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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So, today’s tip is about, “What happens if someone is not waking up after a heart attack in intensive care?” So, the first thing that we need to distinguish here is, a lot of patients with a heart attack do not end up in intensive care. They might end up on a cardiac ward or a CCU, a telemetry unit, cardiac care unit in a hospital, and they never needed an induced coma or ventilator to begin with. So, it probably really comes down to, if patients go into intensive care with a heart attack, it’s significantly severe heart attack that requires mechanical ventilation and intubation. So, let’s just break down what happens after a heart attack to begin with.

Some patients with a heart attack, they present to an emergency department or emergency room, and they might just have some thrombolysis to begin with to dissolve the clot that has presented around the arteries of the heart. They might end up in cath lab, have a stent put in, or they might just have an angiogram to dilute some of the blocked arteries, or they might have a stent to unblock the arteries. And they might then just end up on a cardiac ward in a hospital and they might be heparinized, they might go on heparin, they might go on high doses of aspirin. And after a few days, they hopefully get mobilized and get onto rehab.

Then, there are other patients that need ICU, and they might still go to the catheter lab and angiogram for an angioplasty, and they might decompensate during the procedure, and their heart rate might go up. They might go into an irregular heart rhythm. They might go hypotensive, have a low blood pressure, and they might decompensate to the point where they need intubation and go into ICU. And they’re at the point probably where they need multiple inotropes or vasopressors to keep them hemodynamically stable.

And then, there’s patients after heart attack that might go for open heart surgery straight away and have bypass grafts because they had the angiogram, and they could see that they couldn’t dilate the coronary arteries or that they couldn’t place a stent. And therefore, they go for open heart surgery. And again, they might decompensate during open heart surgery, or they might need ventilation for a few days because they’re bleeding, they’re unstable. Their cardiac output, their cardiac index might be low, their ejection fraction might be poor, which is the contractility of the heart. Their heart muscle might really be severely damaged. And that’s why those patients are decompensated and need an induced coma and mechanical ventilation for a few days. And that means patients in those situations are really critically ill.

And even though they then are eventually woken up out of the induced coma, it might just take a while for them to wake up. They may during after the procedure, whether it’s open-heart surgery or even an angioplasty or angiogram, they might need a balloon pump, an intraaortic balloon pump for a few days. They might need that ventilation. They might need a Swan-Ganz or a PA (pulmonary artery) catheter to monitor their hemodynamic status with cardiac output, cardiac index, SVR (systemic vascular resistance), wedge pressures, mixed venous blood gases, and so forth.

So, a heart attack that leads to intensive care admission can be managed with multiple forms of life support or needs to be managed with multiple forms of life support sometimes. And therefore, the longer someone then is placed in an induced coma, the longer it might take for them to wake up, you see.

And especially after open heart surgery, again, the patient might bleed, the patient might go into irregular heart rhythm such as AF (atrial fibrillation) or VT (ventricular tachycardia) or even VF (ventricular fibrillation), and they might need resuscitation on that level and therefore, they might need an induced coma for even longer, and then it takes longer to wake up.

Now, if your loved one is in that situation and it’s not waking up, then obviously, the next step is probably to do a CT brain or an MRI scan of the brain to assess whether there has been any neurological damage done. Maybe there has been a stroke, God forbid, or maybe there have been seizures just to rule that out if someone is not waking up.

But overall, unfortunately, recovery in intensive care is like a marathon. It’s not like a sprint. It takes time. And your biggest asset in a situation like that is being patient, and not to give up and not lose hope. Because sometimes, patients just need time to wake up. If someone had a heart attack, they can be very close to death. So, you need to give them time to wake up. So, patience is your biggest asset in a situation like this.  So, I hope that helps and gives you some insights why a patient after a heart attack in intensive care may not wake up.

Last but not least, it also depends on what sedatives someone is on during the induced coma. Are they on propofol? Are they on midazolam or Versed? Are they having a lot of morphine or fentanyl because that may delay waking up as well. And some of those substances such as morphine, fentanyl, midazolam, are addictive in nature. And if they had plenty of those medications, they may go through a withdrawal as well, which can delay waking up as well.

Also, if someone has a heart attack, they might also go into kidney failure because of hypotension, low blood pressure, and the kidneys may not be perfused. And then if that is the case, sedatives and opiates may linger around in the body for longer because they’re not excreted properly through the kidneys. So, it is a very multifactorial situation often if someone is not waking up after an induced coma. Be patient.

Now, if you have a loved one in intensive care, go to intensivecarehotline.com and call us on one of the numbers on the top of our website, or simply send us an email to [email protected].

Also, have a look at our membership for families in intensive care at intensivecaresupport.org. There, you have access to me and my team, 24 hours a day, and we answer all questions intensive care related in a membership area and via email.

If you need a medical record review for your loved one in intensive care in real time, please contact us as well. We can help you interpret clinical data in real time while your loved one is in intensive care. We can also help you get access to medical records if you’re struggling with that. We also review medical records after intensive care, if you’re suspecting medical negligence after intensive care, or if you’re simply seeking for answers of what exactly happened.

Now, subscribe to my YouTube channel for regular updates for families in intensive care, I also do a weekly YouTube live where I answer your questions on a YouTube live show, share the video with your friends and families, give it a like, click the notification bell, and comment below what questions and insights you have from this video.

Thanks for watching.

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