My name is Patrik Hutzel from intensivecarehotline.com where we instantly improve the lives for families of critically ill patients in intensive care so that you can make informed decisions, have peace of mind, control, power and influence, making sure your loved one always gets best care and treatment even if you’re not a doctor or a nurse in intensive care.

Today I have a question from Betty.

“Hi Patrik,

Nice talking to you earlier. Below is a brief overview of my father’s situation. Today marks day 30 of his admission to ICU. He got severe COVID viral illness during which he forgot to take his heart medication, which he has been taking for the last 20 years. This led to a heart attack followed by an emergency angioplasty. They put a stent in his LAD, which is the left anterior descending artery, but he also had 3 more blocked arteries which couldn’t be dealt with due to his weak condition.

Since then he has been on a ventilator almost 1 month now and for 2 weeks he has been on VA ECMO, which is ECMO for heart failure. For one week since he’s been on VA ECMO, and now they’ve changed him to VA VV ECMO. It’s been one day since they converted him to VV VA ECMO. They are hoping to take off the arterial cannula on Monday. He also suffered from viral pneumonia and other infections and sepsis since being in the ICU.

His treatment plan includes remdesivir, blood thinners for the ECMO like heparin, ivermectin, and supplementation including vitamin C, melatonin, thiamine, glutathione, NAC, vitamin D, zinc, magnesium, and a range of antibiotics and steroids. They have been trying to wean him off the ECMO, but his blood pressure and oxygen requirements keep fluctuating. His hemodynamics were erratic but seemed to be stabilizing now. They have given him about 4 units of blood as he required over the last couple of weeks. He seems to have reactions to the transfusions which have led to occasional transfusion related acute lung injury, so they are wary about doing transfusions unless essential.

They also added a hemofilter yesterday, which helped offload a lot of the fluids that was causing edema, bloating, additional pressure on his heart and his blood pressure. He expelled about 9 liters in the last 24 hours, 6 via the hemofilter and 3 via urine. They have increased his protein intake and nutrition since he’s now tolerating it. We are naturally seeing muscle degradation and his blood pressure is slightly elevated right now and his albumin is at 2.1.

With all these said, do you think Patrik, my father can be weaned off ECMO despite fluctuating and unstable blood pressure, increasing oxygen requirements, erratic blood investigation levels, low hemoglobin, and transfusion related acute lung injury complications? Can you please advise?

From Betty.”

Betty, thank you so much for reaching out and for trusting me with your father’s case, and thank you for being a client. I can hear the concern in your email and also on our phone call, and I want you to know that you’ve come to the right place.

Let’s look at understanding your father’s complex ICU journey. Betty, your father is dealing with what we call a multi-system crisis in intensive care. Let me break this down for you in a way that makes sense. After 30 days in ICU with the last 2 weeks on VA ECMO and now transitioning to VV VA ECMO, your father’s medical team is navigating some very challenging terrain. The fact that he had a heart attack from missing his heart medications during severe COVID, followed by emergency angioplasty with a stent to his LAD, and still has 3 other blocked arteries means his heart is working under enormous stress.

We need to evaluate if ECMO weaning with unstable hemodynamics is possible because that’s your ultimate question. Here’s what you need to understand about ECMO weaning, Betty. When blood pressure is fluctuating and oxygen requirements keep changing, the short answer is yes, it’s possible, but it’s going to take time, patience, careful management, and improvement of your dad’s heart condition, because your father’s body has been through massive trauma, the COVID infection, the heart attack, the viral pneumonia, the sepsis, and now 30 days of critical illness. This is a marathon, not a sprint.

The fact that they’ve transitioned from VA ECMO initially to now VV VA ECMO actually shows progress. Each of these transitions means they’re trying to reduce the amount of cardiac support he needs. The plan to remove the arterial cannula on Monday is another positive step forward.

The question now is why is his blood pressure so unstable? There are several reasons, Betty, why your dad’s hemodynamics are erratic. First, his heart took a significant hit with a heart attack and still has 3 blocked arteries that couldn’t be addressed. This means his heart muscle is compromised and can’t pump as effectively as it should. Second, the infections and sepsis he’s experienced wreak havoc on blood pressure regulation. Sepsis causes blood vessels to dilate inappropriately, making blood pressure control incredibly difficult. Third, the fluid overload that he’s been experiencing and the 9 liters that came off in the last 24 hours was putting enormous pressure on his heart. Too much fluid makes the heart work harder, and when you remove it quickly, the body needs time to adjust.

Also, the transfusion complication and low hemoglobin challenge. This is a really tricky situation, Betty, and I’m glad you brought this to my attention. Your father needs blood transfusions because his hemoglobin is low, but the transfusions are causing transfusion related lung injury. This is what we call being stuck between a rock and a hard place in intensive care. Low hemoglobin means less oxygen carrying capacity, which means his heart has to work harder to deliver oxygen to the rest of his body, including major organs. But the transfusions are causing lung injuries, which makes oxygenation worse. The ICU team is right to be cautious about transfusions, they’re trying to find that sweet spot where his hemoglobin is adequate enough without triggering more lung complications.

Let’s look at some positive signs that I’m seeing. Despite all these challenges, there are actually several encouraging signs here. The addition of the hemofilter yesterday and the removal of 9 liters of fluids is significant. Fluid overload is one of the biggest obstacles to ECMO weaning, and getting that off is huge progress. His hemodynamics are stabilizing. You said they were erratic but seems to be stabilizing now. That’s exactly what we want to see. He’s tolerating increased nutrition, protein intake, this is critical for healing and recovery. His body needs these building blocks to repair damaged tissue. The transition through different ECMO configurations shows the team is actively working towards weaning, not just maintaining him on full support.

What about elevated liver enzymes and low albumin? The slightly elevated liver enzymes and low albumin at 2.1 tells me a few things. The liver enzymes can be elevated from the congestion that happens with heart failure and fluid overload. Now that they’ve removed the fluid, these should start to improve. The low albumin is concerning because it reflects malnutrition and critical illness, but also because low albumin makes fluid management more difficult. The good news is they’re increasing his protein intake, which over time will help rebuild his albumin levels.

Can he be weaned off ECMO? The realistic timeline. Here’s what you need to hear, Betty. Yes, your father can potentially be weaned off ECMO, but this is going to take more time. We’re not talking days here, we’re talking potentially weeks of careful, gradual weaning. His fluctuating blood pressure, the increasing oxygen requirements, the transfusion related lung injury complications and the low hemoglobin all make this process slower and more complex, but slower doesn’t mean impossible.

What the ICU team needs to do is take baby steps each day. Each day they’ll try to reduce the ECMO support slightly and watch how his heart and lungs are responding. Some days they’ll be able to dial it down, other days they might need to dial it back up a bit. This is completely normal in complex ECMO cases.

Now, Betty, here’s something absolutely crucial that I need you to understand. Everything I’ve told you so far is based on the summary you have provided, which is an excellent summary, by the way, but to truly assess your father’s situation and give you the most accurate guidance, I need access to all of his medical records. This includes his daily progress notes, his lab results, his chest x-rays, his echocardiograms, his ECMO flow sheets, his ventilator settings, his medication lists, and his nursing notes. These records contain the detailed story of what’s happening day by day, hour by hour. Without seeing the complete picture, I can give you general guidance, but I can’t tell you with certainty what specific interventions might help your father or what questions you should be asking his ICU team.

This is where a consulting call with myself or one of my team members at intensivecarehotline.com becomes invaluable. Here’s what we can do for you. We’ll review every single page of your father’s medical records in detail. We’ll look at trends, patterns, and opportunities that might not be immediately obvious. We’ll prepare you with specific, targeted questions to ask your father’s ICU team, not generic questions, but questions specific to his case, his complications, and his treatment plan. We’ll help you understand what the medical team is thinking and why they’re making certain decisions. Sometimes families and doctors aren’t speaking the same language, and we can bridge that gap.

Most importantly, we can advocate for your father. We can question treatment decisions respectfully but firmly. We can suggest alternative approaches or therapies that might not have been considered. We can help ensure that nothing is being missed. When we consult with the ICU team directly or help you prepare for family meetings, we bring decades of intensive care experience to the table. We know what questions to ask, what answers to expect, and what red flags to watch for.

What questions should you be asking right now? Betty, based on what you’ve told me, here are some questions you should be asking your father’s ICU team. What is the specific plan for ECMO weaning over the next few weeks? What are the milestones they are looking for? What is his ejection fraction? How is his heart functioning looking on echocardiography, also known as ultrasound? An ejection fraction refers to the contractility or the pump function of the heart, which can be restored whilst patients are on ECMO in some cases.

Have they considered any cardiac medications that might help stabilize his blood pressure during weaning? What is the plan for addressing the 3 remaining blocked arteries? Will he need bypass surgery once he’s off ECMO? What specific markers are they using to decide when to transfuse blood, given the transfusion-related lung injury risk? Are they using any strategies to reduce the risk of the transfusion-related lung injury, such as washed red blood cells or specific blood products? What is the target hemoglobin level they’re comfortable with given his cardiac issues and his ventilation status? How are they managing his lung recruitment? Are they using prone positioning, specific ventilator strategies, et cetera? What is the infection status right now? Are the cultures clear?

But Betty, these are just starting questions. With access to his complete medical records, I can give you a much more targeted list specific to his exact situation.

The supplementation protocol, is it enough? I noticed the treatment plan includes vitamin C, melatonin, thiamine, glutathione, NAC, vitamin D, zinc, magnesium. This is actually quite comprehensive and shows the team is thinking about supportive care. However, dosing matters enormously. Is he getting high dose intravenous vitamin C? What dose of NAC? These details make a real difference in outcomes. This is another area where reviewing the complete medical records would allow us to assess whether the supplementation protocol is optimal or if adjustments should be suggested.

What about the muscle degradation? The muscle degradation you’re seeing after 30 days in ICU is expected but concerning. This is called ICU acquired weakness, and it’s one of the biggest obstacles and challenges to recovery. The fact that they’re increasing his protein intake is good, but we also need to think about early mobilization strategy. Even on ECMO, there are ways to start gentle physical therapy. Has the ICU team mentioned anything about physical therapy or early mobilization? This is something we can help advocate for, ensuring he gets the rehabilitation support he needs, even while he’s still critically ill.

Let’s look at the reality about COVID recovery plus the heart attack. Betty, I need to be upfront with you, your father is fighting two massive battles simultaneously, severe COVID with viral pneumonia and a significant heart attack with additional blocked arteries. Either one of these alone would be a major ICU challenge. Together they create a situation where recovery is going to be measured in weeks and months, not days and weeks. The good news is that people do recover from this. I’ve seen patients come back from similar situations, but it requires time, patience, excellent medical management, and often strong family advocacy.

This is why family advocacy matters so much. Here’s something most families don’t realize. ICU teams are managing multiple critically ill patients simultaneously. They’re doing their absolute best, but sometimes small details get missed, sometimes alternative treatments aren’t considered, sometimes there’s a better way to approach a problem. This isn’t about the ICU team being bad at their jobs. They’re not most of the time. It’s about the complexity of critical care and the reality that having an extra set of experienced eyes reviewing the case can and will make a real difference.

When you have someone like myself or my team at intensivecarehotline.com reviewing the records, talking to doctors and nurses directly in ICU and helping you ask the right questions, you become a much more effective advocate for your father. We help you speak the medical ICU language. We help you understand what’s really happening. We help you push back when something doesn’t seem right, and we help you support the team when they’re making good decisions.

Here’s what I recommend, Betty, you do right away. First, request complete copies of all of your father’s medical records from the ICU. You have the legal right to get these medical records, and most hospitals can provide them within a few days, sometimes within a few hours. In this day and age, 2025, they should just give you a username and a password to a website or to an app, and you should have access to all medical records.

Next, get on a consulting call with me or one of my team members 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 contact information. You can also book a call with me on the website at intensivecarehotline.com.

Start keeping a daily journal of what the doctors are telling you. Write down the names of who you speak with, what they’re saying, what the plan is. This will help you track progress and identify patterns. Don’t be afraid to ask questions. The ICU team should be communicating with you regularly. If you’re not getting daily updates, ask for them.

You want to know, can your father survive this? This is the question you’re really asking, isn’t it, Betty? The straightforward answer is his situation is very serious, but there are pathways to recovery. 30 days on ventilator, 2 weeks on ECMO, the heart attack, the sepsis, the transfusion related lung injury, all of these are significant complications. His body has been through tremendous stress, but he’s also still fighting. His hemodynamics are stabilizing, fluid is coming off, he’s tolerating nutrition. The team is attempting weaning strategies. These are not the signs of someone who’s given up. These are signs of someone whose body is trying to heal, given enough time and support.

What he needs now is time, optimal medical management, good nursing care, and strong family advocacy to ensure he’s getting every possible chance at recovery. I’ve worked with hundreds if not thousands of families of critically ill patients and their families in intensive care here at intensivecarehotline.com in very similar situations to yours. Families who felt lost, confused, scared and unsure whether their loved one could survive. What they all had in common is they needed someone who would look at the complete picture, make sense of the medical complexity, and help them navigate the ICU system effectively.

Many of these families have seen their loved ones survive situations that seemed impossibly difficult. Others have gained clarity about their loved one’s condition and have been able to make informed decisions about their care. All of them have told me that having expert guidance, having someone in their corner who truly understands intensive care, made an enormous difference during the most difficult and vulnerable time of their life.

I know that reaching out for private consulting might seem like an additional expense during an already financially stressful time, but here’s how you want to think about it. What is the value of having expert eyes on your father’s case, independent expert eyes? What is it worth to ask the right questions that might lead to a treatment change that saves his life? What is the peace of mind worth knowing that you’ve done absolutely everything possible? Families often tell me that our consulting services were the most valuable investment they made during their loved one’s ICU stay, not because we perform miracles, but because we help them become more effective advocates and navigate an incredibly complex system.

Your father is fighting, now fight for him. Betty, your father has survived 30 days of critical illness. He’s survived COVID, a heart attack, viral pneumonia, sepsis, and a few weeks on ECMO. He’s definitely a fighter. Now he needs you to fight for him. He needs you to be his voice, his advocate, his champion in ICU. You can do this on your own or you can do it with experience, guidance and support. Either way, do not give up. Keep asking questions, keep pushing for answers, keep making sure the ICU team knows that your father’s life matters, that he’s not just another patient, another number, but someone’s beloved father who deserves every chance at recovery.

Don’t wait another day to get the help that you need at intensivecarehotline.com. Either call us on one of the numbers on the top of our website or send us an email to [email protected] with a brief overview of your family member’s situation. It is too important to leave to chance.

Thank you for watching. I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy because of our insights. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast section where we have done client interviews because our advice is absolutely life changing.

The biggest challenge for families in intensive care is simply 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. That’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always. That’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

That’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I hand-hold you through this once-in-a-lifetime situation that you simply cannot afford to get wrong. When I talk to families directly, I also talk to doctors and nurses directly, asking 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 in case 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, and 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’ve personally written and recorded. All of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment, always.

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.

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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.