First visit between October 5 and 7
14 days after Jaya’s admission to Apollo Hospitals
Apollo doctors informed that she was admitted to the hospital on September 22, after she felt uneasy. She had altered levels of consciousness and low blood pressure. She had fever for last seven days. Her diabetes was uncontrolled with random blood sugars around 400 mg/dl. She was improving after treatment and fever subsided
On September 28, she had severe breathlessness and altered levels of consciousness, which did not respond to bronchodilators and non-invasive ventilation. So she had to intubated and put on mechanical ventilation. She required sedation and paralysis at the time of intubation
Our team examined Jayalalithaa and suggested tracheostomy for further management and reducing the sedation
The tracheostomy was performed at 4.30 am on October 7, which was uneventful. After this procedure, she was stable. At 11 am, she was responding to verbal commands
On October 7, our team was of the opinion that she continued to be critically ill and it would take quite some time to recover from the present condition
Second visit between October 9 and 10
Jayalalithaa was slowly progressing, but stable on life support and she would require medical care in UCU and hospital for a longer period of time (a few weeks depending on response to treatment)
Third visit between October 13 and 15
She was responding to verbal commands and was communicating with lip movements and could move
her legs and feet on her own. Her vital parameters were stable. On October 15, Jayalalithaa was better and her blood oxygen parameters were improving. The clinical progress was encouraging
Fourth visit on December 3
Jayalalithaa was progressing well and was undergoing physiotherapyregularly. She was on tracheostomy and required minimal respiratory support in the night. She was fully conscious. She could sit in the chair for 20 minutes or so, but could not stand as there was neuromuscular weakness. The AIIMS team opined that it would take time (weeks to months) for complete recovery
Fifth and last visit between December 5 and 6
The team was informed that Jayalalithaa had a cardiac arrest about 4.30 pm on December 4, and received cardiopulmonary resuscitation for 45 minutes, following which an open cardiac massage was done and put on ECMO and external cardiac pacemaker
The neurologist opined that there was no response to any stimuli, however, true neurologic status could not be assessed because of hypothermia
On clamping the tube of ECMO there was rapid drop in blood pressure, indicating that the heart had no function. Also on momentarily switching off the pacemaker, there was straight line on ECG monitor
All parameters denoted futility of support. So, it was decided to discuss the clinical situation regarding futility of life support with family members/relatives of Jayalalithaa and take further decision