Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM, where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED” and in last week’s episode I answered another question from our readers and the question last week was
You can check out the answer to last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer another question from one of our readers and the question this week is
I have lost my 62 year old husband last year in Intensive Care after cardiac arrest! The Intensive Care team withdrew treatment against my will! Could he have been saved?
This question from Lara formed part of an email counselling and consulting session with me.
Lara writes
Hi Patrik,
I have lost my 62 year old husband in Intensive Care last year when he died a few days after cardiac arrest!
The Intensive Care team put a DNR(Do not resuscitate) order on my husband without my permission, but possibly with my adult step daughter’s permission when he was given a trachostomy 6 days after a cardiac arrest.
He was still heavily sedated with Propofol, Ativan(Lorazepam), Morphine, Heparin and blood pressure medications.
After the cardiac arrest he was treated with hypothermia therapy and he was on daily kidney dialysis for acute kidney failure.
I had to fight with the medical staff in Intensive Care, as he was full code care and yes to CPR(Cardiopulmonary resuscitation) initially on his admission to ICU if needed.
They were so very negative and suggested removal of life support at only day 2-3 after the cardiac arrest. Patients need more time always and especially after hypothermia, kidney dialysis, meds, cardiac arrest and induced coma, just to reboot and come back.
He responded to me with raised blood pressure and breathing when I came in the room to talk to him and hold his hand. He cried tears when I talked about our kids and when I told him that I was waiting for him.
He one time turned his head to me and moved his mouth , but he had a tracheostomy so he couldn’t make any sounds.
I could understand him telepathically, and I gave him my strength to hang on and fight. I loved him with all my heart and he loved me. I tried to get him transferred to a more specialty cardiac hospital, and the hospital where he was at didn’t want to do that either.
With above email, how long could it have taken my husband to heal as best as possible, and what treatment is best for a Patient who has had cardiac arrest, with hypothermia therapy and kidney dialysis with low blood pressure and coma, possible anoxic brain injury?
I was thinking at the time that it would have been best to go to a cardiac critical specialty ICU and be put on ECMO machine, possible blood transfusion, and antibiotics and physical therapy on arms and legs, and wait for the Patient to wake up from the coma, while playing loved ones voices on CD player and favourite music and touch and hold hands. Maybe a magical kiss from Patients wife or husband daily.
What do you think about this situation?
Many thanks
Lara
Hi Lara,
thank you for sending this question through and also thank you for signing up for my 1:1 email counselling and consulting!
I’m very sorry to hear that you have lost your 62 year old husband in Intensive Care last year! I can only imagine how terrible you must feel and I can only imagine the loss you are feeling!
The circumstances that surrounded your husband’s death doesn’t sound to me like it was an amicable death either, especially if you felt like the Intensive Care team was negative from the start and that the Intensive Care team used the first opportunity to issue a DNR(Do not resuscitate) order and withdrew treatment as soon as they had permission from your adult step daughter!
I wish you could have sent this question through before your husband passed away and unfortunately I currently see an increased number of clients coming to me when it’s too late.
This is a worrying trend and I’d rather have you or other families in Intensive Care seeking out my counsel and consulting before it’s too late!
Related:
I would much rather prefer helping you and other families in a situation that could have helped saving your husband’s life.
Unfortunately many families in Intensive Care still trust the Intensive Care team blindly and they still think that they can “go it alone” to only find out later that this was a situation where they desperately needed help in order to make the right decisions!
You haven’t commented on the NOK(Next of Kind) or power of attorney(POA) situation and I would assume that you, your husband’s stepdaughter or any other adult children that you have would have been the decision makers in cooperation with yourself and the Intensive Care team.
The issuing of a DNR(Do not resuscitate) order and/or the decision to withdraw treatment should never be made by one or two parties alone if there are more parties involved that have the best interest of a Patient at heart in the decision making process.
Even if your adult step daughter agreed to a “withdrawal of treatment” and the DNR, it still would have needed your and/or your other children’s input on this crucial decision unless she was the sole POA, however that would be unlikely.
For anyone reading this who’s in a similar situation and you are unsure about what to do, my advice is clearly to ask for the Intensive Care Unit’s protocol or policy regarding end of life, withdrawal of treatment and/or DNR(Do not resuscitate) or NFR(Not for resuscitation) orders.
Related:
Once you have asked for that you will find that most Intensive Care Units are breaching their own policies when it comes to the decision making process around end of life, withdrawal or limitation of treatment as well as DNR/NFR.
I will elaborate more on this a bit later!
Unfortunately, Intensive Care teams can be very negative in critical situations like this and they can be particularly negative when it comes to “perceived” end of life situations.
Related article/ video:
Now from what you are telling me, I would think that initially the Intensive Care team was making all the right decisions by starting your husband on cooling therapy and kidney dialysis.
You also mention the induced coma, the ventilator, the tracheostomy, the sedation and the blood pressure medications. He was also on Heparin and that all makes sense after a cardiac arrest.
Even the next steps make sense to me with the cooling therapy. Cooling therapy usually goes for up to 72 hours and it’s a therapy that is trying to protect the functionality of vital organs such as the heart, the brain, the kidney and the liver.
Normally the body gets cooled down to 32-33.9 °C (90-93°F) in order to protect those vital organ functions for up to 72 hours.
After 72 hours, a slow rewarming period will commence and depending on other vital functions such as the heart rate, the heart rhythm, the blood pressure etc… warming up as well as “waking up” after the induced coma should be considered.
This also usually is followed by a CT of the brain to ensure that there hasn’t been any brain damage from the cardiac arrest.
Cardiac arrest can cause hypoperfusion in the brain due to the lack of oxygen during the cardiac arrest and lead to irreversible brain injury.
I don’t know what went wrong in your husband’s case, because if he had a tracheostomy after 6 days that would have been a good sign to me. Given that he also had kidney Dialysis he was off to be getting all the right treatment at the right time as far as I can see.
It would have given your husband the opportunity to recover in his own time.
62 years of age is not very old as far as I’m concerned and he should have been given the opportunity to recover in his own time.
The fact of the matter and the stark reality in many Intensive Care Units however is that often at the first sign that a critical illness may require a prolonged ICU admission, Intensive Care teams don’t want to invest in the required physical as well as the emotional resources that it takes to get a critically ill Patient out of Intensive Care alive.
I have consulted a lady recently who was in a similar situation, you can check the counselling/consultation session out here. The counselling session will explain what to expect after cooling therapy.
The fact of the matter is that if your husband had no brain injury that he definitely should have been given the chance of a full recovery in his own time.
At the end of the day the Intensive Care team will try and make those decisions without much or any family involvement, because they often see it from the point of view that only they know “what’s best” or what’s “in the best interest” of a critically ill Patient.
They do so with the knowledge of their financial budget in mind, they do so with the number of critically ill Patients in mind who need an ICU bed and they do so by seizing you and your family up in how likely you are in questioning their decision making process.
I know for a fact that 99% of the families of critically ill Patients in Intensive Care are intimidated by the “perceived power” and the “perceived authority” of the Intensive Care team. Those families are not making informed decisions, they don’t get peace of mind, don’t have control, power and influence! In fact the Intensive Care team can just walk all over them.
It’s a sad state of affairs really and you should have taken a stand in all of this, because everything in life is negotiable.
What often makes or breaks such a situation is your and your family’s level of preparedness and also your willingness to challenge the Intensive Care team. Given that you didn’t really know how to position your husband’s diagnosis, prognosis as well as his care and treatment, you stood a very low chance in getting what you wanted.
You were certainly thinking along the right lines with getting your husband referred to a specialised cardiac ICU with the ability to commence your husband on ECMO.
ECMO again could have bought your husband time and ECMO could have bridged your husband on to be getting a heart transplant. This could have well been a possibility at the age of 62 years.
If there was no brain injury, ECMO could have been a definite option.
Related article/video:
This leads me to comment on how long it would have taken your husband to recover had he been given the chance.
Again, given that he was on cooling therapy, had a tracheostomy and was commenced on kidney dialysis he was off to the best possible start as far as I can see.
It would have really depended on how big the damage of the heart was and what his ejection fraction(=measurement in how well the heart is pumping blood) was at the time. This would have also determined whether he would have been a candidate for ECMO or not.
Furthermore, it would have also depended on the severity of his kidney failure, however after cardiac arrest many critically ill Patients develop kidney failure that can be reversed.
Recovery time without brain damage could have been anywhere between many weeks to many months, again depending on the heart and the option to use ECMO and then have a heart transplant.
There would have been no guarantee that a heart transplant would have been successful after ECMO but the option should have been given from my perspective at such a young age.
If there was anoxic brain injury, again it would have decreased the odds of your husband recovering and surviving to a level that you and your husband would have been happy with, however the biggest healer in all critical illness is often time. How much time?
Sometimes it can take many weeks or many months. It all depends. The fact of the matter is that for whatever reason you didn’t manage to convince the Intensive Care team to take the steps you wanted them to take and that’s the sad bottom line.
Related:
And you are right to suggest that love, nurturing as well playing music and talking to your husband while holding hands are all factors that help. The more supportive a family is the higher the chances of survival and recover there is no doubt about this in my mind.
Again for anybody reading this, don’t let it get to that stage and do your own research! Start learning the things quickly that you need to learn when it comes to the critical illness of your loved one!
Start learning how to position your critically ill loved one’s diagnosis, their prognosis as well as the care and treatment of your critically ill loved one.
Do just that and the power dynamics will change and flip in your favour because the Intensive Care team doesn’t expect you to have this knowledge!
Become difficult and demanding, get help and ask for what you want after you have done your own research!
I hope this helps Lara, wishing you and your family all the very best!
How can you become the best advocate for your critically ill loved one, make informed decisions, get peace of mind, control, power and influence quickly, whilst your loved one is critically ill in Intensive Care?
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Thank you for tuning into this week’s YOUR QUESTIONS ANSWERED episode and I’ll see you again in another update next week!
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This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!