Why Christa Pike survived two lethal injections from 'blood disorder' to vein theory

Why Christa Pike survived two lethal injections from 'blood disorder' to vein theory Killer Christa Pike is now "conscious and speaking" after surviving two doses of the lethal injection, raising questions about why the powerful drug failed to work Christa Pike's lawyers warned the courts that carrying out her execution by lethal injection would end in unimaginable horror. More than a month before the state was due to put the 50-year-old to death, her legal team spent three days arguing with the Tennessee Supreme Court that the drug would not work, and would cause extreme pain and suffering. Pike even begged to be hanged or killed by an all-female firing squad after being sentenced to death at Riverbend Maximum Security Institution in Nashville, Tennessee, for the brutal murder of Colleen Slemmer, 19, in 1995. Her legal team argued that, having suffered numerous sexual attacks as a child, Pike would be retraumatised by being restrained and touched by male officers. The state refused both requests and she was set to be put to death on September 30 using pentobarbital - a barbiturate that depresses activity in the central nervous system. In a lethal dose, it is intended to induce deep unconsciousness and suppress the brain activity responsible for breathing, ultimately leading to respiratory and cardiac arrest. But this wasn't the case for Pike, who remained alive and snoring loudly after not one, but two doses of the drug. Yesterday, her legal team announced that she is awake and talking, branding her recovery "medically unprecedented". "Against all odds, Christa Pike is conscious, speaking, and continues to receive critical medical care," they said. "Despite the severe damage she endured to her arms, she is still handcuffed and shackled to the bed. Her recovery is medically unprecedented. Her prognosis remains unclear but, at a minimum, we expect a long recovery." So what went so wrong and how did Pike survive the drug that has become the most widely-used lethal injection in the US? Before the execution, lawyers argued that she had small, difficult-to-access veins and suffered from thrombocytosis, a blood disorder involving an abnormally high number of platelets which can increase the risk of blood clots. They warned that establishing an intravenous line could be difficult and that problems during the process could cause her significant pain. Defence medical expert Dr Joel Zivot told the hearing that Pike could potentially feel as though she was "burning alive" if problems occurred. But the state disputed the claims. Hematologist Dr Richard Mansour told the court that Pike's recent medical records showed her veins were accessible and that medical staff had successfully completed almost all of her recent blood draws with a single needle stick. The judge ultimately rejected most of Pike's claims, concluding that the evidence did not establish that her veins or blood disorder created a substantial risk of severe pain during lethal injection. But on September 30, the very problem Pike's lawyers had warned about appeared to unfold inside the execution chamber. The execution team reportedly went through at least seven needles in attempts to establish suitable intravenous access. One needle is said to have been bent at a 90-degree angle when it was removed. Randy Spivey, one of Pike's lawyers, said she even tried to help execution staff find a suitable place for the IV lines. "She over and over again said, 'Please, try up on my shoulder higher, please try here, please try here,'" he said. According to Spivey, Pike eventually thanked staff when they believed the two IV lines had been successfully established. But the lawyers later alleged that the lines were not correctly placed, or that the veins had blown, allowing some or all of the pentobarbital to enter Pike's tissue rather than her bloodstream. Witnesses heard Pike complain about a burning sensation in her arm. Outside medical experts said those details were consistent with the possibility that the drug had leaked into the tissue surrounding the IV rather than entering Pike's bloodstream. At one point, she reportedly said: "My arm feels like it's about to burst open" and asked if what was happening was 'normal'. The medical term for this is IV infiltration. If an IV catheter is not properly positioned inside a vein, medication can instead enter the surrounding tissue. In Pike's case, experts said that could have meant the pentobarbital failed to reach the concentration in her bloodstream needed to cause death. Dr Mark Heath, an assistant professor of anesthesiology at Columbia University Irving Medical Center, said the pain Pike described during the execution should have been a warning sign that the IV was infiltrating. Pike's lawyers later said she was left with blistering and burning around the sites where the IV lines were inserted. The Tennessee Department of Correction has maintained that it followed the state's established execution protocol. Dr Zivot, who had previously been retained by Pike's lawyers as a medical expert, said an infiltration could potentially explain what witnesses saw. He said Pike's small veins may have made her particularly susceptible to the problem. "Her venous system was small, and there could be some fragility there," he told The Telegraph. He explained that pushing a large quantity of a caustic substance into a small or fragile vein could cause the vein to rupture, allowing the drug to enter the surrounding tissue. In simple terms, the lethal drug may not have gone where it needed to go. Tennessee's execution protocol provides for a secondary set of syringes if an inmate has not died after the first set of drugs. But even after the second dose, Pike survived. By then, the execution had lasted more than two hours. Members of the media who witnessed the procedure reported hearing Pike crying, whimpering and breathing loudly. When the witnesses were eventually removed from the viewing chamber, Pike could still be heard breathing and later snoring behind the curtains. She was eventually taken to hospital unconscious. Her arms were swollen and blistered around the IV sites, according to her lawyers, and she was intubated and placed on a ventilator. Dr Zivot said there could also have been an issue with the pentobarbital itself, including the possibility that the drug had degraded, expired or was improperly constituted. Medical experts have warned that if the drug lowered her oxygen levels or weakened her circulation for a prolonged period, she could have suffered permanent brain damage. Her lawyer Stephen Ferrell has said that Pike may not fully recover and that her long-term prognosis remains unknown.