The girl who died twice: How doctors saved a 12-year-old whose heart stopped for 45 minutes – nj.com

The first time the girl died, her heart stopped for one full minute.

Jissel Rosario slipped into cardiac arrest during surgery, surrounded by doctors trying to remove a blood clot in her left leg.

They brought her back to life just before 5 p.m. on April 21. Then the 12-year-olds heart stopped again.

Five minutes passed. Then 10. Fifteen. Thirty.

After 45 minutes of frantic resuscitation efforts, Jissel finally had a pulse.

Doctors wondered for how long.

For someone to have been so sick that she required such a prolonged effort at resuscitating her, I wasnt expecting her to make it, Dr. Derrick McQueen, the director of pediatric critical care at Childrens Hospital of New Jersey at Newark Beth Israel Medical Center, told NJ Advance Media.

As Jissel lay in a medically induced coma, her doctors pondered the long odds she faced. They worried if she did live, what condition the Newark girl would be in after her brain was starved of oxygen for so long.

And they debated what role the coronavirus was playing in all this.

We werent sure what was going to happen, McQueen said.

Then Jissel woke up four days later.

The coronavirus seemed to spare children in the early days of the pandemic.

Few pediatric COVID-19 cases were reported in March in New Jersey, including no deaths.

But as Jissels story illustrates, a growing number of kids exposed to the virus face life-threatening complications including a rare, mysterious inflammatory syndrome attacking blood vessels.

Only 2% of the states total COVID-19 hospitalizations involved pediatric cases, Dr. Ed Lifshitz, medical director of the communicable disease service at the New Jersey Department of Health, said last week. And only one death has been recorded among state residents under the age of 18, a 4-year-old with underlying medical conditions.

But parents now know their children are not immune in a pandemic that to date has infected 150,399 people in New Jersey and killed 10,747.

In Jissels case, a blood clot cutting off circulation in her leg had traveled to her lungs as doctors tried to remove it. She had no history of clots, but they are a common symptom of COVID-19. She was otherwise asymptomatic and twice tested negative for the coronavirus only to test positive for antibodies, meaning she had been exposed.

But doctors had more immediate concerns last month after Jissel went 45 minutes without oxygen. They feared brain damage. Organ failure. A third bout with cardiac arrest.

The girl who loved to bake cookies, paint and dance around the apartment with her mother had cheated death twice. But her chances of survival were slim.

Only one-third of pediatric patients who go more than 20 minutes without a pulse survive, according to Dr. Anthony Rosania, an associate professor of emergency medicine at Rutgers New Jersey Medical School. The survival rate was once as low as 6%, said Rosania, who was not involved in Jissels care.

Then a miracle happened, or something close to it.

After three days in a coma, Jissel started to move her eyebrows. Then her fingers. She woke up the next morning.

And she seemed ... perfectly fine. No brain damage. No organ failure.

As a doctor, I always have a hard time calling things a miracle or almost a miracle, but I do think this story of survival after 45 minutes is nothing short of extraordinary, Rosania said. Its generally unlikely, and its amazing that it was able to happen."

Jissel would limp out of the Newark hospital on crutches May 12, nearly recovered after three weeks of life-threatening issues and medical procedures.

I never lost hope, said Alma Cruz, Jissels mother. I knew my baby was going to be OK. I trusted in God. I said, I dont know what test or what youre trying to put me through,' but I had faith. I had trust."

Jissel Rosario and her mother, Alma Cruz. Jissel was treated at Newark Beth Israel Medical Center after her heart stopped twice and she was revived. Ed Murray | NJ Advance Media for

The ordeal began with a little soreness in Jissels left thigh.

A warm rag worked well enough to mask the pain for a day. Then a warm bath helped. Then nothing did.

It just kept getting worse and worse," Jissel said. It was a horrible pain. It was like someone was stabbing me over and over again.

An urgent care doctor initially diagnosed the red swelling in her thigh as cellulitis, a bacterial skin infection. But after two days on antibiotics, the swelling worsened.

Jissels foot then turned blue and ballooned as the swelling migrated beneath her knee.

On April 21, Cruz rushed her to the emergency room at Saint Barnabas Medical Center in Livingston, where doctors discovered the clot. They transferred her to the Childrens Hospital of New Jersey at Beth Israel for surgery to remove it.

By then, the clot had cut off circulation to her foot.

You know the Michelin Man? Imagine that Michelin Man how pudgy he is with the rolls? Think of her left leg looking like the Michelin Man and the rest of her looking normal, said Dr. Marc Cohen, Chairman of Medicine and a cardiologist at Beth Israel who treated Jissel. "It was cold. You could barely feel a pulse.

There was hardly any blood flow going to the leg until we started working on her.

No one can say for sure what caused the massive clot, but doctors believe it is related to the coronavirus.

Jissel never showed any symptoms. No fever. No cough. No shortness of breath. She never got sick and didnt have any underlying medical conditions.

But she did test positive for antibodies to the virus.

Theres always the possibility that she was predisposed to having problems with clotting and the exposure to the virus may have aggravated it or unmasked it, Cohen said.

Jissels case may be evidence of how COVID-19 can manifest itself differently in patients, posing a bigger threat to children than originally thought.

Reports of strokes caused by blood clots in people who test positive for the coronavirus are rising, especially in young adults.

And at least 15 New Jersey children, ages 2 to 18, were recently treated for a Kawasaki-like inflammatory syndrome that caused swelling of their arteries. In Jissel, the virus targeted her veins.

Common to both is the inflammation triggered by the infection," Cohen said. She did not have any issues with her arteries or coronary arteries, and the fact that the veins were attacked makes it very unique. To my knowledge, this was the first time weve seen something like this in a child.

Jissel Rosario talks with her mother, Alma Cruz. Rosario was treated at Newark Beth Israel Medical Center after her heart stopped twice and she was revived. She returns to the hospital every day to receive hyperbaric oxygen therapy.Ed Murray | NJ Advance Media for

As a mother, Alma Cruz just knew.

She sat in a Beth Israel waiting room, just on the other side of the wall from the pediatric catheterization lab, waiting for news on Jissels procedure.

Then an announcement was made over the hospital intercom. She saw doctors and nurses barreling toward the lab.

This was my baby. I knew it was for my baby," Cruz said.

After doctors brought Jissel back the second time that April Tuesday, they stabilized her on an extracorporal membrane oxygenation (ECMO) machine, which oxygenates and pumps blood, allowing the heart and lungs to rest. She was also placed on a ventilator. Cohen and a team of doctors then worked to remove the clot from her lung.

I just wanted to stay positive, Cruz said. "Even though there were times I had that cringe feeling, I would shake it off and say shes going to be fine and go back to being her crazy usual self and being that awesome light in my life.

After three days on the ECMO machine, Jissels heart started beating on its own.

Later on the night of April 24, she began moving her eyebrows.

I was just like, Oh my God, baby, if you can hear me, move them again, Cruz said. "I would see her moving her fingers and hand, and then it was one step at a time.

McQueen left for the day on April 24 still worried about Jissels status. He shared his concern with Cruz.

I told them I was worried about her brain, he said. So I left Friday night not knowing what was going to happen.

The next morning, Jissel opened her eyes and was responsive. The ventilator was removed that afternoon.

McQueen returned April 26 after a day off to find a different patient.

She was being a 12-year-old, he said. She wanted to get out of bed and stuff. I was so happy and relieved that she had gone through this and that she had come out on the other side."

Jissel Rosario, a 12-year-old girl from Newark, poses after being discharged from Newark Beth Israel Medical Center following a three-week battle with a life-threatening blood clot that was likely caused by the coronavirus. From left to right: Stacie Perry, nursing care director; Alma Cruz, Jissel's mother; Jeanie Kenneally, nurse manager, pediatric critical care; Jissel; and Jamel Corbett, nurse manager, pediatrics.Photo provided by Linda Kamateh

Doctors are still left with questions. Questions about the coronavirus specific role in her illness. Questions about what it could mean for other kids exposed to COVID-19 who are asymptomatic, only to later develop life-threatening complications.

Questions about Jissels miraculous recovery.

Some of it might be luck. Some of it might be the work of a higher being, McQueen said. The fact that she had no life in her for a good 45 minutes and she made it out of here makes it special to me.

After 22 days at Beth Israel, Jissel finally made it home.

But before she left, doctors and nurses lined the hospitals hallways for her dramatic exit, sending her off with a round of applause and plenty of balloons.

It was amazing to know that all of those people were there, helped me and supported me in everything I went through, Jissel said.

For now, shes using crutches as she returns to the hospital each day for hyperbaric oxygen treatments to help her regain the circulation in her toes.

In general, her prognosis is excellent," Cohen said.

Almost a month ago, they were just happy she had a pulse.

16

Girl survives heart failure, twice

Donations to help support Jissels continued medical care can be made to her familys GoFundMe account.

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Patrick Lanni may be reached at planni@njadvancemedia.com.

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The girl who died twice: How doctors saved a 12-year-old whose heart stopped for 45 minutes - nj.com