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

So today, I have an email from Roseanne who says,

“Hi Patrik,

My brother had a massive heart attack. He’s on a ventilator. When reduced, he wakes up and responds to commands. Therefore, he’s not brain-dead. The doctors did a catheterization. It showed his three main arteries are blocked. He needs a quadruple bypass. His heart is only functioning at 12%. They put in a balloon pump to help his heart. They can’t do surgery until he can be completely weaned off the ventilator. Yesterday, they removed it, but after 5 minutes, they had to reinsert it. They said they would try again. My question is what else can be done, if anything? He was breathing on his own but struggled. His blood pressure went up. He’s not strong enough due to his heart. Please help.

From, Roseanne.”

Thank you so much, Roseanne, for writing in.

So, if his heart is only functioning at 12% it’s very weak. That means his ejection fraction is probably only a 12%. They probably did an ultrasound of the heart (Echocardiogram) after the heart attack.

Now, what probably needs to happen here next is he’s probably already on inotropes or vasopressors such as the dobutamine, milrinone, noradrenaline, norepinephrine, maybe other medications as well, such as phenylephrine, vasopressin, and other inotropes or vasopressors that would help maintain a blood pressure that is compatible with life.

Now, I argue that his blood pressure went up too high with an ejection fraction of 12%. That is to a degree, very unlikely because the heart is simply too weak to produce a high blood pressure with what you have shared with me here.

Now, obviously, they have put in a balloon pump (IABP intra-aortic balloon pump) to help his heart and whilst they’re saying they can’t do surgery, yes, his heart probably needs to get stronger first, the balloon pump might help with that to give his heart time to recover at least to a certain degree. He also might improve with the dose of Levosimendan. That might also improve his contractility or the ejection fraction.

If the balloon pump and the vasopressors and the inotropes are not helping his heart, then ECMO might be another option. That might be another option. ECMO stands for Extracorporeal Membrane Oxygenation. It’s basically a bypass machine that will take over the function of the heart for a period of time, once again, giving the heart time to recover.

Another thing that you need to do in a situation like that, you need to speak to the cardiologist. You need to speak to a cardiac surgeon, what exactly needs to happen for them to consider cardiac surgery and do a quadruple bypass.

Now. again, it’s probably too risky with an ejection fraction of 12%. It’s probably too risky with him being on multiple inotropes and vasopressors. It’s probably too risky for him to be on the balloon pump and having cardiac surgery. I can understand that.

So, he probably needs to rest for a few days, maybe even longer. He needs to have some inotropes, vasopressors including Levosimendan. They may need to consider ECMO if his situation isn’t improving and then maybe revisit cardiac surgery. And yes, with an ejection fraction of 12%, it might be very difficult for him to come off the ventilator. It’s something you need to assess on a day-by-day basis. I hope that answers your question, Roseanne.

It’s going to be a day-by-day thing and hopefully his heart can improve and if his heart can’t improve, then he might need to go on ECMO and maybe he can be a candidate for a heart transplant if his heart isn’t improving. That is sort of the short- to medium-term outlook from my experience.

I’ve worked in critical care for nearly 25 years in three different countries where I also worked as a nurse manager for over 5 years. We’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com.

We have saved many lives with our consulting advocacy. You can verify that if you go to our testimonial section and you have a look at the testimonials, see what our clients are saying or you can check out our intensivecarehotline.com podcast where we’ve done some client interviews, also verifying that we have saved lives with our consulting and advocacy for families in intensive care.

Because we are getting so many emails from families in intensive care with so many questions, that’s one of the main reasons why we created a membership for families of critically ill patients in intensive care. 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 e-books and 21 videos that I have personally written and recorded helping you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment when they are critically ill in intensive care.

I also offer and do one-on-one consulting advocacy over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I talk to doctors and nurses directly. I talk to you and your families directly, almost handing you through the process so that you can understand the process, manage intensive care team, so they don’t manage you.

Like I said, I also talk to doctors and nurses directly and I ask all the questions to the doctors and nurses that you haven’t even considered asking but must be asked when you have a loved one, critically ill in intensive care. Also, 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, and that once again, you make informed decisions, have peace of mind control, power and influence, making sure your loved one gets best care and treatment. We also offer medical record reviews after intensive care.

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

Now, 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 do you want to see next, what questions and insights you have.

I also do a weekly YouTube live where I answer your questions live on the show. You will get notification for the YouTube live if you’re a subscriber to my YouTube channel or if you are a subscriber to our email newsletter at intensivecarehotline.com.

If you want your video done quickly, just make a small donation to the super chat button here. I have emails sitting back as far back as October. That’s how many emails we get, how many questions we get. If you want your email read out and answered, make a small donation. The more videos we can make, the more families we can help that have a loved one critically ill in intensive care.

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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