Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
Today’s tip is about when should ECMO be initiated when someone is in ARDS and proned already, and proning isn’t working. So let’s look at a case study here. We are currently working with a client. The client contacted us yesterday, sharing that their 52-year old husband is in intensive care with COVID-19 and has now got a full-blown ARDS/lung failure picture.
The client got intubated last Monday. Today, the time of the recording of this video is on a Saturday. The client got intubated on a Monday for COVID-19 ARDS/lung failure. He ended up on a ventilator in an induced coma, he ended up paralyzed then they started to prone him, which is often the first-line option of treatment when someone is in ARDS for COVID-19 because the lungs are more or less shutting down. The P/F ratio, the perfusion ratio, is very low. Lungs are shutting down. Patients often end up on a 100% of oxygen on the ventilator. They often end up on nitric oxide. They often end up on epoprostenol/Flolan nebulizers. They often end up on remdesivir and steroids to treat the ARDS picture.
After a couple of days of proning, the signs were there that the client is not improving and that things were getting worse, not better. So then, what does the intensive care team do? The Intensive care team does what they always do in a situation like that. They go back to the family and say, “Well, your loved one is not going to survive. And your loved one needs palliative care.” And it’s not in their loved one’s interest to continue treating them. And that they should simply die.
Now, since when is dying, in the best interest of anyone? We all want to live forever if we can, but since when is dying in the best interest of anyone? But here’s the crux of the matter, the intensive care unit the client is in, also has ECMO available. ECMO as a treatment option. So with ECMO as a treatment option, we only found out after we started working with the client, the client wouldn’t know what to ask for. The client didn’t even know that ECMO, A. was available and B. an option.
So we obviously asked the intensive care team, when we were talking to them with the client, what about ECMO? And the intensive care team was quick to dismiss that he would not be a candidate for ECMO. So here are some issues there, like I always say, the biggest challenge for families in intensive care is 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 nothing could be closer to that truth in this situation, because if that family had asked for help from day one, from us here at intensivecarehotline.com, that situation could have been avoided. As soon as the client was proned, we would have asked what about ECMO?
So we are still negotiating with the intensive care team at the time of this recording that, the client should have ECMO. Especially at such a young age of 51 years, he’s very young. The problem at the moment is that ECMO beds are in high demand because of the COVID situation and ARDS cases going through the roof.
But the bottom line is this. If you don’t ask for help, and if you don’t ask the right questions from day one, when you have a loved one in intensive care, it is literally a life or death situation if you don’t have help and if you don’t ask the right questions.
Now, if you have a loved one in intensive care, go to intensivecarehotline.com, call us on one of the numbers on the top of the website, or simply send us an email to [email protected].
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This is Patrik Hutzel from intensivecarehotline.com and I’ll talk to you in a few days, take care.