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Quick Tip for Families in Intensive Care: My Dad’s in ICU for 14 Days on Double ECMO (Extracorporeal Membrane Oxygenation) with Heart, Lung, and Kidney Failure, Can He Survive?

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

Today, I have an email from Ashley who says,

“Hi Patrik,

My father is in ICU due to flu pneumonia. They had to ventilate him and put him on ECMO. He has had days of progression and days of setbacks.

We went in last Wednesday and we were approached by the nurse who said he had an excellent day. He’s on 50% on the ventilator and the cardiologist wants to change out the double ECMO to a single ECMO in his neck and asked me to sign a consent. Mind you, at this point, he had no signs of lung damage or heart damage.”

Now, let’s just stop here before I carry on with the email for those of you who wonder what is ECMO? ECMO stands for Extracorporeal Membrane Oxygen. It’s basically a bypass machine that can take over the function of the lungs and or the heart for a period of time.

“Now, we move forward Thursday. He tolerated the procedure, and they were trying to wean him off the paralytics, but he was starting to try to breathe over the ventilator. So, they had to put him back on the paralytics. So, they kind of left him at the plateau for Friday into Saturday.”

Now, before I carry on with Ashley’s email, when patients are on ECMO they often need to be paralyzed, which is why she’s talking about paralytics here because if you’re not paralyzing a patient that’s on ECMO, the ECMO machine might not be able to do its work because it’s a very difficult procedure with ECMO. If a patient is moving around ECMO might not work, which is why they have to be paralyzed.

“I called Saturday for an update and the doctor asked to speak to me, I don’t care for this doctor. He has no bedside manner or compassion at all, and he asked for a DNR (Do Not Resuscitate). I told him that my father refused the DNR and asked us not to sign it before he was ventilated.

The doctor proceeded to tell me that my father has no progress at all in the 14 days, but he’s been on the ventilator or ECMO that he was on 100% ventilation and 100% of ECMO for the complete 14 days. I advised him that was incorrect.

Then, I had to come in there Wednesday and they asked me to sign a consent form because he was on 50% on the ventilator. The doctor told me I misunderstood the nurse. I advised the doctor we would not sign a DNR, that his organs were not failing, and he was not brain dead.

Within 12 hours, we got a call that my dad is now in kidney failure. We’ve asked for this doctor to be removed from my dad’s case. We’ve also asked for my dad to be transferred to a more critical hospital that specializes in equine ventilation.

With both requests, we were denied. We reached out to the chief medical officer, and we reached out to the case manager, we reached out to the ICU supervisor, and they all refused to speak to us. They want us to sign a DNR and we’re actually going in this afternoon for a second opinion meeting with the doctor. But after reading your articles and the questions that you answered, I now have a better basis and understanding of what to go off from.

We have looked into legal action because he was perfectly fine Thursday and by Sunday, he had irreversible lung damage and irreversible heart damage. His kidneys are failing and now they believe he is in multiorgan failure and says that he has no sustainable life after coming out of the ICU.

Any advice would be much appreciated.”

Well, thank you, Ashley for detailing your dad’s situation.

Now, if you ask for your dad to be transferred to a more critical hospital that specializes in equine ventilation, I don’t even know what you mean with equine ventilation. I have to admit that. The reality is very few hospitals and very few ICUs can offer ECMO, which means your dad most likely is in the best place right now. Very, very few hospitals can offer ECMO for a prolonged period of time. You’ve mentioned your dad has been on ECMO now for 14 days.

Now, initially, he probably went on the ECMO for lung failure. Then he might have developed some heart failure as well, which is why they were most likely putting him on double ECMO. So, the challenge here is that they need him off the ECMO for heart failure and the ECMO of lung failure.

So, here’s how that works. Let’s just begin with the lungs. He’s on 100% of oxygen on the ECMO and on the ventilator. First off, they need to gradually reduce the support from the ECMO machine. Once they’ve achieved that, then ECMO can be removed for the lungs. Then, once that’s achieved, then ECMO can be weaned off of the heart as well. Could be the other way around. Maybe the heart ECMO needs to be weaned off first. There’s not enough detail in there in terms of why his heart is failing or has failed.

So, what do you need to do? So, once the heart is improving, for example, what needs to happen there is inotropes and vasopressors need to be reduced. He’s on inotropes and vasopressors, I am 100% certain of that. Once they can be removed, then ECMO can hopefully be reduced. The flow can be reduced, and cardiac output studies need to be done.

Also, ultrasound of the heart, (Echocardiogram) needs to be done, ECGs (Electrocardiography) need to be done for the heart. Then hopefully, the heart can regain some of its function, most of its function and the ECMO can be removed. That’s how that works.

Again, the same for the lungs. The flow needs to be reduced, and then you need to check arterial blood gases to make sure that when you reduce and remove ECMO for the lungs, that there’s still adequate oxygenation in the blood and that CO2 (Carbon dioxide) is being removed as well.

Now, you are questioning your dad being in kidney failure. Now, I will say this, if your dad is in heart and in lung failure and they’ve mentioned he’s in multiorgan failure, which is actually accurate. The heart is failing, the lungs are failing, the kidneys are failing. It sounds to me like the brain might be failing, but there’s no evidence for that.

So, it often happens that when there’s cardiac failure, it is often followed by kidney failure. The simple reason for that, if there’s cardiac failure and blood pressure plummets, it needs to be brought up by vasopressors or inotropes that can lead to kidney failure. So, I am actually not surprised hearing that. I’m actually not surprised hearing that.

So, at this particular point in time, as much, as I’m the first one to say, to point out, that hospitals are not doing the right thing, you are very lucky that your dad is in a hospital where they can actually provide ECMO. It’s a very specialized skill.

So, what do I mean by that? When someone is in critical care. they need ICU doctors, ICU nurses, they need specialist staff. Now, when someone is in critical care and they need ECMO, they need even more specialized staff. Very few staff in ICU doctors, nurses can actually look after ECMO. I used to look after ECMO patients in one of the ICUs that I worked in for many years, but it is a unique and special skill. There were only a few staff that could look after ECMO in an ICU.

So, sending him out is not really an option. Also, he would be most likely too unstable to be sent out.

Now, if he does have irreversible lung damage and irreversible heart damage, one of the questions that needs to be asked here, Ashley, is can he have a heart transplant or lung transplant? Can you have both? Also, do not sign a DNR because if you do sign a DNR, chances of him getting a heart transplant or a lung transplant are pretty slim. So, you have done all the right things by not signing a DNR but I do argue he is in the best of all places at the moment.

As much as patients on ECMO can be transferred to other hospitals, it is very risky, and I wouldn’t recommend it. So hopefully, they can wean him off ECMO, even though they are talking about irreversible heart and lung damage.

I would be good if you can get us access to the medical records, so we can help you with the second opinion. So, we can help you with the reviewing the medical records. Otherwise, you might be flying blind here and you might be jumping to too many conclusions. So, I strongly recommend that you give us access to the medical records or that you and I talk to the doctor or to the doctors directly so I can ask all the questions that are really, really detailed when it comes to ECMO.

So, I hope that answers your questions, Ashley, and I hope it all goes well with your dad.

Now, I have worked in critical care for nearly 25 years in three different countries where I work as a nurse unit manager in intensive care for over 5 years. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com.

I can confidently say we have saved many lives with our consulting and advocacy. You can verify that on our testimonial section at intensivecarehotline.com, click on the testimonial section or you can watch our intensivecarehotline.com podcast where we’ve done some client interviews.

That’s also one of the many reasons why we have created the membership for families of critically ill patients in intensive care. You can actually 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 have personally written and recorded sharing all my decades worth of experience of critical care nursing with you so that you can make informed decisions, have peace of mind, control, power, and influence so that you can influence decision making fast so that your loved one gets best care and treatment.

I also do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever meeting works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you can’t afford to get wrong. 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 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 you have unanswered questions, if you need closure, or if you are 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] 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.