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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 coming from a frustration that one of our readers shared with us when they opted in for their free instant impact report. And you can get our free instant impact report on our website at intensivecarehotline.com.

Anyway, the reader shared with us, “After traumatic open-heart surgery. Now, my mom is on the ventilator and ECMO (Extracorporeal membrane oxygenation). Why is her body shaking and trembling?” That’s a great question and is something that I’ve seen many times when working in intensive care looking after ECMO patients. So, first things first, when patients after traumatic or open-heart surgery end up on ECMO, it probably means they had a cardiac arrest or they had cardiac surgery going wrong, like bypass grafts or valve surgery, like valve replacements or valve repairs. I would imagine that could be one of the reasons why your mom ended up on ECMO.

And the ECMO, for those of you who don’t know what ECMO is, ECMO can take over the function of the heart for a period of time through a bypass machine. And it’s basically, exchanging, pumping blood around the body and also oxygenating the blood and also removing CO2, carbon dioxide as well. Why is your mom shaking? There could be a number of reasons for that.

When someone is on ECMO, their temperatures automatically going down because the body is cooling down because the blood is running through the ECMO machine. And even though it’s running through a warmer, it still often means that temperature of a patient is going down. So that could be the cooling aspect and low temperature because of the ECMO machine that could get her to shiver. Other things could be simply that, her cardiac output on the ECMO machine is not optimized. And she’s simply cool because maybe her cardiac output needs to be increased. If cardiac output is too low, she might simply be cool as well, and that could be another reason why she’s shivering.

Other reasons for shivering could be, general hemodynamic instability. Again, maybe she’s on multiple inotropes or vasopressors for low blood pressure, and that could lead to shivering as well. Maybe she’s not sedated well enough. I.e. she’s on a breathing tube and she needs more sedation so she can tolerate the breathing tube. That could be another reason. Other reasons could be that she’s got arrhythmias. I.e. her heart is not beating in a regular heart rhythm. Like sinus rhythm is a regular heart rhythm. Maybe she’s got an irregular heart rhythm as part of what happened in the operating room or operating theater during cardiac surgery. So that could be another reason why she’s shivering.

And last but not least, she might be shivering because she’s withdrawing from medication such as sedation or opiates, depending on how long she’s been on some of those medications. Maybe she’s been on ECMO now for a couple of weeks and she’s now, maybe they want to slowly wake her up and now she’s withdrawing from sedatives such as midazolam or opiates such as fentanyl or morphine, which are addictive in nature. And she might simply be withdrawing from that, and that could lead to shivering as well. So I hope that helps to answer your question.

That is my quick tip for today.

If you have a loved one in intensive care, go to 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.

Also have a look at our membership for families in intensive care at intensivecaresupport.org. There you have access to me and my team 24 hours a day in a membership area and via email, and we answer all questions intensive care related.

If you need a medical record review for your loved one in intensive care in real time, please contact us as well, we review medical records for patients in intensive care in real time. We also talk to doctors and nurses directly on your behalf and with you. Of course, we also can represent you in family meetings as advocates and consultants because we speak the intensive care language. We also review medical records after intensive care, if you have unanswered questions, if you need closure, or if you’re simply suspecting medical negligence. But we highly recommend to have us review medical records during ICU.

Now, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, share the video with your friends and families, and comment below what questions, insights you have from this video or what you want to see next.

Thanks for watching.

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

Take care.