My name is Patrik Hutzel from intensivecarehotline.com, with another quick tip for families in intensive care.

Here at intensivecarehotline.com, we instantly improve the lives of families of critically ill patients in intensive care, so that you can make informed decisions, have peace of mind, control, power, and influence — even if you’re not a doctor or a nurse in intensive care — making sure your loved ones always get the best care and treatment in intensive care.

Today I have a question from Shirley. Shirley says:

“Hi Patrik,

My dad is currently in ICU. I’ve been told that his brain has been affected due to anoxic brain injury when he fainted, which lasted about 25 minutes. Firstly, I find it odd considering that CPR was done immediately. He has had movements and even opened and closed his eyes briefly, and teared. He also moved and turned red when they were moving the breathing tube. The neurologist is saying it’s just jerking movements. They are basically pushing for us to stop treatment, but I still find some things odd.

We need help.”

From Shirley

Thank you, Shirley, for writing in, and I’m very sorry to hear what you and your family are going through.  Let’s look at some explanations and solutions.  So, let’s start with:

What Is an Anoxic Brain Injury and Why Does Timing Matter?

Anoxic brain injury means the brain was deprived of oxygen. In cardiac arrest situations, every minute without oxygen causes progressive brain cell death. The widely cited threshold is that after approximately 4–6 minutes without circulation, significant brain damage can occur. At 25 minutes, the medical team is understandably concerned about the extent of the injury.

However — and this is a critical point — the outcome is not always as straightforward as a single number suggests. Several factors influence the actual degree of brain injury:

• The quality and speed of CPR (cardiopulmonary resuscitation) performed at the scene, and whether CPR was truly uninterrupted and effective
• The temperature of the patient — therapeutic hypothermia can protect the brain
• The underlying cause of the cardiac arrest
• The patient’s age and baseline health prior to the event
• How quickly return of spontaneous circulation was achieved

Shirley, you mentioned that CPR was done immediately. If that’s accurate — and this is why accessing all medical records matters greatly — then the effective downtime without circulation may be significantly shorter than 25 minutes. This is a crucial distinction that needs to be clarified with the ICU team.

Are the Signs Shirley Is Describing Clinically Meaningful?

You’ve described several observations, Shirley, that are clinically significant and that deserve a thorough, honest explanation from the treating team — not dismissal of your concerns.

1. Opening and closing eyes briefly — this can indicate emerging awareness or a sleep-wake cycle, which is a positive neurological sign
2. Tearing or crying — emotional responses mediated by the brain stem and higher cortical areas
3. Moving and turning red when the breathing tube is being repositioned — this is a pain and discomfort response which requires a functioning nervous system to produce
4. Movements in general — distinguishing purposeful movements from reflex movements, such as posturing, is complex and requires serial neurological assessment, not a single opinion

When a neurologist dismisses these signs as “just jerking movements” without further investigation, that should prompt you to ask for a detailed written neurological assessment, because you are entitled to a full explanation of the clinical basis for that opinion. That includes a CT (computed tomography) scan of the brain, an MRI (magnetic resonance imaging) scan of the brain, and potentially an EEG (electroencephalogram).

Why You Must Access All Medical Records — Immediately

This is non-negotiable. I said, every family I worked with, you cannot advocate effectively for your father without seeing the full clinical picture. The medical records will tell you:

• The exact timelines of when CPR was started, how long it lasted, and when return of spontaneous circulation was achieved
• Whether targeted temperature management, such as therapeutic hypothermia, was used
• The results of CT brain scans and MRI imaging
• EEG results, brain activity monitoring, and whether they were performed at all
• Medication history —sedation and paralytic agents can suppress neurological responses and make a patient appear less aware than they are
• Arterial blood gases, lactate levels, and organ function results over time
• Specific neurological assessments performed, and by whom

In most jurisdictions — the US, Canada, Australia, UK, India — you have the legal right to access your father’s medical records. Request them in writing from the hospital’s medical records department. Do not wait. The sooner you have them, the sooner you can ask informed questions and get a second opinion.

Accessing medical records

in 2026 should be no more complicated than the hospital sending you a link to a website with a username and password — or a link to an app. If it is not accessible at the drop of a hat, you should ask the question: What do they have to hide? Any time a hospital is not transparent, ask those questions.

What Are the Treatment Options for Your Dad, Shirley?  The ICU team is doing what they believe is clinically appropriate based on their assessment — but that assessment is not necessarily final. There are several pathways that need to be explored before any decisions about withdrawal of treatment are made.

1. Continued ICU Support with Serial Neurological Assessment

The brain can continue to show signs of recovery for weeks or months after a hypoxic event. A single neurological opinion in the first days is not sufficient to determine long-term outcomes. Serial assessments over time ideally include EEG, CT scans, and MRI scans — these are the gold standard before any end-of-life decisions are made. You have not confirmed that any of those have even been done.

2. Neuroprognostication the Right Way

Neuroprognostication is the process of predicting neurological outcomes after cardiac arrest. International guidelines recommend a multimodal approach, meaning no single test should determine the outcome. This includes:

• Clinical neurological examination at least 72 hours after cardiac arrest and after sedation washout
• EEG to detect seizure activity or assess background brain activity
• Somatosensory evoked potentials (SSEP) — a test that measures the brain’s response to nerve stimulation
• Brain imaging — CT and MRI scans
• Biomarkers such as NSE (Neuron-Specific Enolase) — blood tests indicating the degree of brain cell death
• Ongoing Glasgow Coma Scale observations

If all of these have not been performed and documented, then any prediction of outcome is very premature. Ask the team directly which of these tests have been done and what the results are.

3. Sedation Review and Washout

Sedation and analgesia medications can profoundly suppress neurological function. Before any neurological assessment can be considered valid, a full sedation washout must occur — meaning all sedating medications are stopped and enough time is allowed for them to be cleared from the body. Ask the team: when was the last sedation washout performed, and for how long?

4. Seeking a Second Neurological Opinion

You are entitled to request a second opinion. If the current neurologist has made a determination that you do not feel confident in — especially given the signs you have observed — you can formally request that another neurologist independently assess your father. This is a legitimate and important step.

5. Family Conference with the Full ICU Team

Insist on a formal family meeting with the ICU consultant, the neurologist, and the nursing staff who have been caring for your father. Come prepared with written questions and get myself into the meeting so you have someone on your team who can challenge the clinical team that speaks the same clinical language but is also on your side. Ask them to explain every test result in plain language. Ask what the best, worst, and most likely outcomes are at this stage, and on what basis they are making those predictions.

And also, one more word about: what “meaningful” does not really mean, what they think is meaningful — it must be meaningful for you and your family, and nobody else.   Keep that in mind, what’s meaningful for you might not be meaningful for them, and that’s the bottom line.  The bottom line is you and your wishes, and what your loved ones’ wishes would be. And to get a meaningful response, that might take days, weeks, and maybe even months, we don’t know.  But what’s meaningful for you might not be meaningful for the intensive care team.

How a Consulting Call with Patrik Hutzel from intensivecarehotline.com will help you.  You said to me help, Shirley.   I want you to know that this is exactly what me and my team are here for. When you book a consulting call with me or one of my senior ICU nurses at intensivecarehotline.com we will:

• Review your father’s medical records and test results with you
• Help you ask the right questions with the ICU team, or ask them on your behalf
• Help you formulate the right strategy to deal with the ICU team
• Explain the neurological findings in plain language
• Identify whether all appropriate neuroprognostication tests have been performed
• Relentlessly advocate on your behalf, including participating in calls or meetings with the ICU team, with you have been there
• Provide independent clinical perspectives on whether withdrawal of treatment is being proposed prematurely, unnecessarily, or potentially illegally

We charge very transparent consulting fees, which you can find on our website, with ongoing support available. You can find all the details at intensivecarehotline.com. You should not have to navigate one of the most difficult moments of your life without experienced clinical guidance, this is what we are here for. I also encourage you to have a look on our testimonial section,  we have saved so many lives for our clients in ICU with our consulting and advocacy.

If Your Dad Needs Long-Term Ventilation — There Is a Life Outside of ICU.  Especially at this stage, when the ICU team may be presenting withdrawal of treatment as the only alternative, you need to know that there is another pathway.

If your father cannot be weaned off the ventilator— whether due to neurological injury or any other reason — long-term ventilation plus or minus tracheostomy does not have to mean a lifetime in an ICU or any other facility.

Intensivecareathome.com – my specialist home nursing company —  exactly provides and supports adults and children on long-term mechanical ventilation with or without tracheostomy, including invasive ventilation or non-invasive ventilation such as BiPAP or CPAP, in the comfort and dignity of your own home.

We are the only provider that has achieved third-party accreditation for intensive care at home nursing. We are ISO 9001:2015 certified and accredited. Whether the goal is long-term ventilation with or without tracheostomy, or tracheostomy care without ventilation, we provide 24-hour intensive care nursing at home, so your dad can stay at home permanently and predictably.

Home-based intensive care is not a last resort — for the right patients, it is a genuinely superior alternative to prolonged institutional care, with a much better quality of life.  Go and have a look at our sister site Intensive Care at Home and call us on one of the numbers on the top of our website.

What You Should Do Right Now — Step by Step

1. Request all medical records in writing from the hospital today
2. Ask for a formal family meeting with the ICU consultant and neurologist
3. Ask specifically whether a full sedation washout has been performed before neurological assessments
4. Ask which neuroprognostication tests have been done and request written results
5. Ask for the name of the neurologist and their specific qualifications in neuroprognostication
6. Request a second neurological opinion if you are not satisfied
7. Contact us at intensivecarehotline.com immediately for clinical guidance and advocacy support. Contact us at intensive care hotline.com, call us on one of the numbers on top of our website or simply send us an email to [email protected]

Final Words

What you are experiencing, Shirley, is one of the hardest things a family can go through. The fact that you are questioning, observing, and advocating for your father is exactly what he needs from you right now. Trust your instincts. Trust your gut. Ask every question. Request every record. Do not allow a premature withdrawal of treatment decision to be made without a thorough multimodal neurological assessment and with enough time on your side.

If you need support, you know where we are.  This is what we are here for.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over five years in intensive care. And I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. And I can very confidently say that we have saved many lives with our consulting and advocacy, because of our insights, and you can verify that on our testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section, where we have done client interviews.

And because our advice is absolutely life-changing, right? The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for, they don’t know what questions to ask, they don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care. And that’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always. And that’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

And that’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. And I talk to you and your families directly. I handhold you through this once-in-a-lifetime situation that you simply cannot afford to get wrong. And when I talk to families directly, I also talk to doctors and nurses directly, asking all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.  I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care, so, if, in case you have unanswered questions, if you need closure or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com. If you click on the membership link or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team 24 hours a day in the membership area and via email, and we answer all questions intensive care-related. In the membership, you also have exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded. And all of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always.

And all of that you get at intensivecarehotline.com. Call us on one of the numbers at the top of our website or simply send us an email to support at intensivecarehotline.com with your questions.

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Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.

Take care for now.