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

Today, I have an email from Donna who says,

“Hi Patrik,

My sister has been placed on ECMO for pneumonia. She’s currently been receiving treatment for 5 days on ECMO (Extracorporeal membrane oxygenation). They tried to wean her sedation yesterday, but her saturations and respiratory rate have dropped. Is this normal? Will she be strong enough to come off the ECMO?”

Thank you, Donna, for writing in and for asking this very important question.

I’ve seen this situation a lot of times when I worked in ICU. I worked in critical care for nearly 25 years in three different countries where I also worked as a nurse manager for over 5 years. I’ve been consulting and advocating for families in intensive care all over the world since 2013 here at intensivecarehotline.com.

I can confidently say we have saved many lives for our clients. You can verify that at intensivecarehotline.com in our testimonial section or in our podcast section where we have done many client interviews.

So, when someone goes into ICU with the pneumonia and every treatment option has been maximized, i.e., antibiotics are given, antivirals are given, or antifungals are given, for the pneumonia and the pneumonia isn’t clearing up and oxygen requirements go up, and arterial blood gases get worse and worse chest X-ray get worse and worse.

One of the options to escalate treatment is to go on ECMO. What that basically means is ECMO machine is a bypass machine. The bypass machine basically takes over the function of the lungs for a period of time so that the lungs can rest and heal.

So, patients are put in an induced coma. They are intubated most of the time with a breathing tube and they’re induced into a coma. Then, that’s when ECMO can hopefully be weaned off slowly as the lungs improve. That’s when you try to wean off sedation and that’s when patients may or may not wake up. They may like to wake up or they may not like to wake up and that’s when things happen like Donna describes them.

Patients are not ready to wake up. It’s very challenging for them to wake up. Their saturations drop. The respiratory rate goes down or goes up. They’re almost fighting against the ventilator or they’re fighting against the ECMO machine and that could potentially make her unsafe if she’s not quite ready to be weaned off the ECMO machine.

So, what needs to happen here is she needs to gradually wean off the ECMO machine. The flow needs to be reduced. The FiO2 needs to be reduced. When she’s ready to come off ECMO, that means she’ll still be ventilated and in a breathing tube. It is almost like a two-step process.

First, she needs to be weaned off ECMO, she needs to be gently woken up. But then she will still require the ventilator and the breathing tube. Then hopefully, once the pneumonia is cleared, she can be extubated. If she can’t be extubated, she might need a tracheostomy.

If ECMO goes on for much longer, she would benefit from a tracheostomy as well. However, the problem with being on ECMO and the tracheostomy is that when a patient is on ECMO, they are also on a heparin infusion for anticoagulation. When patients are on a heparin infusion, which can’t really be stopped when patients are on ECMO, doing a tracheostomy is too risky, but it’s also too risky doing a tracheostomy with high oxygen requirements. When patients go on ECMO, their oxygen requirements are often above, 60, 70 if not 80% of FiO2 (fraction of inspired oxygen). So therefore, it’s too risky to do a tracheostomy anyway.

So, what should you be looking for and what should you be doing in situations like that? First off, they have to keep trying to wean the ECMO off first and foremost. That is probably more important. Then, when she’s off ECMO, hopefully they can clear the pneumonia with the right antibiotics or right antifungal or right antiviral medication.

Once the pneumonia is cleared, then ECMO requirements should reduce anyway. FiO2 should come down, the flow should come down, and then hopefully ECMO can be removed, like I said, Then, ventilation weaning can happen next. That might take some time and she may need a tracheostomy to come off the ventilator.

Also, when patients are on ECMO, they might also be needing inotropes or vasopressors because a lot of blood is going around through the ECMO machine and that might drop blood pressure and therefore other mechanisms of life support such as vasopressors or inotropes might be needed to keep the blood pressure on certain levels, making sure the blood pressure is compatible with life.

So, you’re asking, will your sister be strong enough to come off it? She should still receive nutrition throughout her being on ECMO and whether she’d be strong enough or not, time will tell. So, you got to be patient here.

Some patients can be on ECMO for weeks. The shorter, the better, of course, because the longer your sister stays in an induced coma, the more deconditioned she will get and the higher the chances are that she needs a long recovery time. The longer she’s on ECMO, there’s also a higher chance that she may not survive. I hope that’s not the case, but it’s just something you need to look out for.

Because we get so many questions for families of critically ill patients in intensive care, that’s why we have created membership for families of critically ill patients in intensive care at intensivecarehotline.com. You can become a member when you click on the membership link, or 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 then recorded the videos. Those e-books and videos will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment. It shows you all the insights that I have gathered in nearly 25 years of critical care nursing in three different countries all around the world. So, it will really help you managing this difficult territory.

I also offer one-on-one consulting and 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 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. When I talk to doctors and nurses or to ICU teams directly, I ask all the questions you haven’t even considered asking but must be asked so that you can make informed decisions, have peace of mind, control, power, and influence. I also represent you in family meetings with intensive care teams.

We also offer medical record reviews in real time so that you can get a second opinion in real time. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence.

All of that, you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or 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 from this video, share the video with your friends and families.

I also do a weekly YouTube live where I answer your questions live on the show and you can get notification for that if you subscribe to my YouTube channel or if you subscribe to our email newsletter at intensivecarehotline.com.

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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