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If you want to know if a patient on VA-ECMO (Veno-arterial extracorporeal membrane oxygenation) after cardiac arrest and hypoxic brain injury can have a heart transplant, stay tuned! I’ve got news for you.

So currently, we are working with one of our members who has their father in intensive care on VA-ECMO after cardiac arrest and hypoxic brain injury. Currently, the father can’t be weaned off VA-ECMO, it’s very slow. When it’s very slow to wean someone off VA-ECMO, the question inevitably needs to be answered what is next for VA-ECMO, and the inability to wean someone off a VA-ECMO is to look at a heart transplant or a RVAT (right ventricular annular tilt) or a LVAT (left ventricular annular tilt) as a bridge to a heart transplant. But the question is, would that make sense with a hypoxic brain injury? So, let’s dive into the answer to that question today.

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

So, a patient on VA-ECMO, also known as venoarterial extracorporeal membrane oxygenation, after cardiac arrest and hypoxic brain injury might theoretically qualify for a heart transplant under specific circumstances. But the situation can be complex and depends often on several factors. 

Let’s get to an overview what are the key considerations for a heart transplantation. 

Number 1, the reversibility of a hypoxic brain injury. Hypoxic brain injury is a significant factor. Transplant teams, generally speaking, require a thorough neurological evaluation to assess the extent of brain damage. If the injury is severe and irreversible, i.e., persistent coma or brain death, transplantation is not an option. However, if there’s evidence of neurological recovery or the potential for meaningful recovery, the patient may still be a candidate. Now, I want to interject here that, what is meaningful recovery? Meaningful might mean very different things for different people, just as a thought here. 

Number 2, stability on VA-ECMO. VA-ECMO is often used as a bridge to decision-making or transplantation. The patient must demonstrate adequate organ function other than the failing heart to ensure they can survive the surgery and recover post-transplant.

Number 3, underlying cardiac condition. The cause of the cardiac arrest, and whether it is reversible without a transplant play a significant role. If the heart is irreversibly damaged and transplantation is the only option, this supports consideration. This is once again where you need to look at, can VA-ECMO be weaned? Most patients in intensive care on VA-ECMO have a poor ejection fraction, i.e. the contractility of the heart is really poor. Whilst ECMO (extracorporeal membrane oxygenation) gives the heart a chance to recover and recoup some of that contractility, there’s no guarantee for that, and the time a person can spend on the ECMO is unfortunately limited.

Number 4, systemic complications. Patients on VA-ECMO are at high risk for complications like infection, bleeding, or multi-organ failure, which can disqualify them from transplant candidacy.

Number 5, eligibility for transplantation. Each transplant center has specific criteria. Any centers assess psychological factors, likelihood of compliance with post-transplant care, and the availability for adequate family or caregiver support. I guess, when you talk about compliance here, can someone with an irreversible brain damage be compliant? Again, those are all questions that need to be asked.

Number 6, ethical and resource considerations. The limited availability of donor hearts means that prioritization is based on the likelihood of a successful outcome. Patients with severe brain injury or systemic complications might not meet the criteria.

Then, let’s look at scenarios where transplant may be possible: mild to moderate hypoxic brain injury. If neuroimaging and clinical assessment suggests that brain injury is not severe, the patient is showing signs of improvement.

Next, stabilization on ECMO. If the patient is otherwise healthy, and has no systemic complications, VA-ECMO can be a breach to a transplant, which is something that I mentioned earlier. Well, the conclusion is that a heart transplant is possible, but only in select patients who meet stringent criteria. Each case is reviewed by a multidisciplinary team, including cardiologists, neurologists, transplant surgeons, and ethics committees to determine the appropriateness of proceeding with the heart transplant.

But I also want to add here is, the number of heart transplants that can be done is limited. The number of donor hearts is very limited. If you followed my channel for any time, I am very pro-life and I’m all for trying everything that can be done.

In terms of organ donation, it is less likely that someone with a hypoxic brain injury without a view of recovery will be receiving a donor heart because there would be many other patients with heart failure that would be waiting for a donor heart, and that are not having hypoxic brain injury.

So, I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives for our clients in intensive care. 

You can verify that on our testimonial section at intensivecarehotline.com. You can verify that on our intensivecarehotline.com podcast section, where we have done client interviews and you can listen to the interviews yourself, what our clients say about how we have helped them to save their loved one’s lives.

Furthermore, that’s why we have helped hundreds and hundreds of members and clients over the years to improve their lives instantly, to make sure they make informed decisions, have peace of mind, control, power, and influence, making sure their loved ones get best care and treatment, always.

That’s why I do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. I also talk to doctors and nurses directly on your behalf or with you, and I ask 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, if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

All of that you get at intensivecarehotline.com where 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 and 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 eBooks and 21 videos that I’ve personally written and recorded. Those eBooks and videos will help you to once again make informed decisions, have peace of mind, control, power, and influence, so that you often get best care and treatment always.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, comment below what you want to see next, what questions and insights you have from these videos, and share the video with your friends and families.

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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.

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