Three tests.

First of all, happy Father's Day to all the dads (and daddo's--which is what Henry calls Jonathan) out there!  Both Jonathan and I were blessed with amazing fathers growing up, so a big thank you to John Maddox and Jerry Helms. We love you!

Now to Bonnie.  She had what the nurse described as a "rough" night last night.  Her blood pressure and oxygen saturation (% of O2 in her blood) were too low, and they ended up cranking her up to full blast ECMO with 100% oxygen.  By the morning, she was back to more reasonable settings, and they speculated that her blood pressure was low because of all the morphine she's been getting, as it can cause a decrease in BP.  The decision was made to switch her from a morphine drip to fentanyl, which apparently doesn't have the same effect on blood pressure.  While I was visiting, Bonnie was resting comfortably and all her vital signs were great.  By the time I left, she was down to 48% flow on the ECMO and about 40% oxygen.  Way to go, Bonnie!


So, the deal with the three tests is this.  Currently, she's on the surgery schedule to be decannulated (taken off ECMO!) tomorrow at noon.  However, there are three tests she has to pass first.

1. She has to make it down to 40% flow on ECMO and behave. Good blood pressure, good blood gases, etc.
2. If she accomplishes #1, she will have a "low flow" ECMO trial from 4 a.m. to 8 a.m. tomorrow (Monday) morning.  They'll turn her ECMO support waaaaay down for four hours and see how she handles it.  Again, she needs to behave.  Good blood pressure, good blood gases, etc.
3. If she does well with her low flow trial, they're going to do another echocardiogram (ultrasound of her heart).  She's had several already, but this one is different because they're going to completely turn off the ECMO to do it.  (Don't worry, she'll still be on a ventilator, and the echo doesn't take long.)  The reason for this is that they're interested in the contractility of her heart, i.e. how well it can pump.  It hasn't had to work very hard for the past week and a half, because the ECMO machine has been doing a lot of the work for her.  They want to make sure her heart is ready to kick into gear when she comes off ECMO.  The reason to turn it off completely is so they can get the best possible look at what her heart is capable of when it's flying solo.

So. If she can do allllll that, our baby girl will be off ECMO by this time tomorrow.  I would love the ECMO phase of our journey to be over, but I do want to be sure she's completely ready.  As I mentioned in a previous post, once you're off ECMO, you're off for good.  The reason for this is that when they take you off, they ligate (tie off) the blood vessels that have been used.  That would be the jugular vein and the carotid artery.  If those sound familiar, it's because they're gigantic and extremely important blood vessels that run to and from your head (as in, your *brain*).  Once she's off ECMO, Bonnie will no longer have a functional right jugular vein or right carotid artery.  She won't have a pulse on the right side of her neck. (Which could be a neat party trick later on down the road.)  Anyway, all that to say, once ECMO is done, it's d-o-n-e.  We want to be completely sure that she can handle being supported by just a ventilator before taking her off.

So that's where we stand at the moment.  We are grateful to God for getting Bonnie this far with minimal drama. There is so much that could have gone wrong up to this point that *hasn't* gone wrong.  God is definitely hearing and answering our prayers.  Please continue to pray for our sweet girl that if she's really ready to be off ECMO, that she'll pass these three tests tonight/tomorrow morning.  If she's not ready, please pray that she'll let her doctors know that she needs a little bit more time on ECMO.