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Quick Tip for Families in Intensive Care: My Mom had Cardiac Arrest and Pulmonary Embolism in ICU and Now She’s on ECMO (Extracorporeal Membrane Oxygenation), What Should I Expect?

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 mom had a spleen infarct that they didn’t seem to pay too much attention to. She was hallucinating a little bit and had to be put on CPAP (Continuous positive airway pressure). It was only discovered throughout the time in the hospital she had sleep apnea and diabetes due to the steroids they have been giving her.

While on the CPAP, when I last saw her, she was doing okay. Before putting her on the CPAP. She had very low blood pressure, lowest being 75/45. They were able to stabilize it in rehab. So, that’s when I left her thinking she would be ok.

Her boyfriend stayed with her and one minute she was telling him she was okay. To the next minute, a monitor beeping and her being completely unresponsive, not waking up. I rushed her down to the ICU and discovered she had a massive blood clot and infarct in her lungs which she needed to be put on ECMO (Extracorporeal membrane oxygenation) for.

I do have hope she will pull it through because she’s pulled through once before. I am at a loss of words because all day today, me and my family told nurses there was something wrong. I’m constantly praying, hoping she will pull through again. My mom has to make it. What should I expect?

From, Ashley.”

Thank you, Ashley for sending this detailed email.

If your mom is on ECMO, she would be in the highest category of sick patients in the ICU. On a scale from 0 to 10, meaning zero, low acuity in intensive care to 10, meaning the highest acuity in intensive care, she would be on the top, highest acuity.

Now, after pulmonary embolism going on ECMO means that the ECMO is supporting the heart, she had an infarct, a cardiac arrest and now, the heart needs time to recover. The ECMO will enable your mom’s heart to recover. The ECMO will take over the function of the heart for a period of time and she will be supported with inotropes, vasopressors such as noradrenaline, norepinephrine, vasopressin, potentially dobutamine, dopamine, maybe milrinone, maybe Levosimendan, and hopefully that’ll give the heart time to recover.

Now, other organs may fail throughout the treatment as well because her blood pressure will have plummeted as you’ve already indicated in your email that it was 75/45 before she even had the arrest, and that means there’s a risk that there’s some form of a lack of kidney perfusion.

With lack of kidney perfusion, she might go into kidney failure. She might also go into liver failure. Her lungs would have failed by now because she’s on a ventilator with a breathing tube. She would be in an induced coma. She would be under cardiology. The next few days will need to show that the heart can slowly but surely recover.

If the heart can recover, then they can slowly but surely wean off the ECMO step-by-step. They will need to do some weaning studies. They will need to do some ECGs (Electrocardiography), measure cardiac output, cardiac index, do an ultrasound of the heart (Echocardiogram), potentially a to a transesophageal echocardiogram of the heart. That’s the test that you should be expecting.

If God forbid, she goes into kidney failure, she might need hemodialysis or hemofiltration to make sure the function of the kidneys can keep going while she’s very critically ill.

Let’s just say she can’t be weaned off the ventilator and she can’t be weaned off the ECMO, which often goes hand in hand. Then, the question inevitably needs to be asked, can she go on a heart transplant list? The question is, how old is your mom? Depends on that. The question is, are other organs intact is the brain intact.

Now, we haven’t talked about brain injuries yet. As part of the cardiac arrest, did she potentially have a hypoxic or an anoxic brain injury? If she does go on a heart transplant at least, assuming she can’t get a heart quickly, she then would need to go on LVAD (Left Ventricular Assist Device) or RVAD (Right Ventricular Assist Device) depending on whether she’s in right heart failure or left heart failure. Then, she could potentially go home on an RVAD or an LVAD, which takes again, takes over the function of the heart for a period of time while she’s waiting for a heart transplant. That is what you should be expecting.

Keep in close contact with the intensive care teams. Keep in close contact with the cardiologist. Get access to the medical records and get that second opinion that you can get here at intensivecarehotline.com. We do review medical records, we talk to doctors and nurses directly and we 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 would also keep a very close eye on blood results, arterial blood gases, and general pathology. That’ll paint the full picture.

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

I can confidently say we have saved many lives here at intensivecarehotline.com. You can verify that through our testimonial section on intensivecarehotline.com. You can verify that on our intensivecarehotline.com podcast where we’ve done client interviews.

That’s why we created a membership for families of critically ill patients in intensive care. You can become a member, like hundreds of patients and their families have become members over the years. 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 have personally written and recorded and that will help you to make informed decisions, have peace of mind, control, power, and influence, making sure 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 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 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.

Now, 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, I also represent you in family meetings with intensive care teams.

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

I also do a weekly YouTube live  where I answer your questions live on the show. You will get notification for the YouTube live if you are a subscriber to my YouTube channel, or if you are a subscriber to my intensivecarehotline.com email newsletter at intensivecarehotline.com.

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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