Baba's last minutes: Blood clot linked to fatal cardiac arrest

“We continued CPR and other measures but we could not make him survive.”

These are the words of Alphons Sabs of Devamatha Hospital, where former Prime Minister Raila Odinga, popularly known as Baba died.

CPR, or cardiopulmonary resuscitation, is an emergency technique performed on a person who has lost heartbeat.

“What has been reported is a cardiac arrest. Simply put, cardiac arrest means the heart has lost its beating rhythm: the heart stops beating,” says Bernard Samia, a consultant physician and interventional cardiologist, at MP Shah Hospital in Nairobi.

A cardiac arrest denies blood supply — and therefore oxygen and nutrients — to key critical organs: the brain and the heart.

“All other parts of the body would be affected but the brain and the heart are the most critical. The time period within which these organs can survive without blood supply is quite limited. The brain has about a minute or two and the heart has 10 to 15 minutes at the longest,” Dr Samia says.

According to the doctor there are two possible causes of cardiac arrest. The first is an electrical rhythm problem; where the heart rhythm goes too slow and stops, or goes too fast and stops, or it becomes irregular and stops.

The other possible cause is a heart attack. Also known as myocardial infarction, heart attacks are usually caused by a blood clot that blocks a major artery supplying blood to the heart itself.

Samia, who has previously served as the President of Kenya Cardiac Society, suspects based on Dr Alphons account – this is what could have transpired with Raila.

“It is said he was taking a morning walk. Then he possibly had sudden chest pain, shortness of breath, and loss of consciousness.

“So what we can hypothesise is that he got a heart attack through one of the major arteries. Most likely a coronary artery known as left anterior descending, blocked, and then the cardiac arrest - stoppage of electrical activity in his heart followed.

“After a deadly clot causes heart attack, we move from a condition we call cardiac arrest to sudden cardiac death. This is death occurring within a very short period of time and can occur even without antecedent history of heart illness,” he says.

CPR, he explains, is what the right action that follows a cardiac arrest. It’s for this reason, he says, that everyone should be competent in delivering CPR.

“This is simply massaging the chest to cause some movement of the heart muscle to continue pumping blood while the patient is rushed to a health care facility for more specialised intervention,” he says.

Alphons explained that Raila arrived at Devamatha at 8.20 am after collapsing suddenly. Doctors continued to administer CPR while also intubating him to get air into his lungs.

He was swiftly moved to Intensive Care Unit where doctors managed to register some heart activity. An injection to dissolve a clot was also administered also.

“They established there was a blood clot. The challenge they were possibly facing is that Raila was in a very unstable condition to allow them perform more specialised procedures like catheterisation,” says Samia.

In a patient who is more stable, he explains, doctors would prefer tracing the clot physically and removing it. This is because the injection to dissolve the clot only works up to a certain level of success.

“But this cannot be done in a very unstable patient, unfortunately. Because resuscitation was continuing.”

It has also emerged that Odinga was battling a set of deadly comorbidities, among them hypertension, chronic kidney disease, and diabetes.

At the age of 80, Tasneem Yamani, a geriatric and a healthy ageing expert at Hamat Healthcare in Nairobi, says, it was not unusual for Odinga to be battling the conditions.

She says: “When we reach our 40s, the body starts going on a decline. The ageing process occurs at a biological level, at a cellular level, at a physiological level, at a psychological level, at an environmental level and at a pathological level.

“Older people are more prone to non-communicable diseases such as diabetes and hypertension. They are also prone to infections because they undergo immunosenescence; weakening of the immune system.

“At old age you also start encountering problems with kidney function, your eyesight, hearing loss, muscle loss (sarcopenia), a drop in sensory function; there’s lower sensation on your tongue as your taste buds diminish.”

“It is true: the longer one lives the higher the likelihood of suffering a cardiovascular disease,” says Redempta Kimeu, a cardiologist based at the Nairobi Hospital.

Dr Kimeu adds: “That’s why we say, for example, men will start presenting with a heart disease by the age of 50 or 55. They’ve lived long enough to have had all the major risk factors.”

The former Prime Minister is no stranger to ill health. Whether publicly or in private, many Kenyans have maintained an interest in his wellbeing. Which explains the hullabaloo that followed after it was apparent that he was missing from public appearances.

 In June 2010, while serving as Prime Minister, Raila was abruptly admitted at Nairobi Hospital due to a bad headache.

At the hospital, doctors discovered that he had pressure build-up in the brain, which was causing the headache. Apparently, the Prime Minister had hit his head in one of his vehicle three weeks earlier.

In 2011, while in office, Raila flew to Germany for — among other things — a procedure on his right eye.

In several public speeches, Odinga has linked the trouble with his right eye to detention and torture he experienced in the 80s and 90s in the hands of the State during clamour for multiparty democracy.

In June 2017, at the height of the presidential campaigns that preceded the General Election the same year, Raila —flying the NASA coalition flag — fainted and needed urgent medical care at a Mombasa hospital. The incident was largely blamed on fatigue as the campaign trail can take a toll on person of his age.

In 2021, at the height of Covid-19 pandemic, Odinga spent five days at a Nairobi hospital after contracting the virus. Upon being discharged, he was upbeat and his media team releasing a clip on social media while exercising and having light conversations with his wife, Ida.

As fate would have it he was never rising past this latest tryst with ill health. According to his brother Oburu Oginga, the former PM was slightly indisposed but was recovering well and would be back in the country soon.

What are one’s chances of rising from a cardiac arrest?

According to Samia, it depends on which vessel is blocked leading to the heart attack. When it is a major vessel then there’s usually not much time and therefore lowered chances of survival.

“But if it’s a smaller vessel in the extremes you may have the same presentation but it’s more forgiving. I have handled heart attack patients who have recovered quite well,” he says.

Kimeu says: “It is very possible. But it depends on many factors, including the quality of emergency response, as well as doctors being able to identify the cause for the cardiac arrest and reversing it.”

To be of help to a person suffering cardiac arrest, Kimeu says it is important to have CPR skills.

 “If the patient is not breathing, and you cannot feel a pulse, it becomes very important that someone starts resuscitation by repetitively pressing on the chest to stimulate heart activity.

“If you can’t perform CPR, start my making sure that the patient is safe in the environment you find yourselves in. Then call for help; alert others and explicitly say you a cardiac arrest case,” she says.

Dr Tasneem advises young people to start caring for their health now in order to experience healthier outcomes in their old age; noting that many non-communicable diseases today do not discriminate.

“We used to see illnesses such as diabetes, high blood pressure, and so on in older persons. Now, because of lifestyle changes, that is not true. Even young people are now being admitted for hypertension and high blood sugar problems.”

The best way to grow old healthier, she says, is to eat healthy food ticks all the boxes for a balanced diet.