Chapter 1854: 1789 Caught in a Dilemma

"What do we do if the patient's family hasn't signed?" Su Yun asked.

"Find Director Lin." Zheng Ren said.

"Well, the Medical Department's work is to safeguard clinical operations." Su Yun said contemptuously: "But that doesn't include someone like you!"

"Emergency rescue, any other way?" Zheng Ren said, "Ask Zhao Yunlong if the signing is done. He's been working on it a long time; I estimate this time it should be about done."

"How do you know?"

"Doing a head MRI takes a day to figure out, let alone IABP." Zheng Ren said: "The condition isn't good either; issue a critical condition notice, and if the patient can tough it out, they'll come back."

"……" Su Yun frowned, "Are you sure?"

Zheng Ren sighed, looking at the patient's system panel flashing red, almost dripping blood, feeling somewhat helpless.

"Maybe we still need ECMO support; will you go ahead with it?"

"No problem." Su Yun said firmly.

ECMO is an extracorporeal circulation technology that exits the cardiac operating room.

Its principle is to draw venous blood from the body, pass it through a special material artificial heart-lung bypass oxygenator, then infuse it into the patient's arterial or venous system, providing partial cardiopulmonary support to maintain organ tissue oxygenation.

Haicheng City First Hospital doesn't have ECMO; the first time Zheng Ren saw this after graduation was on Dr. Mei Ha'er.

Zheng Ren gave a bitter smile, shook his head, and said, "Have you looked at the MRI?"

"The diagnosis of smog disease is clear." Su Yun said: "If we put the patient on ECMO, a large amount of heparin will enter the circulation. Do you think it would trigger worsening of smog disease, leading to cerebral hemorrhage?"

"Hmm, the possibility is quite high." Zheng Ren said relatively politely, having just entered the system operating room, he attempted the ECMO procedure.

But less than two hours after the procedure, the patient died from cerebral hemorrhage.

This is a dilemma operation.

The conflict between heparin anticoagulation and bleeding, hemolysis, poor biocompatibility of biomaterials. The path of exploration is long; on this road, countless have died, yet countless have also survived.

Su Yun performing ECMO, from a technical standpoint, there is no problem.

But Zheng Ren judged that a large amount of heparin would cause cerebral hemorrhage, so Su Yun hesitated. Using ECMO, not to mention the cost, just technically it is an extremely difficult thing.

"Should we call neurosurgery?" Su Yun asked.

"First find Lin Ge, right away!" Zheng Ren said, "The surgery was performed with the heart stopped, blood heparinized, it's likely already…… Why hasn't Zhao Yunlong come back yet?"

"I'll make a call to urge them." Su Yun said.

"You watch, I'll go take a look." Zheng Ren finished packing up the IABP equipment, glanced at the patient's vital signs, opened the door, and strode into the EICU hallway.

Heading toward him, Zhao Yunlong walked back quickly holding an A4 sheet.

"Old Zhao, I'm looking for you." Zheng Ren waved.

"After going back to finish the IABP, I'm worried we might still need cardiac arrest." Zhao Yunlong said hurriedly.

"It's already done." Zheng Ren said.

"Done…… finished?" Zhao Yunlong said in surprise, then lowered his voice and hurried to Zheng Ren's side, "Boss Zheng, just now you did it?"

"Yeah, the heart had a sudden situation; we couldn't not do it. Now the condition has slightly eased, but not much." Zheng Ren said: "I'm considering using ECMO for support for a while, but there's a contraindication."

"Smog disease? Can you confirm it?" Zhao Yunlong was troubled.

"Yes." Zheng Ren said, "Before opening the chest, how did you explain things to the patient's family?"

"At first there wasn't time to explain; the patient was sent to the operating room for surgery while receiving external chest compressions." Zhao Yunlong said: "Later, before initiating extracorporeal circulation, I spoke with the patient's family once, suspecting smog disease again, and that heparinizing the blood would likely cause cerebral hemorrhage."

"What did the family say?" Zheng Ren's main concern was this.

If the family cooperates, the patient has at least a 30% to 50% chance of being saved.

But if the patient's family does not cooperate……

It would be better to simply give up rescue; that would be more straightforward. Then medical disputes and conflicts would be much fewer.

Once on ECMO, whether the patient lives or dies is uncertain. But for hesitant family members, the hospitalization costs rise sharply.

However, without ECMO, the patient will certainly die; the only difference is possibly a few extra hours of life.

Feeling weary, Zheng Ren also doesn't want to face this situation.

But life is like this; it's impossible to do as one pleases like in the system operating room.

"The patient is in a second marriage; her current husband says to give up treatment." Zhao Yunlong said, "But her daughter just arrived, firmly demanding treatment, and she happily signed the consent."

Zheng Ren's heart had just sunk, then it rose again.

What a complicated family situation; no wonder even the MRI had to wait a day at first.

Being able to undergo surgery and survive, Zhao Yunlong has already taken on enormous risk.

"I'll go check." Zheng Ren said.

"Boss Zheng, Professor Zhang is outside communicating with the patient's family." Zhao Yunlong said, "Wait a bit before going."

"Communicating about what?" Zheng Ren sensed a hint of ill intent in Zhao Yunlong's tone.

"To be frank, I'm repeating once again that the patient's chance of survival is not high." Zhao Yunlong said dejectedly.

No one expects the patient to live more than the lead surgeon and the attending physician; this expectation is complex and hard to put into words.

Zheng Ren also knows that after Professor Zhang finishes his explanation, the family will likely give up treatment, and the patient is as good as dead.

As long as the patient's family abandons rescue, withdraws the IABP, waits for the next rapid ventricular contraction, heart function fails, and the patient dies.

He let out a deep sigh.

"Is it a financial problem?" Zheng Ren asked.

"Yeah, the family isn't well-off." Zhao Yunlong said, "They're migrant workers, haven't paid social security back home."

"If I……" Zheng Ren started to say, then stopped.

Zhao Yunlong helplessly patted Zheng Ren's shoulder, said nothing, and silently walked back to the ward.

Live broadcast emergency rescue, put on ECMO?

The Xinglin Yuan live broadcast; success rate is a crucial factor.

And the patient's own various problems, after being put on extracorporeal membrane lung, what can happen? Smog disease, because the blood inside the body is heparinized, a tiny arterial aneurysm ruptures and bleeds, then we must livestream the patient's death.

For a mature business operation, this is completely untenable.

Zheng Renyi's painstakingly accumulated reputation would also suffer a fatal blow due to the patient's death.

But…… what Zheng Ren was pondering was not the extracorporeal membrane lung issue, but rather performing surgical treatment for smog disease.

First, block the sites that could bleed; then the other matters become easier to resolve.

Zheng Ren judged that, with the support of extracorporeal membrane lung, the bypass surgery would be fine, and the patient would still have a chance to survive.