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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, my 52-year-old husband is in ICU with a massive heart attack. What are his chances of survival? The ICU team is very negative saying he may not survive the next 72 hours.

So, let’s break this down so you understand what options are and how a positive trajectory and recovery can look like. Because I’ve seen it over and over again after having worked in intensive care for over 20 years in three different countries. Out of those over 20 years, I have also worked for over 5 years as a nurse unit manager in intensive care. And I’ve been professionally consulting and advocating for families in intensive care for over 9 years now. And I’m talking to families in intensive care and to intensive care units all day, every day.

So, let’s break this down so that you can understand what options you may have if your loved one is in a similar situation.

So, if someone is going into ICU with a massive heart attack, the first step that they often go to is the catheter lab where an angiogram is done or potentially an angioplasty. What happens during a heart attack, the coronary arteries get blocked, or some of them get blocked off. And then after a heart attack, the best course of action often is to go to the catheter lab, do an angiogram, and see what vessels are blocked. Either stent them so that they get unblocked, or potentially do open-heart surgery to circumvent some of those blocked vessels by putting in new veins, to reperfuse the blocked sections of the heart, so that the heart muscles can regain functionality. But that all needs to happen very quickly, needs to happen within hours. Otherwise, the heart muscles can get damaged irreversibly and that might be what your husband is facing in this situation.

So, what else is happening in situations like that? Other things that happen in a situation like that is an ultrasound of the heart is being done, and it will be determined what the ejection fraction is of a heart. Ejection fraction means basically what is the contractility of the heart? How well can it pump?

Often what also happens during a heart attack is that inotropes will be started, inotropes or vasopressors. The most common inotropes or vasopressors that are started after a heart attack are dobutamine, dopamine, and milrinone but also medications such as noradrenaline also known as norepinephrine, adrenaline also known as epinephrine, and also sometimes levosimendan. Especially dobutamine, milrinone, dopamine, and levosimendan purely work on the contractility of the heart to increase the pump function. Whereas medications such as noradrenaline or norepinephrine, and adrenaline or epinephrine are vasoconstrictors. Basically constricting the vessels of the body, so that blood will be pumped towards the heart. And the heart has more volume to work with.

Next, other things that often happen after a heart attack or after open-heart surgery, following on from a heart attack is that patients end up with a PA catheter or pulmonary artery catheter, or a Swan-Ganz catheter to measure cardiac output or cardiac index, to measure SVR (systemic vascular resistance) and see how well the heart is working. How do the medications and the heart function work together? Is it getting the desired outcome with a PA catheter or a Swan-Ganz catheter? You can get a series of numbers that will tell you how well is the treatment working.

Now, I’m not going to break this down into too much detail today. You need to understand a lot of the anatomy and physiology to understand what numbers you can get from a PA catheter or from a Swan-Ganz catheter. But for you as a family member who is looking at a situation like that, you need to know that options are there to get detailed information.

Now, next, if the treatment that I just described fails after a heart attack, the next step often is to go on ECMO. Now, what does ECMO mean? ECMO stands for extracorporeal membrane oxygenation. It’s basically a bypass machine that gets inserted into someone’s arteries and veins and takes over the functionality of the heart. So, the heart can have a rest and hopefully recover whilst the ECMO is doing all the work, extracting blood from the body, and running it through an oxygenator. And therefore, again, pumping blood back into the body and taking over the functionality of the heart. At least for a period of time, you can do that for a limited period. The longest that I’ve seen is now around three or four weeks, but I’ve also heard now with COVID that there have been patients on ECMO for longer than three or four weeks successfully, apparently.

Then, what happens next after ECMO? If ECMO can’t be weaned, what are the options? The options are that you could go on an LVAD (left ventricular assist device) or an RVAD (right ventricular assist device), depending on what side of the heart is impacted from the heart attack. And that can be a bridge to a heart transplant.

So, that is my quick tip for today.

And I hope that it really gives you some insights of what the options are. This could be broken down into even more details, but that’s when you should contact us.

Because if you have a loved one in intensive care, you should be looking at our website intensivecarehotline.com. Call us on one of the numbers on the top of the website or send us an email to [email protected].

Look at our membership for families in intensive care at intensivecaresupport.org.

And, if you want a medical record review while you have a loved one in intensive care or after intensive care, go and check out our medical record section. We can help you with that.

Like this video, comment below what you want to see next, and subscribe to my YouTube channel  for regular updates for families in intensive care. Share this video with your friends and families, and click the notification bell.

And also, look out for some livestreams that I’m doing regularly, where you can ask questions live on a livestream here.

Thanks for watching.

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