Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

Yesterday I made a video, “My dad was on VA-ECMO for cardiac arrest. He got decannulated. Was it too early? He has deteriorated.” Today, I want to look at the next episode there because this is the client we’re currently working with.

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

So currently, we’re working with one of our clients and members. We have a membership for families of critically ill patients in intensive care at intensivecarehotline.com. 

One of our members has their 51-year-old dad in ICU after cardiac arrest and heart failure and he was placed on VA-ECMO (veno-arterial extracorporeal membrane oxygenation) for about 3 weeks. VA-ECMO basically means that the ECMO machine or bypass machine is taken over the function of the heart to let the heart recover, if possible, at all.

Now, the heart has recovered to some point, but a couple of days ago, they changed him and took out the ECMO cannulas and ECMO machine. They put him just on an Impella. Impella is a smaller device, smaller machine that takes over just the function of the left ventricle in the heart.

Yesterday in the video, the patient deteriorated a lot after they’ve taken him off ECMO and I explained that in yesterday’s video, which we will put a link towards the written version of this blog below the video.

But let’s look at whether there’s any progress. I’m just reading out the doctor’s notes. Obviously, this is a client we’re working with one-on-one. We have access to the medical records. I’m not giving away any names here whatsoever, of course, but I will read out what’s happening today, and you can have a look how the patient sort of has improved or not. I will comment on that in a minute.

“So, we’re still on the Impella, epinephrine is running at 0.025 mcg/kg/min. His CVP is between 8 to 9, which means it’s not too high. CVP is Central Venous Pressure. It gives an indication of whether there’s any fluid overload or whether the right heart is working in particular. So, with the CVP of 8 to 9, that’s okay. It’s pretty good. PA pressure (Pulmonary Artery) is 56/24. The pulmonary artery diastolic is ranging from 23 to 26. Cardiac index is 2.5 to 3.0 which means we are talking about a normal cardiac index. Mixed venous blood gas or SVO2 is around 55, it should ideally be above 60. Patient is now successfully weaned off the nitric oxide with no significant increase in central venous pressure and pulmonary artery pressures are normal.

So, he is now also weaned off the Levophed and the vasopressin, and an attempt to wean epinephrine is also being made, if he can tolerate that. Continue the Impella for now. Right ventricular function is reasonably good by now, with good hemodynamics. Continue fluid removal through the continuous renal replacement therapy or hemodialysis at 150 ml/hour to maintain negative state of 1.5 to 2 liters of fluids. Consider increasing to 200 mL per hour fluid removal if CVP is increasing.

Still on Lidocaine to prevent any arrhythmias. Continue amiodarone at 0.5 mg/min. Antiarrhythmics, the lidocaine and the amiodarone, need to be continued for now. Vancomycin and cefepime are to be continued, given to the suspiciousness for pneumonia on the CT chest. Continue to monitor lactic acid daily as well as monitoring the SVO2 or mixed venous blood gas. Continue with heparin. Heparin or a blood thinner is needed because he’s on the Impella. Continue atorvastatin 40 mg daily. Continue epinephrine at 0.025 mcg/kg/min for now.

Depending on his candidacy for advanced heart failure therapies as well as neurological recovery, we need further discussions about revascularization, and also about a VT (ventricular tachycardia) ablation if he turns out to be not a candidate for advanced therapies. If he recovers well though neurologically without any organ damage and able to ambulate, then we will consider advanced therapies like an LVAD (left ventricular assist device).

The family does understand his prognosis is poor and may not be a candidate for advanced therapies if he does not recover neurologically to where he can be ambulatory and cognitively intact.

Discussed with mother and sister at the bedside about above plan of care. The daughter is the power of attorney and have explained all of the above care, and they’re willing to proceed with the above full care and would like to continue aggressive measures. Completed family meeting on the 30th of the January 2025. They would like to revisit code status as well as the tracheostomy and PEG (Percutaneous Endoscopic Gastrostomy) next week based on his neurological recovery throughout this week. 

Monitor electrolytes and replace them as needed. Also optimize the nutritional status, micronutrient levels as ordered.”

So, it’s pretty much all that I’ve got for you today and that helps you understand how to continue weaning a critically ill patient off ECMO.  Also, the Impella, because the weaning needs to continue with the Impella. He may not succeed with weaning the Impella, and he may need the LVAD, but I’ll report back here in the next few days how this is going. It remains touch and go for now.

Now, I have worked in critical care nursing in 3 different countries for over 25 years, and I have worked as a nurse unit manager in intensive care for over 5 years, and I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very, very, very confidently say that we have saved many lives for our clients and members and their families. 

You can verify that on our testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section where we’ve done some client interviews.

You can join a growing list of members and clients that we’ve helped over the years. Hundreds and hundreds of members and clients who’ve helped over the years and we improve their life instantly when they have a loved one critically ill in intensive care. Our advice is absolutely life changing. 

Once again, you can verify that on our Intensive Care Hotline podcast section at intensivecarehotline.com or on our testimonial section at intensivecarehotline.com.

That’s one of the many reasons why I do one-on-one consulting and advocacy over the phone, Zoom, Skype, 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 doctors and nurses directly, 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.

We also have 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. You also have exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded. Those e-books and videos will help you to make informed decisions, have peace of mind, control, power, and influence.

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, share this video with your friends and families.

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

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.

Related Articles:

Case Study: How We Successfully Advocated to Extubate a Patient in ICU and Avoid a Tracheostomy! Quick Tip for Families in Intensive Care: The ICU Team Told My Family that I Wouldn’t Survive After Cardiac Arrest! My Family Didn’t Give Up! Quick Tip for Families in Intensive Care: My Dad Went Back into ICU with Pneumonia & a Weak Heart Needing Vasopressors & Inotropes, Can He Improve? 5 Reasons Why Families in ICU Have the Perception that ICU Teams Want to Stop Treatment Prematurely Quick Tip for Families in Intensive Care: The ICU Doctors Want to Meet with Family to Discuss Next Steps Since My Mother is Not Waking Up!