A witness who testified at the inquest into the death of Muhammad Adib Mohd Kassim told the Corner’s Court here today why the life support machine at the hospital could not save the fireman’s life.
Dr Mohamed Ezani Md Taib, a cardiothoracic surgeon at the National Heart Institute (IJN) where Adib succumbed to his injuries three weeks after the Seafield temple riots last November, said the fireman’s kidneys were not working properly.
“Once the patient was there, the main strategy was to restore oxygenation as quickly as possible through the ECMO,” he said, referring to the extracorporeal membrane oxygenation machine.
“This was done within 15 to 20 minutes,” he said, adding that Adib had been hooked up to the system at 12.40am on Nov 28.
“The hemodynamics and oxygenation became 100%. He was more stable compared to when he was in the ambulance,” he said.
He said the ECMO had been used to address other life-threatening injuries as well.
He said the ECMO was meant as a temporary measure to help Adib’s heart and lungs deoxygenate and oxygenate blood. It was supposed to be removed if his organs showed signs of failure or if oxygenation returned to normal.
Adib was taken off the ECMO on Dec 11 as he had been able to breathe on his own, Ezani said.
He added that the fireman appeared fairly stable and had responded to IJN’s physiotherapy exercises.
However, Adib required dialysis as his kidney function had not recovered despite his response to the calls and instructions of hospital staff.
At that point, he was still able to move his limbs and was aware that he was in the ICU.
“He was able to sit on a chair,” Ezani said.
On Dec 13, he said, a tube was inserted to help Adib’s breathing. The fireman was still able to do his exercises but became lethargic and experienced shortage of breath the next day despite maintaining acceptable oxygenation levels.
“By Dec 15, his condition had deteriorated further, and on Dec 16, he became gravely ill.
“Despite all attempts to support him, he passed away on Dec 17 at 9.14pm.”
Ezani, the 14th witness in the inquest which entered its ninth day today, told coroner Rofiah Mohamad that surgery could not be done as Adib was hooked up to the ECMO and on blood thinners which could cause uncontrollable blood loss.
Ezani, who is clinical director of IJN’s Heart and Lung Transplant Department, said Adib’s cause of death was “acute lung failure secondary to lung injuries associated with blunt force trauma”.
He said the blunt force trauma was the result of a hard object hitting the fireman in the chest. However, he declined to say what this object could be, saying it would be speculation on his part.
A medical witness from the Subang Jaya Medical Centre (SJMC), where Adib was admitted before being transferred to IJN, earlier told the inquiry that he had heard cracking noises in Adib’s rib cage when inspecting him at the emergency unit on Nov 27.
Dr Nantha Kumaren Muthu Kerishnan attributed this to a fracture of rib bones and said Adib’s lungs had been injured. He, too, said the injury was likely due to major blunt force trauma.
But Dr Anand Sachithanandan, a SJMC cardiothoracic surgeon, said other possible causes included crush injury, a fall from a height, acceleration and assault.
Ezani earlier said he had received a call on the night of Nov 27 from Deputy Minister in the Prime Minister’s Department for national unity and social well-being Mohamed Farid Md Rafik, an anaesthesiologist, who asked if IJN had an ECMO system.
He said he then facilitated Adib’s transfer from SJMC to IJN, which he called “risky and complicated” as the fireman’s blood pressure was unstable, and he had six chest tubes connected to him.
“When I viewed the patient at his bedside (at SJMC), I noted that he had multiple chest drains inserted into him which were bubbling vigorously. To me, this meant that he had a significant leakage of air coming out of his lungs,” he said.
“This would be the main reason for the difficulty in maintaining his oxygenation.”
He said this was why he, too, had suggested the quick use of the ECMO.
The inquest continues this afternoon.
The inquest into Adib’s death was called by the Pakatan Harapan government this year amid conflicting claims on the cause of the fireman’s death. Thirteen witnessed have testified so far.
Adib, 24, was part of the Emergency Medical Rescue Services sent from the Subang Jaya fire and rescue station to the Sri Maha Mariamman temple on Nov 27. He is said to have been attacked there. He succumbed to his injuries on Dec 17. – FMT