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Quick Tip for Families in Intensive Care:  My Brother had a Cardiac Arrest 7 Days Ago, He’s Ventilated in ICU and Not Waking Up, Is There Hope?

Today, I have an email from Valentine who says her brother has been in an induced coma for 7 days and he’s not waking up. And we’ll look at her email in much detail today.

My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.

Today, I have an email from Valentino who says:

“Hi Patrik,

My brother went to hospital for a routine ankle surgery. He was supposed to come home after 7 days. On day 6, he went into cardiac arrest. It was so unexpected. He’s now day 7. He’s not acting right at all. He did nothing for the 1st 5 days, and when they would lower the sedation to do breathing trials, he wouldn’t breathe without the ventilator. The last couple of days, he started breathing the full 3 hours by himself until he gets worked up and starts breathing with his stomach. When he opens his eyes, they’re looking up and off to the right, and his eyelids blink repeatedly, but he doesn’t follow commands. What’s strange is the EEG (Electroencephalograph) shows a brain that’s symmetric and reactive to stimuli like lights, and the MRI shows no infarct, no hemorrhage, no blood, no blood clot or signs of stroke, or signs of brain damage from lack of oxygen. The EEG does show continuous slowing and encephalopathy. It is day 7, and we were wondering when he’s going to wake up, and if he’s going to be OK. Any advice would be great”.

From Valentine.

I’m very sorry to hear, Valentine, that you and your family are experiencing this massive challenge with your brother. Now, know this, 7 days in ICU after a situation like that is not a long time. I think the first thing that I want to remind you of here is being patient. I know 7 days for you sounds like an eternity, but in the bigger scheme of things, it’s not a long time. I have worked in critical care nursing for 25 years in 3 different countries where I looked after thousands of critically ill patients and their families, so I’ve seen this over and over again, be patient. Be positive and be optimistic. And that is often half of the battle. You need to know that. Approximately 90% of intensive care patients actually survive, so the odds are in your brother’s favor. Be patient, but let’s break it down in more detail. It obviously sounds like this has been a shocking and very distressing turn after what was supposed to be a routine ankle surgery. You’re absolutely doing the right thing by seeking clarity, advice, and by advocating for him. Because that’s what we do here at intensivecarehotline.com. We are the number one consulting and advocacy organization for families in intensive care. Here’s a breakdown of the situation and what might be happening based on what you’ve shared.

Number one. His breathing and response to weaning. Initial ventilator dependency is common after a cardiac arrest due to sedation and neurological impairment. The fact that he can now breathe on his own for several hours is an encouraging sign, even if he tires or becomes distressed. Using his stomach to breathe suggests he’s working hard, likely due to weakness, possible diaphragm dysfunction, or altered brain signaling (i.e., you mentioned the encephalopathy). But also keep in mind, for example, to run a marathon, you need to train. You won’t run a marathon without training. In your brother’s situation, how does that compare? His muscles are weak, his breathing muscles are weak, they need to do some breathing exercises. They need to wake him up, get him off sedation, get him off opiate, sit him up, ideally get him out of bed to strengthen his breathing muscles, because sitting upright will help to strengthen his breathing muscles.

Number 2. Eye movement and responsiveness, eyes deviated up and to the right with repetitive blinking may suggest cortical or subcortical dysfunction, possibly from metabolic or hypoxic encephalopathy. It may suggest seizure activity, because it can present subtly like this, especially if the EEG hasn’t ruled out non conclusive status epilepticus. Ask if this was considered.

Next, persistent unresponsiveness with abnormal eye movement but no clear structural damage is often due to functional rather than structural brain injury, like toxic metabolic encephalopathy.

Number 3. Imaging and EEG findings. MRI showing no infarct or structural damage is a hopeful sign. It means there’s no stroke or visible injury. EEG showing generalized slowing and encephalopathy is concerning but not necessarily permanent. This pattern is typical after a global insult like cardiac arrest, but it can improve with time. Reactivity to light or sound is very promising. Studies show that EEG reactivity is associated with better outcome and these outcomes. And this is what I’m saying, 7 days is not a long time. 70 days might be a long time, or it might not be, depending on whether you see progress or not. Don’t let the impatience from intensive care teams diminish your hope and your goals that you have for your brother.

Number 4. Prognosis and timelines. Day 7 is still considered early in neurological recovery after cardiac arrest. Patients can take several days, 2 weeks, 2 months to regain consciousness, especially if they were sedated or if the brain is still healing. And what you haven’t shared in your email is whether your brother is still on sedatives or opiates. Make sure he’s not on any sedatives. Make sure he’s not on any opiates, such as morphine or fentanyl. And also check out if he is on any anti-seizure medications such as Keppra or phenytoin, also known as Dilantin, because they may also have some sedative effect. And that may also hinder your brother from waking up.

Next, encephalopathy may improve, especially if it’s related to reversible factors like medication effects, sedatives, opiates, electrolyte or metabolic imbalances, infection or inflammation.

What can you do and what can you ask the team?

Number one. Neurologist’s review. Ask if a neurologist has examined him specifically and reviewed the EEG or MRI. Consider requesting another EEG to check for evolution. Non conclusive seizure evaluation. Ask if they ruled this out. It can cause unresponsiveness without full-body convulsions.

Like I said before, sedation clearance. Confirm that all sedative and opiate medications have cleared, and if any could be lingering, like long-acting benzodiazepines or opiates. That also ties in with whether his kidneys or his liver are working, because, for example, if liver or kidneys are impaired, that might delay getting clearance of sedatives and opiates.

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, which is exactly what you’re up against.

Next, Rehabilitation consultation. If he stabilizes medically, early neurorehabilitation can sometimes accelerate recovery. Daily neurological exams. Track for small improvements blinking to threat, eye tracking, following commands, reacting to voice. What’s the bottom line?

 

The bottom line is that the absence of visible brain damage and the reactive EEG are good signs. This unresponsiveness may be due to encephalopathy that takes time to resolve and heal.

And bear in mind, there’s plenty of patients in ICU that do not wake up in 7 days or any artificial timelines that intensive care teams or even families might put on their loved one. Patients will wake up in their own time. You’ve got to give patients time. Don’t put any artificial timelines on them. They’re critically ill, they need time to heal, to recover, and it often doesn’t happen according to timelines that are artificial. And nothing else, give your brother time. If he’s stable, many patients show improvement slowly, sometimes over many days, weeks, and months. Don’t let the team push for withdrawal of treatment based on 7 days alone. It’s not a long time.

You may still be in the window of uncertain but potentially improving diagnosis. Also, ask them what the weaning plan is. Pass some spontaneous breathing trial? What are the weaning plans for him? What’s the plan? Physiotherapy, physical therapy, getting him out of bed.

If he can’t be weaned off the ventilator, he probably needs a tracheostomy.

They’re probably and this is the other thing, intensive care teams are not even telling families half of what’s going on, unless you know what to look for, unless you know what questions to ask. They’re not even telling you half of what’s going on. And we see this over and over and over again.

I have worked in critical care nursing for 25 years in 3 different countries where I worked as a nurse manager for over 5 years. I have 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 for our clients and families in intensive care. And you can verify that on our testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section where we have done plenty of client interviews. Because our advice is absolutely life changing. And like I said, I can very confidently say here, with many testimonies behind me, that we have saved many lives for our clients in intensive care.

If intensive care teams tell you the doom and gloom, and you know “Oh, your loved one won’t survive” and “You shouldn’t survive,” or “She shouldn’t survive,” always keep in mind that there’s hope, that there’s help. And that you should not buy into the doom and gloom.

That’s why you can join a growing number of members and clients that we have helped over the years to improve their lives instantly, making sure they can make informed decisions, have peace of mind, control, power, influence, making sure their loved ones get the best care and treatment always, because that’s what we do here at intensivecarehotline.com all day, every day.

I do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I handhold you through this once-in-a-lifetime situation that you simply cannot afford to get wrong. I also talk to doctors and nurses directly with you, on your behalf. I set you up with the right questions to ask. And when 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.

We also medical record reviews after intensive care. If you have unanswered questions, or if you need closure, or if you’re simply suspecting medical negligence.

We also have a membership for families of critically ill patients, 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. 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 make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always. regardless of what intensive care teams are telling you.

 

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.