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Quick Tip for Families in Intensive Care: 16-Year-Old in Coma with Hypoxic Brain Injury After Cardiac Arrest: What are the Chances of Recovery?

“My 16-year-old son is in a coma with hypoxic brain injury after cardiac arrest. What are his chances of recovery?”

My name is Patrik Hutzel from intensivecarehotline.com, where we help families of critically ill patients in intensive care and this is another quick tip for families in intensive care.

Today, I have an email from a reader who says,

“Hi Patrik,

My son is 16 years with hypoxic brain injury and coma of 15 days. The hypoxic brain injury is due to a cardiac arrest in a suspected GBS, and GBS stands for Guillain- Barré Syndrome. There’s no improvement with IV immunoglobulin from Day 1. Now, he’s on a ventilator with a tracheostomy and he’s dependent on that. He’s got bilateral pupil light reflex and the pupil size is a 3. What will his recovery be like?”

First of all, I do want to say, I’m really sorry to hear what you and your family are going through. When a young person like your son ends up in ICU with such a severe condition, it’s heartbreaking and it’s critical to understand all your options and what to expect moving forward. So, let’s break this down.

Number one, hypoxic brain injury after cardiac arrest. Hypoxic brain injury means there was a period where the brain didn’t get enough oxygen, usually due to the heart stopping which is what happened here. The brain is very sensitive to oxygen deprivation and even a few minutes without oxygen can cause injury, however the extent of the injury can vary a lot. Some patients make significant recoveries over time, especially young people, while others may have long-term effects. The fact that your son is only 16 gives him a major advantage. Young brains have far more plasticity and potential to recover than older brains.

Next, let’s look at Guillain- Barré syndrome (GBS) and cardiac arrest. You mentioned suspected Guillain-Barre syndrome. While Guillain-Barre syndrome, also known as GBS, can cause muscle paralysis, it very rarely causes cardiac arrest. So, if the GBS was causing paralysis of the diaphragm and breathing muscles, this could lead to a respiratory arrest and eventually cause the heart to stop due to lack of oxygen and cause a cardiac arrest. Either way, GBS is a serious illness and condition that can recover slowly over time even over months, but not always immediately after IV immunoglobulin therapy.

So do not give up hope just because there’s been no change in 15 days. I’ve seen Guillain-Barré syndrome in ICU for up to 12 months. We’ve also looked after Guillain-Barre Syndrome at home with Intensive Care at Home type services.

Number 3, no improvement with IV immunoglobulin so far. IV immunoglobulin is a standard treatment for Guillain-Barré Syndrome. It can take time to see effects. Lack of improvement doesn’t mean it’s not working, it could mean the disease is very aggressive or that time is needed to reverse the damage. A repeat course of IV immunoglobulins or plasmapheresis might also be considered.

Number 4, ventilator and tracheostomy dependency. If he’s already had a tracheostomy, that’s actually a good sign. It means they’re planning for long-term support, which is appropriate in this case. With tracheostomy and ventilator support, it’s easier to manage comfort sedation, and gradual weaning of the ventilator, even when he starts to breathe on his own again.

Next, pupil light reflex with the pupil size of 3+, that’s also very encouraging. If his pupils are equal and reacting to light at the 3+ level, that typically suggests that brain stem function is intact. That’s very important and a positive prognostic indicator in coma after cardiac arrest.

So, what’s the outlook? It’s too early to make any definitive prognosis after just 15 days. In our experience here at intensivecarehotline.com, we’ve seen many patients, especially young ones, wake up or start showing signs of recovery after weeks or even months in ICU. The most important thing right now is keep him stable, avoid infections or other setbacks. Start passive physiotherapy and stimulation. Get regular EEGs (electroencephalogram) or brain scans if possible. Ensure he’s not being over-sedated. As a matter of fact, he should be off sedation completely now that he’s got the tracheostomy.

Also, from a psychological point of view, stay positive. I know that’s easier said than done, but you and your family staying positive is very important. ICU teams often give up too early. If you’re being told something like, “There’s no hope,” I urge you to not accept that at face value. ICU teams often underestimate what’s possible, especially with younger patients.

We’ve worked with families whose loved ones woke up after 30, 60, 90 days, sometimes many months in a coma, especially when they’re given time, proper care and ongoing stimulation. So, don’t let them pressure you into withdrawal of treatment or end of life decisions too early. I wouldn’t entertain a discussion around it even. It is not up to them, and it is your choice and your choice only how much time you want to give your son, because that’s what he needs. He needs time and a fighting chance.

So, if you want to discuss your son’s case in more detail, I offer one on one consulting where I can help you interpret scans, EEGs, care plans, and advocate for best care and treatment for your son. Simply contact us at intensivecarehotline.com and book a call with me.

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 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 handhold 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 if 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 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 eBooks and 21 videos that I have 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.

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

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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.

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