By Patrik Hutzel — Critical Care Registered Nurse | 25+ Years ICU Experience (Germany & Australia) | Founder, Intensive Care Hotline & Intensive Care at Home

My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care. At intensivecarehotline.com, we improve the lives for families of critically ill patients in intensive care instantly so that you can make informed decisions, have peace of mind, control, power and influence, making sure your loved one always gets best care and treatment, even if you’re not a doctor or a nurse in intensive care.

I receive messages from families in crisis every single day, but Merry’s message hit particularly hard: 

“My son has been in the Cardiothoracic ICU for six weeks after contracting the H1N1 virus. He was airlifted to a specialized hospital to receive a higher level of care. He remains on a ventilator and is being supported by two ECMO machines, yet is still showing no signs of improvement and continues to be in a medically induced coma.  How long can this go on before we know there is no hope?  The question of pulling the plug lies with his wife, and I am afraid that she will soon give up hope.”  — Merry

Merry, I hear you. What you are describing is one of the most complex, high-stakes clinical situations a family can face — and you deserve a clear, honest, and compassionate explanation of what is happening, what the treatment options are, and what your rights are as a family. Let me walk you through everything.

1.  What Is H1N1 — And Why Is It So Dangerous?

H1N1 is an Influenza A virus, most famously associated with the 2009 pandemic, but it continues to circulate and cause severe disease. Unlike seasonal influenza, H1N1 has a particular tendency to cause severe viral pneumonia and Acute Respiratory Distress Syndrome (ARDS), a life-threatening condition in which the lungs fill with fluid and can no longer transfer oxygen into the bloodstream.

H1N1 ARDS is one of the most severe forms of respiratory failure seen in the ICU, and it predominantly affects younger, previously healthy adults — which makes it especially devastating for families who never expected their loved one to end up in this situation.

Key point: H1N1-associated ARDS can take weeks to months to resolve — even in patients who do recover. The fact that your son is still on the ventilator and ECMO at six weeks does not, by itself, mean there is no hope.

2.  What Is ECMO — And What Does It Mean That He Needs Two Machines?

ECMO stands for Extracorporeal Membrane Oxygenation. It is a machine that takes over the work of your heart and/or lungs by circulating blood outside the body, removing carbon dioxide, and adding oxygen — then returning it to the body. It is one of the most advanced forms of life support available anywhere in the world.

There are two main types of ECMO:

• Veno-Venous (VV) ECMO — supports the lungs only. Used when the heart is still functioning, but the lungs have failed completely.
• Veno-Arterial (VA) ECMO — supports both heart and lungs. Used when the heart has also failed.

The fact that your son requires two ECMO machines suggests he is receiving a combination of both — meaning both his heart and his lungs are significantly compromised. This is an extremely serious situation. But hospitals that run dual ECMO  programs have done so successfully in the past, and your son being transferred to a specialized center is the single most important thing that could have happened to improve his chances.

Being on ECMO for six weeks is at the extreme end of the spectrum. Most ECMO runs are measured in days to a few weeks. Longer runs carry higher risks of complications — including bleeding, clotting, infection, and organ damage. This is information the ICU team should be discussing with the family openly and regularly.

3.  What Does a Medically Induced Coma Mean in This Context?

A medically induced coma — more accurately called deep sedation or controlled sedation — is deliberately maintained by the ICU team to:

• Prevent the patient from fighting the ventilator or ECMO circuits
• Reduce oxygen consumption so the body can direct all resources to healing
• Protect the brain and other organs from the stress of critical illness

Being in a medically induced coma does not mean a patient is brain dead. It does not mean they cannot recover. It means the ICU team has made a clinical decision that deep sedation is currently in the patient’s best interests.

However — and this is critical — the depth of sedation makes it very difficult to assess neurological function, the true degree of organ recovery, and the patient’s own will. That is why ongoing assessment, communication, and advocacy are so important.

4.  Treatment Options — What Should Be Happening Right Now?

For a patient in your son’s situation — H1N1 ARDS, dual ECMO, ventilator-dependent, medically induced coma — the treatment options and considerations include:

Continued Aggressive Support

The most common approach for a six-week ECMO patient who has been transferred to a specialized center is to continue aggressive support while closely monitoring for signs of lung and cardiac recovery. This includes:

• Daily assessment of lung compliance and gas exchange to detect any improvement
• Echocardiograms (heart ultrasounds) to assess cardiac function
• Careful management of anticoagulation (blood thinners) to prevent both clotting and bleeding
• Nutrition support, physiotherapy as tolerated, and infection control

Trials of ECMO Weaning

As lung and heart function improves, the ICU team will attempt gradual weaning — slowly reducing the support provided by ECMO and increasing the work the patient’s own organs do. If the patient tolerates weaning, it is a very positive sign. If they cannot tolerate it, it tells the team the organs are not yet recovering sufficiently.

Lung Transplantation Assessment

In some centers, patients with irreversible H1N1 ARDS who fail to wean from ECMO are assessed for lung transplantation as a rescue option. This is a highly specialized pathway available at only a small number of centers in Australia. It carries its own significant risks but has been used successfully. If the treating team has not raised this, it is a question worth asking directly.

Tracheostomy

If your son remains ventilator-dependent beyond a certain point, the ICU team may recommend a tracheostomy — a surgical airway placed directly into the neck — to allow for more comfortable long-term ventilation, reduce sedation requirements, and facilitate rehabilitation. This is not a sign of giving up; it is a routine step in managing patients who need prolonged ventilatory support.

Palliative Care and Withdrawal of Treatment

In situations where the medical team believes there is no realistic prospect of recovery — or where the patient (or their legally authorized substitute decisionmaker) would not wish to continue — withdrawal of life-sustaining treatment is a compassionate and legally valid option. This is a deeply personal decision that should never be made under pressure or without complete information and full consent.

Please always make decisions that you don’t regret in 12- or 24-months’ time. Once your loved one has passed away, there is no return from it. Make decisions wisely and don’t let ICU teams pressure you.

The decision to withdraw treatment should ONLY be made after the family has received a full, honest briefing from the treating team — including a clear explanation of what ‘no signs of improvement’ actually means in terms of objective clinical markers, not just clinical impression.

5.  How Long Can This Go On — And When Is There ‘No Hope’?

This is the hardest question — and the honest answer is that there is no single universal timeline. I have seen patients on ECMO for eight, nine, ten weeks who have made meaningful recoveries. I have also seen patients who, despite every intervention, did not survive.

What matters is not the calendar — it is the trajectory. The questions the ICU team should answer for your family right now include:

• Is there any objective evidence of lung or cardiac recovery, however small?
• Have there been any successful weaning trials, even brief ones?
• Are there complications — such as irreversible organ failure, uncontrolled infection, or neurological injury — that independently limit prognosis?
• Has lung transplantation been considered and, if not, why not?
• What does the team’s honest assessment of the likely outcome look like at this point?

If these questions are not being answered clearly and regularly, that is a problem — and it is exactly why independent advocacy matters.

6.  You Must Have Access to All Medical Records

One of the most important things I can tell you, Merry, is this – you and your son’s wife have the right to access all his medical records. This is not optional. It is not a courtesy. It is a legal right.

Medical records include:

• Daily ICU nursing and medical progress notes
• Ventilator and ECMO parameters and trends
• Imaging reports (chest X-rays, CT scans, echocardiograms)
• Blood test results including inflammatory markers, organ function, and coagulation
• Medical team meeting notes and multidisciplinary team (MDT) discussions
• Any documentation related to goals of care or end-of-life discussions

Why does this matter? Because when you have the actual records in front of you — not just what the team tells you in a corridor conversation — you can see the trends for yourself. You can ask specific questions. You can identify whether the team’s narrative matches the data. And if you are working with an independent consultant like myself, I can review those records with you and give you a frank, experienced assessment.

Families who do not access medical records often make the most important decisions of their lives based on partial information. Do not let that happen to your family. Request the records today.

7.  The Role of a Consulting Call with the ICU Team

One of the most powerful things me and my team do through Intensive Care Hotline is facilitate three-way consulting calls — where I join the family on a call with the treating ICU team and help facilitate a real, honest, clinically informed conversation.

On that call, I can:

• Ask the clinical questions families don’t know to ask
• Interpret the answers in plain language in real time
• Push back on vague or dismissive responses
• Advocate for the patient’s best interests while remaining clinically credible
• Help the family understand what all treatment options actually mean
• Ensure the family’s voice is heard and respected in decision-making

In Merry’s situation, a consulting call will help establish clearly what objective evidence of improvement — or lack of improvement — actually exists, what the team’s honest prognosis is, whether transplantation has been properly considered, and what a withdrawal decision would actually look like in terms of timing and process.

Need urgent help navigating your loved one’s ICU care? Call us NOW at www.intensivecarehotline.com to book a consulting call with Patrik or email us at [email protected]

Book your call at www.intensivecarehotline.com

8.  What If He Survives but Cannot Leave ICU? Intensive Care at Home

If your son’s condition stabilizes but he remains ventilator-dependent — whether on invasive ventilation through a tracheostomy or on non-invasive ventilation — the ICU does not have to be his permanent home.

Intensive Care at Home is Australia’s only third-party accredited intensive care at home nursing service, operating across all Australian states and territories, Victoria, NSW, Queensland, South Australia, Western Australia, ACT, Northern Territory, Tasmania. We specialize in caring for ventilator-dependent adults and children in their own homes, supported by Critical Care Registered Nurses — the same level of nursing that ICU patients receive in hospital.

But even if you’re in the USA, Canada, UK, India or anywhere else please reach out, we can help you as well!

This pathway is available for patients who:

• Cannot be weaned from the ventilator or from NIV (non-invasive ventilation)
• Have a tracheostomy and require ongoing airway management
• Are medically stable but remain too dependent on critical care support to go to a standard ward or nursing home
• Wish to receive end-of-life or palliative care in a home environment with the clinical support they need

Going home — really going home, not to a nursing home or step-down facility — changes everything for patients and families. It can extend life, improve quality of life, and reduce the enormous financial and emotional cost of long-term ICU stays.

If your son is going to need long-term ventilation support, the ICU is not the only option. Contact Intensive Care at Home at www.intensivecareathome.com to understand whether a home-based care package could be the next step.

9.  A Direct Message to Merry

Merry, I want you to hear this: the fact that your son is still alive at six weeks on dual ECMO in a specialized cardiothoracic ICU tells me that he is being cared for by an extremely skilled team, and that his body has not yet given up. That matters.

But I also want to be honest with you: your family is at a critical decision point. The next conversation with the ICU team needs to be the most important conversation you have had so far — and I want to help you be prepared for it.

Please do not make any decisions based on exhaustion, fear, or incomplete information. Get the medical records. Get a second opinion. And reach out to me and my team so we can help you ask the right questions and advocate for your son.

Need urgent help navigating your loved one’s ICU care? Call us NOW at www.intensivecarehotline.com to book a consulting call with Patrik or email [email protected]

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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 with our consulting and advocacy because of our insights. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast section where we have done client interviews because our advice is absolutely life changing.

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.

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 best care and treatment always. 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.

That’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. 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. 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 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 eBooks and 21 videos that I have personally written and recorded. 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 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.

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Your FREE Download: ICU Family FAQ: H1N1, ECMO and Ventilator in ICU

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.