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Today's article is about, “My Mother's Been in ICU for 2 Days After Cardiac Arrest, 20 Minute Downtime, ICU Wants to Stop Treatment! Quick Tip for Families in Intensive Care!”

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My Mother’s Been in ICU for 2 Days After Cardiac Arrest, 20 Minute Downtime, ICU Wants to Stop Treatment! Quick Tip for Families in Intensive Care! 

“My mother is in ICU since yesterday morning. My brother was there to give her CPR (cardiopulmonary resuscitation) after cardiac arrest. The ambulance came after 5 minutes, and it took 20 minutes to get a pulse. She has kidney failure and a high potassium. Her vital signs are almost normal now, but she hasn’t woken up yet. They said if she goes into cardiac arrest again while on dialysis, then they will pull the plug.”

That is an email that I have from a reader.

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

So, let’s break this down in detail. I’m really sorry that you’re going through this. You’ve been facing so many incredibly hard situations in a short period of time, and now your mom is in ICU after cardiac arrest, it’s really heartbreaking. Based on what you’ve shared, let’s break down your situation and some thoughts to help you navigate this challenging situation.

So, let’s look at Number 1, cardiac arrest. Your mom lost her pulse and was without circulation for about 20 minutes. It’s a very long time, and it raises concerns about possible anoxic brain injury from lack of oxygen if CPR was not effective. The brain and any other major organs can be without oxygen for about 3 minutes before any major irreversible damage is going to happen.

So, it’s good that CPR and ambulance response was quick and that your brother started CPR. It may have helped preserve some brain function, again, depending on how effective CPR was, but it’s also too soon to tell.

Also, the question that you should be asking is, is she still on sedatives and opiates? Usually sedatives that are being used after cardiac arrest and potentially hypoxic brain injury are Propofol, midazolam/Versed, sometimes Precedex. Opiates usually are Fentanyl and Morphine that can be used.

You also want to find out what her ventilator settings are. Is she still in a controlled ventilation mode such as SIMV (Synchronized Intermittent Mandatory Ventilation), ACV (Assist-Control Ventilation), etc? Or is she already breathing in CPAP (Continuous Positive Airway Pressure) or BIPAP (Bi-level Positive Airway Pressure) or pressure support? Also, what are arterial blood gases? Is there a weaning plan?

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 exactly what you’re up against here.

Also, what do the EEGs (electroencephalogram) show of the brain, MRIs (Magnetic Resonance Imaging) of the brain, CT (Computed Tomography) scans of the brain? Has a neurologist given an opinion and review? With potassium being high and your mom being in kidney failure, what’s the nephrologist saying? What’s the cardiologist saying after the heart attack? Did she have an angiogram or an angioplasty to screen the heart? Did she have a cardiac ultrasound?

With a high potassium, also known as hyperkalemia, kidney failure, these can both contribute to cardiac arrest. Dialysis is typically used to lower potassium and stabilizer, so it’s really important that she’ll be getting a potassium infusion because a lot of potassium will be lost by her running through the dialysis. If they’re saying she has another cardiac arrest potentially when while she’s on dialysis, that could mean they’re not replacing electrolytes, such as potassium.

Now, you’re also saying vitals are “almost normal.” That is promising, it means her heart and blood pressure are stable for now, but not waking up is still concerning. Also, the ICU team says they will withdraw treatment if she codes during dialysis, that is a massive red flag.

You have every right to ask questions about that decision and push back if it doesn’t sit right with you. It is not up to intensive care teams to make life or death decisions without your or your mom’s input. I do not understand why families in intensive care think that end of life is happening or end of life decision making is happening in a vacuum, it is not. You have a say, stop being intimidated by intensive care teams.

End of life decision making happens under laws, guidelines, policies, and procedures. It does not happen just with a one-sided decision-making process, which is basically ICU teams saying who can live and who can die, that is ludicrous.

So, what questions should you ask the ICU team now?

Number 1, neurological condition. Has she had a brain scan, CT or MRI or an EEG? Are they doing neurological assessments such as pupil response, motor response? What is her current Glasgow Coma Scale ?

Next, kidney support. Are they doing continuous dialysis, CRRT (Continuous Renal Replacement Therapy), or planning regular hemodialysis? What are the risks of dialysis in her current condition and how are they preparing to manage them?

Next, her DNR and code status. Who made the decision about “pulling the plug” if she arrests during the dialysis? Is she currently listed as full code, DNR (do not resuscitate) or DNI (do not intubate)? Did the family consent to this? If not, ask the ICU team to stop and explain all options before making any assumptions. It is illegal for them to say that treatment is being stopped if she ends up with a cardiac arrest while she’s on dialysis. That is illegal.

 Intensive care teams are very good at pretending they can do whatever they want until you challenge them, and you haven’t challenged them yet. We’ve never had an issue in turning situations like that around when families are following our guidance.

Also, what’s the hurry to talk about end of life? What’s the hurry to kill your mom? There is plenty of time to talk about end of life if things are not working. Make decisions today that you do not regret in 12 months’ time. It sounds like you’re already doing that, you don’t want your mom to die.

Next, prognosis and monitoring. How long are they willing to observe her for signs of neurological recovery and improvement? Are they doing EEG (electroencephalograph) or other tests to check for seizure activity or brain function?

Next, what are your rights? You and your family have the right to ask for a second opinion, especially from a neurologist and nephrologist. Get access to the medical records as quickly as possible. We also look at medical records and give you a second opinion as well. Refuse withdrawal of treatment unless you’re fully informed and in agreement, and you’re not. Request a family meeting with all key specialists, ICU doctor, nephrologist, neurologist, cardiologist, case manager, etc.

Get access to all medical records and ask them for the end of life decision making policy in their ICU. If you feel pressured to agree to end treatment, document who said what and when, and ask for things in writing when possible. Take names and potentially report people to the police.

So, what can you do right now?

Well, gather your family and decide what your mom would want. Has she ever said anything about life support, dialysis, or resuscitation? Ask for updates every few hours, don’t wait for them to come to you. Get access to all medical records. Make it clear that you are not ready to withdraw treatment unless there’s overwhelming and clear medical evidence and agreement within your family to do so.

It is very simple to stop ICU teams from doing that. We’ve done it many times. We know what to do. We are professional consultants and advocates for families in intensive care.

I have worked in critical care nursing for 25 years in three different countries, and I can very confidently say that we have saved many lives for our clients in intensive care. You can verify in our intensivecarehotline.com testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section where we have done client interviews, plenty of them.

Because our advice is absolutely life changing, that’s why we have saved so many lives and have helped so many families in intensive care all around the world to improve their lives instantly, making sure they make informed decisions, have peace of mind, control, power, and influence so that they love ones get best care and treatment always.

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 can’t afford to get wrong. When I talk to you and your families directly, I also offer to talk to doctors and nurses directly. When I talk to doctors and nurses directly with you or on your behalf, I set you up with the right questions to ask. 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.

We also have a membership for families of critically ill patients in intensive care. 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 videos and 21 e-books that only are exclusively accessible to our members. 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.

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 support@intensivecarehotline.com 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.

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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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