, artificial pulse transmitted from Yang Xu’s chest compressions.

Femoral vein. Needle in!

Dark red venous blood instantly gushed from the tail end of the puncture needle.

A direct hit on the first try!

”Guidewire.”

He took the guidewire and threaded it into the blood vessel.

He withdrew the puncture needle and slid a dilator over the guidewire.

Because the patient’s blood vessels were severely collapsed, Jiang He had to apply a sudden burst of force, dilating the access tract in stages.

Finally, he advanced the drainage cannula over the guidewire into the inferior vena cava.

Next, he located the adjacent femoral artery.

This was also a blind puncture.

The needle went in. In time with the rhythm of Yang Xu’s chest compressions, a weak trickle of purplish-black arterial blood pulsed out.

Insert the guidewire, dilate, and place the return cannula.

The entire cannulation process took less than five minutes.

”Connect the circuit.”

Jiang He took a step back.

The perfusionist swiftly made an airtight connection between the patient’s cannulas and the ECMO circuit.

”Confirm no air bubbles. Start the pump.”

The centrifugal pump began to hum deeply.

Venous blood was drawn from the femoral vein, flowing through the circuit and into the membrane oxygenator.

A few seconds later, the blood turned a bright, oxygen-rich red.

This oxygenated blood was then pumped back into the girl’s body through the other line, flowing in retrograde up the femoral artery to forcibly maintain systemic perfusion!

Everyone in the room held their breath, their eyes glued to the monitor.

Thirty seconds later, the number on the monitor began to climb from 70%.

75%...

82%...

91%...

Finally, the pulse oximeter probe clipped to the patient’s toe settled at 98%.

And as the oxygen-rich blood reperfused the heart’s coronary arteries, the heart, with the support of ECMO, miraculously began to beat on its own.

Although it still required continuous inotropic drug support, the most immediate, life-threatening crisis had been averted.

Seeing the incredible numbers,

Liu Jianbang let out a long, heavy sigh of relief.

Director Li, the team leader from the Respiratory Research Institute, also wiped a bead of cold sweat from his brow.

Outside the door, Gu Yizhou saw the scene through the glass window. His legs gave out, and he collapsed to his knees.

Chen Hao hugged him tightly. ”It’s okay, it’s okay. Old Jiang saved her. He saved her...”

Yang Xu said with relief, ”Incredible work. You’ve earned a break. Go get some rest, we’ll take it from here.”

But Jiang He’s brow remained tightly furrowed.

’I can’t rest yet...’

The resuscitation was far from over!

According to the international ECMO treatment guidelines of 2008, successfully initiating a VA configuration and stabilizing the patient’s vital signs would have been considered a complete victory at this stage.

But as someone who had been reborn, Jiang He was keenly aware of the flaws in the guidelines of this era.

The girl’s heart had indeed started beating again thanks to the perfusion of oxygen-rich blood, but her lungs were still consolidated ”white lungs,” completely unable to oxygenate blood!

This meant that her own now-beating heart would pump deoxygenated ”black” blood into the aortic arch and straight to her brain. 𝘧𝓇ℯℴ𝓂

Meanwhile, the oxygenated blood from the ECMO, fighting against this competing flow, could only manage to perfuse the lower half of her body.

An oxygen-deprived upper body and an oxygen-rich lower body.

—North-South Syndrome (Harlequin Syndrome).

In this era, the term was still far too advanced for clinical practice in the country.

If they were to actually follow the current guidelines, by the time the other doctors noticed the patient’s cerebral hypoxia, the girl would have already suffered irreversible damage and become completely brain-dead...

Therefore, he had to break convention and, within reasonable limits, rewrite the guidelines ahead of schedule!

Jiang He’s mind raced as he searched for a suitable justification.

He finally settled on a cutting-edge paper from a well-established Australian core journal of critical care medicine: *Anaesthesia and Intensive Care*.

With this paper as his justification, his advanced prediction would be logically defensible.

’It used to be, ’When in doubt, cite The Lancet.’’

’This time, in a clinical setting, it’ll have to be, ’When in doubt, cite the AIC!’’

Having devised the perfect justification, Jiang He snapped his head up and ordered in a grim voice,

”Listen up, everyone! This is no time to relax! Prep another puncture kit and get a right internal jugular vein catheter ready!”

”Get a Y-connector and a flow-limiting clamp, now! We’re going to create a branch off the existing arterial return line and run it into the internal jugular vein!”

”I’m establishing a V-A-V ECMO configuration to prevent North-South Syndrome!”