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

So, today’s tip is about answering a question for Donna who writes,

“Hi Patrik,

My sister has been placed on ECMO for pneumonia. She’s currently been receiving treatment ECMO for 5 days. They tried to wean her sedation yesterday, but her saturations and respiratory rate dropped. Is this normal and will she be strong enough to come off the ECMO?” That’s a great question, Donna.

I have looked after many patients on ECMO myself when I worked in ICU. I have worked in ICU for over 20 years in three different countries where I also worked as a nurse unit manager for over 5 years. I have been consulting and advocating for families in intensive care for over 10 years since 2013 at intensivecarehotline.com.

Have a look at our testimonials, have a look at our podcasts where we interviewed clients and helped them to get outcomes. We have literally saved lives with our consulting and advocacy for patients in intensive care. Let’s get into Donna’s question.

So, it’s not unusual that when someone is placed on ECMO in an induced coma, for pneumonia and on ECMO, and then you try to wean them off sedation, that they’re simply not ready. There’s a lot going on with ECMO. Basically, what ECMO is Extracorporeal Membrane Oxygenation, it’s like a bypass machine. Basically, ECMO is taking over the function of the lung because your sister’s lungs are basically not in a position to exchange oxygen and carbon dioxide because of the pneumonia. So, that’s currently happening in the ECMO machine with the bypass.

She would be ventilated, she would be on a breathing tube and if she’s basically not waking up or is combative or aggressive or simply the saturation drops and her respiratory rate dropped, it means she’s simply not ready and she needs more time.

So, what happens during ECMO is the lungs can actually have a rest. Even though the breathing tube is still in, it’s minimal ventilation. The lungs will have time to heal and rest. That can take a few days. It’s not without risk, don’t get me wrong. But ECMO is a good treatment overall.

The challenge is that the longer it takes, the higher the likelihood your sister will be weak to then wean off the ventilator. Chances are that she might need a tracheostomy depending on how long she can stay on ECMO and how long she needs the ECMO for.

The challenge there is that when patients are on ECMO, they also need anticoagulation such as heparin because the risk of blood clots when blood is running through ECMO to basically take over the function of the lung. The risk for blood clots is pretty high and therefore, a tracheostomy cannot be done because the risk of a bleed is pretty, pretty high, because when your sister is waking up at the moment, she’s got the breathing tube in her throat would be very, very uncomfortable. She’s probably feeling like she’s suffocating that’s probably why her saturation is dropping. She might try and breathe for herself, and she simply realizes she’s not ready for that and that’s why she’s probably dropping her saturations.

Now, again, the longer this goes on, the higher chances the lungs will heal, but the higher the chances that your sister will get weaker and weaker, because every day in an induced coma, the challenge is that there’s real deconditioning going on and muscle wastage. Then, it will be more difficult for your sister to wean off the ventilator and it can be a slow recovery process.

But it’s good that ECMO is available because otherwise, your sister may not have survived the pneumonia. So, see it as a positive, just go with the flow for now. It might take a few days until she’s ready to wean off the ECMO. They need to check the flow rates. They need to check arterial blood gases, and they need to wean down FiO2 on the ECMO. It’s probably at 100% at the moment, they need to wean it down to sort of 40%, check blood gases, and then hopefully, they can take away ECMO. So, that’ll be the course of action.

Then, they can also take away slowly the sedation and the opiates and let her wake up ideally gently and hopefully, avoid the tracheostomy.

So, that is my quick tip for today.

We have a membership for families in intensive care at intensivecarehotline.com when 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 a membership area via email, and we answer all questions, intensive care related.

I also offer one-on-one consulting and advocacy for families in intensive care over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I’ll walk you through everything, step-by-step, what’s happening, what questions you need to ask, how to position yourself, how to position your critically ill loved ones so they get best care and treatment. I also 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 in intensive care so that you can make informed decisions, have peace of mind, control, power, and influence.

We also offer medical record reviews in real time so that you can have a second opinion in real time. When the intensive care team realizes you have someone on your team who understands intensive care inside out and who can help you with asking the right questions, the dynamics will change in your favor.

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.

I also represent you in family meetings with intensive care teams so that, once again, you have representation and I’ll make sure that your loved one gets best care and treatment so that the intensive care team won’t negotiate down on that, which is what they’re often trying to do.

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 simply send us an email to [email protected].

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, and comment below what you want to see next, what questions and insights you have, share the video with your friends and families.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.