Bobbi Kristina Brown found unresponsive in bathtub. #3

[IndianSummer]

http://www.gratefulness.org/candles/candles.cfm?l=eng&gi=WS
I started to light a candle for BK but did not know how to bring it over without email,
my prayer was that she goes to heaven peacefully

TY. Done.

 

[katydid23]

I knew a girl who was in a terrible car accident. She was in a coma for months. She was not given a good prognosis. I met her in law school. AFTER the accident. It took her over a year of re-learning everything and she continued to have residual issues. She needed extra time for tests and things like that. But she was in law school.

I'm going to hope for recovery, not pulling the plug.

I asked my neighbor, who works as a critical care nurse, about that exact thing. My daughters friend was in a skateboarding accident, hit his temple on the curb, had brain injury, and was in induced coma for many weeks. And when he was first brought out, he remained unresponsive, although he did breathe rather weakly. They kept him on vent for weeks to help him.

And two years later, he was back in college. Although he still speaks and walks rather slowly, he has his mental faculties back and his great sense of
humor.

But my friend said that this case is not like BK's injuries. Her body/brain ' suffocated 'underwater, and the side effects from that can often be irreversible. Injuries like the skateboarder had, were damaged muscles and tissue and can slowly regenerate and heal, as they are wounds. But the damage from drowning is not always reversible. I don't think I explained it very well, but when she explained it to me, I understood it.

 

[CoolJ]

No. I didn't see that. So what is the prognosis? Is it like a persistent vegetative state?

Thank you for that info. So it's not about swelling necessarily?

The truth is gitana1, we have no idea what her status is. All the gloom and doom that has been presented to us thus far is speculation based off of tabloid reports. The family has asked repeatedly for the media to not report based off of unauthorized sources. Yet, that is what they continue to do. IMO

 

[SwampMama]

BK is demonstrating post-anoxic myoclonus status epilepticus. That means intractable seizures following brain damage from prolonged lack of oxygen. That term can be googled for lots of information, but the long and short of it is, while there are a few survivors, there are no "good" outcomes (defined by cerebral performance categories) in people who have had injuries similar to BK.

A few references:
The presence of myoclonic seizures
early after anoxia has been identified as a poor
prognostic factor. We report a series of patients who developed
postanoxic myoclonus status epilepticus (MSE),
which was defined as continuous myoclonic seizure activity
lasting 30 min or more. The results from 18 patients
were retrieved, 11 men and 7 women, age ranging from
29 to 90 years. Myoclonus developed a mean of 11.7 h
after cardiac arrest, persisting for a mean of 60.5 h. Sixteen
(89%) died following MSE and the 2 survivors were
highly dependent or remained in a persistent vegetative
state, supporting the view that prognosis is poor in this
condition.
Postanoxic myoclonus status epilepticus (MSE) is
thought to refl ect irreversible neocortical damage and has
been considered a poor prognostic factor, but there have
been reports of survivors [13–15] .


http://criticalcaremedicine.pbworks...g+Postanoxic+myoclonus+status+epilepticus.pdf

Abstract

Background:

1. Postanoxic status epilepticus (PSE) is considered a predictor of fatal outcome and therefore not intensively treated;

however, some patients have had favorable outcomes. The aim of this study was to identify favorable predictors for awakening beyond vegetative state in PSE.
Results: All improving patients had preserved brainstem reflexes, cortical somatosensory evoked potentials, and reactive EEG background during PSE. Half of them had myoclonic PSE, while three had nonconvulsive PSE. In the prospective arm, 3/28 patients with PSE showed this clinical-electrophysiologic profile; all awoke. Treatments consisted of benzodiazepines, various antiepileptic drugs, and propofol. One subject died of pneumonia in a minimally conscious state, one patient returned to baseline (CPC1), three had moderate impairment (CPC2), and one remained dependent (CPC3). Patients with nonconvulsive PSE showed a better prognosis than subjects with myoclonic PSE (p = 0.042).

Conclusion: Patients with postanoxic status epilepticus and preserved brainstem reactions, somatosensory evoked potentials, and EEG reactivity may have a favorable outcome if their condition is treated as status epilepticus.

http://www.neurology.org/content/72/8/744.abstract

BBM. Unfortunately, from what we know over the past 3 weeks, BK does not appear to have the kind of criteria that would predict survival.

Just reposting what K_Z so everyone can easily reread it. Thank you K_Z for your experienced and valuable input

 

[nrdsb4]

No. I didn't see that. So what is the prognosis? Is it like a persistent vegetative state?

Thank you for that info. So it's not about swelling necessarily?

I can't find the original post where K_Z posts statistics about drownings with accompanying cardiac arrest. But in this post she refers to it. The studies she showed had adults surviving drowning with cardiac arrest and subsequent resuscitation at very few and essentially none even REMOTELY going back to normal from a neuro point of view. NONE.

Here she references that original post:

No. I absolutely do not think this is Lance-Adams syndrome.

I think she suffered a very prolonged episode of anoxia due to drowning, followed by cardiorespiratory arrest, followed by a long course of CPR/ ACLS resuscitation. I think her brain is irreversibly, terminally damaged. I think the "best" that can be hoped for is PVS on a ventilator. situation, soaked in drama from the money, and celebrities, and rumors about criminal charges.

I know many people like to hold out hope for a miraculous recovery, but I don't think that's even remotely possible here. IMO, any hope of her waking up, and breathing, and being able to be aware, and interacting with loved ones (let alone returning to her old self) is in the category of "unrealistic hope." The statistics don't lie, and her situation is overwhelmingly hopeless. It's just taking a month or so to demonstrate that.

She died in that bathtub. She was discovered soon enough that her heart was resuscitated, and she had "some" brain function, albeit heavily damaged by anoxic cerebral encephalopathy. She has been dying an agonizingly slow "second death" secondary to her resuscitation, for the last 3 1/2 weeks. IMO.

Remember that large retrospective study I posted about, of 1669 adult near drowning victims with cardiac arrest at the scene? 1641 of them died at the scene, or in transit, or in the ER. 28 were resuscitated to a heartbeat and admitted to ICU. Roughly 26-27 of those 28 died during the course of hospitalization (less than a month, IIRC). 1 or 2 (equivalent statistically) survived to PVS. I don't think BK will make it to chronic PVS, if her status epilepticus is this profound at 3 1/2 weeks and 2 attempts to resolve the cerebral depressant coma.

Her prognosis is very, very grim. I believe she will die, and that is a tremendous tragedy for a beautiful 21 year old young woman, in the prime of her life. I don't know how many other statistics I can pull and post to demonstrate that, if the ones I've posted so far aren't persuasive.

 

[K_Z]

There are a few things we know from with a high degree of certainty, even without seeing medical records, or hearing “confirmation” of BK's status from family or medical providers. Using those pieces of information, we can make comparisons and inferences about her status and prognosis, using evidence-based scholarly studies, and statistical outcomes.

It’s quite important to understand that global anoxic brain damage, is not at all the same as traumatic brain injury from something like a blow to the head.

What we know with a high degree of certainty:

- That BK was a healthy 21 year old young lady before the incident that lead to the current hospitalization

- That she experienced an unknown event that lead to her being discovered face down in a bathtub of water

- That she was face down in the water for an unwitnessed period of time

- That when discovered, she was in cardiorespiratory arrest

- That CPR was initiated by the person who discovered her

- That she remained in cardiorespiratory arrest until 911 was called, and continuing until police arrived at the scene

- That she remained in cardiorespiratory arrest during the arrival of EMS, and until some unknown point during transport or admission to hospital ER (CPR/ ACLS duration was at minimum at least 20-30 min, by my best estimate, and is therefore defined as “prolonged”. It is also quite significant that she apparently had no vital signs at the scene, which is a potent predictor of prognosis.)

- That she was admitted from ER to ICU at the first smaller hospital, then later transferred to Emory University Hospital to ICU --a tertiary care university hospital, and most likely to a specialized neuro ICU, since they have at least 2 neuro ICUs according to their website

- That she has remained ventilator dependent for a month

- That she has remained comatose for a month

- That she received a surgically placed tracheostomy and feeding tube

- That she has been in a “medically induced coma” for most, if not all, of that month

- That she has experienced severe seizures when the “medically induced coma” has been withdrawn, which, by reports, is at least twice (if not more).

So, to summarize, we have a healthy 21 yo, unwitnessed event leading to a near drowning in a bathtub, leading to cardiorespiratory arrest, an unknown duration of arrest prior to discovery, prolonged cardiorespiratory arrest by definition, ICU admit on ventilator and “life support”, transfer to tertiary care university hospital, a month of coma and ventilator dependence, preparations for long term ventilator support and care (trach and feeding tube), and reports that are remarkably consistent with post-anoxic status epilepticus upon withdrawal of therapeutic cerebral depressant coma.

Here is the Osaka project link again (66,000 out of hospital cardiac arrests-- note that it is exceptionally recently published, 2013):

* This study with 1669 adults with near drowning and cardiac arrest at the scene is a part of a larger prospective Japanese study of 66,000ish OHCAs, beginning in 1998-2010. It is the largest study I've found without doing an intensive database review of literature. It may or may not be *the* largest study, but I'm sure it's *one of* the largest studies, and certainly the most recent large study.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4092116/ (full text! )

In this thread, posts # 14 and 95 contain a number of studies that are relevant to the situation at hand.

http://www.websleuths.com/forums/sh...sponsive-in-bathtub-3&p=11506018#post11506018

http://www.websleuths.com/forums/sh...sponsive-in-bathtub-3&p=11509673#post11509673

Another relevant studies (OHCA = out of hospital cardiac arrest):

Patients with OHCA due to drowning had a survival rate to 1 month of 11.5% as compared with 8.8% among patients with OHCA due to a cardiac etiology (NS). Among patients with OHCA due to drowning, only one independent predictor of survival was defined, i.e. time from calling for an ambulance until the arrival of the rescue team, with a much higher survival among patients with a shorter ambulance response time.

http://www.ncbi.nlm.nih.gov/pubmed/17997210

 

[K_Z]

Excellent publicly available full text (not just abstract) article published 2012 on Brain Resuscitation in the Drowning Victim:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677166/

 

[Catmommy]

This might be long and I apologize ahead of time

Critical Care Nurse here (unverified but you can trust me LOL) with too much experience with sad cases like this. Had a patient once - beautiful girl - who crashed her car upside down in a creek. She was severely brain injured and in a coma for weeks. She began to regain consciousness and came around, initially talking in a monotone but eventually (after much therapy) resuming her life.

Another patient eventually came to that same room, a young man who was sitting at a stop light on his motorcycle when a motorist hit him from behind throwing him over the back of her car. He was brain dead by the time he got to the hospital but we were giving the family time to digest this tragedy before removing him from the ventilator.

Unfortunately, both families' Pastor was the same man - who did NOT understand the difference between the two cases - brain injury versus brain death. He kept encouraging the family NOT to remove the ventilator because he had "witnessed a miracle in this same room" when the other patient "woke up".

The family was divided. The medical staff was telling them there was no hope but their Minister was telling them differently based on his limited experience. Who do you think they believed? Who do you think they wanted to believe? What do you think happened?

In the end, the vent was removed and the young man died fairly shortly afterwards - within 30 min to an hour. Months later the young woman came back to see us. She was still having difficulties but was walking and talking.

Each case is uniquely different to that individual.

Bobbi Kristina needs to be let go.

 

[Wyle_E_Coyote]

A poster asked if I could explain more from a previous post.

Here is the first study link. Extra corporeal membrane oxygenation (ECMO) is a kind of heart/ lung machine, that this study was researching to determine if ECMO improved survivability in adult drownings. The ECMO process "rests" the lungs when there is severe damage. There is no indication BK was ever on ECMO, although I'm sure they have it at a facility as renowned as Emory. The study has a lot of other pertinent statistics and info in it, which is why I used it.

http://www.sjtrem.com/content/22/1/77#B2

A quote from this article is explaining the purpose of the study, and citing previous studies with statistics from adults who experienced near drowning, WITH cardiac arrest at the scene of the accident.





This study of 1669 patients is from this study: (I'm sorry, cannot provide full text, only abstract)

http://www.ncbi.nlm.nih.gov/pubmed/12528781?dopt=Abstract&holding=f1000,f1000m,isrctn

These are very important statistics, and originally my comments were that someone like a celebrity doctor commentator could present these kind of outcome-based statistics in their commentary. The purpose of that would be to NOT talk about BK's situation specifically (which the commentator cannot do), but would provide comparison statistics for patients who also experienced a few things that we DO know with pretty good certainty about BK: That she experienced near drowning, unwitnessed, with an unknown time of submersion, and that she was found in cardiac arrest at the scene, and was still in cardiac arrest when EMS arrived.

So, breaking down the statistics in the Critical Care Medicine retrospective study ( http://www.ncbi.nlm.nih.gov/pubmed/12528781?dopt=Abstract&holding=f1000,f1000m,isrctn )

- 1669 adult records were reviewed from near drownings

- ALL of THOSE 1669 patients reviewed were in full cardiac arrest at the scene (with various periods of witnessed and unwitnessed submersion times)

- Only 1.7% of the 1669 patients (or, 28 patients) survived at all to hospital admission and discharge, and various amounts of time after that.

- Only 0.7 % ( we get less than one patient statistically of the 28 survivors) of the 1.7% who survived with a heartbeat to discharge from the hospital, had any kind of "favorable" neurological condition.

-"Favorable", meaning breathing independently, with some ability to awaken and have some level of consciousness. Favorable, in this case, DOES NOT mean completely neurologically intact, walking, talking, and functioning in society.

Essentially, what this study of 1669 near drownings with cardiac arrest at the scene shows us is that out of 1669 people in roughly identical situations, only .19 (less than one patient) of them will survive with some level of favorable neurological outcome. 1641 of them (or, 98.3%) will die at the scene, or during hospitalization. The other 27 survivors are permanently vent dependent and PVS. (In order to have even 1 or 2 patients with some level of favorable neuro outcome, we would have to extrapolate the original group of 1669 adult drownings with cardiac arrest up to 10,000 drownings with cardiac arrest.)

The survival odds in this study (and I can't quickly find any studies with a larger population than 1669 patients) mirror those of patients with trauma-induced cardiac arrest (such as from car accidents or falls from great distances onto the head) at the scene of the trauma. Any kind of complete cardiac arrest (aysytole) in an out of hospital cardiac arrest (OHCA) situation has very low survivability, with the exception of cardiac arrest from an electrical malfunction inside the heart (such as v-fib or v-tach)-- which is why we have AED's out and about in all areas of society now. The reason the survivability continues to be so low, is that we can't quickly "fix" the cause of the problem at the scene-- major trauma, or prolonged oxygen to the brain. We can "fix" electrical problems within the heart with an external defibrillator, hopefully before brain damage sets in. (Hope that makes sense!)

*Babies and kids are in a different category for drownings, but the outcomes are also, sadly, quite dismal. Of the kids who do have miraculous recoveries, nearly all of them had regained a pulse at the scene after CPR/ ACLS. I'm not going to pull the studies on babies, because they aren't relevant to BK's situation.

*And the bathtub water BK was found in, even if tap water cold, would not be "cold enough" to provide the level of cerebral protection that a fall thru lake ice would, to clear up that misconception.

Hope this is helpful. Sad and depressing as it is.

Bumping KZ's excellent post.

Sent from my KFJWA using Tapatalk

 

[BetteDavisEyes]

I knew a girl who was in a terrible car accident. She was in a coma for months. She was not given a good prognosis. I met her in law school. AFTER the accident. It took her over a year of re-learning everything and she continued to have residual issues. She needed extra time for tests and things like that. But she was in law school.

I'm going to hope for recovery, not pulling the plug.

Nowhere in this discussion have I ever used the expression "pull the plug". My thoughts and prayers have always been with Bobbi Kristina and her family. If the prognosis is grim, I would not want BK to be kept alive indefinitely by artificial means like Jahi McMath. If at some point it becomes absolutely apparent that Bobbi Kristina would have little quality of life, I hope her family can let her go with grace and dignity. :moo:

 

[ScarlettScarpetta]

I knew a girl who was in a terrible car accident. She was in a coma for months. She was not given a good prognosis. I met her in law school. AFTER the accident. It took her over a year of re-learning everything and she continued to have residual issues. She needed extra time for tests and things like that. But she was in law school.

I'm going to hope for recovery, not pulling the plug.

This not the same thing. She had injuries but she was not underwater and dead for an extended period of time. BK's brain basically is gone. Being without oxygen for that long is not reversible. Being in an accident have having a brain injury like that is entirely different. She is not going to get better. She is gone. And they should at this point be working on letting her go IMO.

 

[nrdsb4]

Bumping KZ's excellent post.

Sent from my KFJWA using Tapatalk

Thanks for posting. I looked and looked for that post last night but apparently didn't go back far enough.

 

[passionflower]

Since Emory is a teaching hospital with a hospice unit and money is no object..........
could stem cell research and therapy be used in a person's brain like BK?
If family wants any miracle, could she be an experiment?
Sorry that was hard to say.............

 

[Kateyes]

This might be long and I apologize ahead of time

Critical Care Nurse here (unverified but you can trust me LOL) with too much experience with sad cases like this. Had a patient once - beautiful girl - who crashed her car upside down in a creek. She was severely brain injured and in a coma for weeks. She began to regain consciousness and came around, initially talking in a monotone but eventually (after much therapy) resuming her life.

Another patient eventually came to that same room, a young man who was sitting at a stop light on his motorcycle when a motorist hit him from behind throwing him over the back of her car. He was brain dead by the time he got to the hospital but we were giving the family time to digest this tragedy before removing him from the ventilator.

Unfortunately, both families' Pastor was the same man - who did NOT understand the difference between the two cases - brain injury versus brain death. He kept encouraging the family NOT to remove the ventilator because he had "witnessed a miracle in this same room" when the other patient "woke up".

The family was divided. The medical staff was telling them there was no hope but their Minister was telling them differently based on his limited experience. Who do you think they believed? Who do you think they wanted to believe? What do you think happened?

In the end, the vent was removed and the young man died fairly shortly afterwards - within 30 min to an hour. Months later the young woman came back to see us. She was still having difficulties but was walking and talking.

Each case is uniquely different to that individual.

Bobbi Kristina needs to be let go.

I too am an unverified (at Websleuths) RN who worked ICU. In another post in an earlier BK thread I spoke about how sometimes the outside chaplain (minister, rabbi, priest,etc) would sometimes come in and give families hope when none existed. I saw this a number of times. I had taken care of a brain injured woman who purposely drove over the side of a raod in mountainous PA in an attempt to kill herslef. She had a craniotomy , and for the first nine months post-op there was little, if any improvement in her status. Her family came in daily with tapes of her kindergarten daughter, and played them over and over. While I was assigned to her she had a pseudomonas infection in her trach, and the charge nurse became upset with me when I took a culture and called the attending MD, who then prescribed antibiotics. Long story short - she was eventually transferred to another unit, and began to "lighten up" in her level of consciousness. With speech therapy she learned to talk again, and eventually learned to amulate, although she had residual weakness of her left lower leg, and used a cane. I ran into her about 2 years later and she told me she remembered everything the staff said and did, even when she could not respond. She thanked me for getting the antibiotic from the physician for her trach infection and remembered the charge nurse saying " her family needs to let her go".

In contrast I took care of a number of others who were brain dead, and probably so at admission to the unit. Many times it was hard for families to understand the difference between brain dead, and brain injured. One neurosurgeon in particular was very blunt with families ( in not a very compassionate way) but he believed the family should know from the beginning what to expect. It was usually the outside pastors, ministers, etc who muddied the waters. I pray someone gets through to Bobby Brown and makes him see the BK would not want to "live" like this for its not truly living.

 

[gitana1]

Hi Gitana,

That's correct. It appears that the multiple times (2? 3?) her doctors have tried to wean BKB off of the medically-inducing coma drugs, she has horrible seizures.

ETA see K_Z's helpful posts #392 and #393

Thank you and everyone else who posted. And K_Z, your explanation of all the evidence supporting your conclusions is quite lawyerly! So, I guess it's pretty hopeless. I'm sad to hear it. I was hoping for her to have a chance.

 

[passionflower]

Thank you and everyone else who posted. And K_Z, your explanation of all the evidence supporting your conclusions is quite lawyerly! So, I guess it's pretty hopeless. I'm sad to hear it. I was hoping for her to have a chance.

IMO, we all were praying BK would be ok and then it started to look very grim, now we just have to pray for support for the family..............just read Cissy wants to stop life support..............tabloid

 

[1&2&3]

As with many of you, I have felt BK was gone the first day. Am glad to hear she does not suffer pain or awareness when the doctors do try to bring her out of the coma inducing drugs.

Having had a BFF who was like my sister on life support and the family was asked to take her off, I know what this is like. After she was taken off, she did not die immediately as we had been told. When she started crying, we all went crazy! I asked the nurse what was wrong, and he said "someone needs to tell her it's okay to go". Just as soon as her mother kissed her and told her, she took a normal breath and was gone. This was at Vanderbilt.

How true this is, I cannot attest to. All I know is it is something I will never forget for the future.

 

[Softail]

Source: Bobbi Kristina Brown has shown ‘absolutely no signs of life lately’

LOS ANGELES – Bobbi Kristina Brown’s father, Bobby Brown, may be holding on to false hope that his daughter will make a recovery, a source will knowledge of the situation told FOX411.

The 21-year-old daughter of the late Whitney Houston reportedly suffered from “violent seizures” earlier this week after being taken out of a medically-induced coma, forcing to doctors to place her back into the coma that she has been in for almost a month.

According to our source, while Bobbi Kristina, who was found unresponsive in a bathtub on Jan. 31, has not had any more seizures, she has shown “absolutely no signs of life lately.”

http://www.foxnews.com/entertainmen...wn-has-shown-absolutely-no-signs-life-lately/

 

[BetteDavisEyes]

Looks like NG is convinced that BK is "resting".

Nick Gordon @nickdgordon
· 12h 12 hours ago
She is good getting some rest lot of stress losing your mother this month

 

[ScarlettScarpetta]

Looks like NG is convinced that BK is "resting".

Nick Gordon @nickdgordon
· 12h 12 hours ago
She is good getting some rest lot of stress losing your mother this month

He is an idgit. Not a crime but I think he is just trying to irk the family and stay relevant. Without BK he is not relevant and I think that bothers him greatly.