Podcast with Dr Monica Williams- Murphy(www.oktodie.com) & "YOUR QUESTIONS ANSWERED" episode

Published: Mon, 10/13/14

Hi, it's Patrik Hutzel from INTENSIVECAREHOTLINE.COM , where we INSTANTLY improve the lives of Families of critically ill Patients in Intensive Care, so that you can have PEACE OF MIND, real power, real control and so that you can influence decision making FAST, even if you're not a doctor or a nurse in Intensive Care!

In last week's BLOG I've asked the question "WHAT WOULD YOU DO if you knew that you COULD NOT FAIL, whilst your loved one is critically ill in Intensive Care?"

You can check out last week's BLOG by clicking on the link here!

In this week's PODCAST I interview a very special guest, Dr Monica Williams- Murphy.

Podcast with Dr Monica Williams- Murphy from OKTODIE.COM

Dr Williams- Murphy is an Emergency room physician and also the co- author of the book "It's OK to die"

Dr Williams- Murphy also has her own website OKTODIE.COM where she's regularly blogging about her experiences about death and dying in a hospital.

Dr Williams- Murphy is a strong advocate for Patients and their Families during the end of life process and she also strongly advocates for her medical colleagues to improve their communication skills when faced with end of life challenges in a hospital!

Listen to the interview here!

http://intensivecarehotline.com/podcast-with-dr-monica-williams-murphy-from-oktodie-com/

In today's INTENSIVECAREHOTLINE.COM PODCAST Patrik and Dr Williams- Murphy talk about

how a moral crisis in her clinical work got Dr Williams- Murphy to start publishing her own blog about end of life WWW.OKTODIE.COM

Dr Williams- Murphy is sharing the story of her "awakening" Patients who turned her grief and challenges into her passion

Why hearing some ribs crack during CPR(Cardio-pulmonary resuscitation) changed Dr Williams- Murphy's outlook completely

Dr Williams- Murphy wants to elevate people's thinking about death and dying

Dr Williams- Murphy gives an example where stage 4 lung cancer of a Patient still didn't lead the primary physician to talk straight with the Patient and their Family about their wishes towards the end of life

Patrik and Dr Williams- Murphy discuss who has to have the conversation about end of life with Patients and their Families

Patrik and Dr Williams- Murphy shed some light on why many clinicians still "suck" at communicating during the end of life phase and what needs to be done about it

Dr Williams- Murphy talks about why it's so important to identify where people are in the "MAP OF LIFE" at the end of their life and how it needs to be integrated in the communication process!

Why the way an end of life message is being delivered is so important

How to bring down the walls of denial during an end of life situation!

Dr Williams- Murphy uses a humorous way if her medical colleagues don't want to talk about death and dying and she reminds them that they need to become an accountant instead

We try and give people a good life and we also need to give people a good death!

Patrik and Dr Williams- Murphy talk about a "good" and "bad" death and how they both apply to a clinical setting

There is an emotional window of opportunity when talking about death and dying and we need to see the window and talk about it compassionately

Why some doctors only see the human body and the organs and not the holistic and whole human being

Patrik shares an experience from Intensive Care where a doctor was in denial that death occurred

Why it's so important to feel a sense of control at the end of life and how to get it!

Why many health professionals(doctors and nurses) in Intensive Care and the Emergency room burn out and how to effectively manage it

Why facing your own mortality is critical and the first step to feel at ease talking about death and dying!

Patrik and Dr Williams identify that in first world countries like the USA and Australia 75-90% of people want to die at home, yet less than 20% actually do

There is a failure in the system and in palliative care in particular where dying is getting more and more institutionalized!

Why we need to move from a "high-tech" to a "high- touch " medicine in order to solve the crisis in end of life situations

Why fear, grief and loss in end of life situations, especially when families are distant makes things worse

How the news about the moment of death is delivered is important as news are going to be carried over even for generations

Patrik and Dr Williams- Murphy feel like they are "walking arm in arm" to bring transparency, advocacy and support for Families and Patients in high acuity areas such as Emergency department and Intensive Care!

Listen to the interview here!

http://intensivecarehotline.com/podcast-with-dr-monica-williams-murphy-from-oktodie-com/

Also, check out our "YOUR QUESTIONS ANSWERED" section

where I answer all of YOUR questions

http://intensivecarehotline.com/category/questions/

This is another episode of YOUR QUESTIONS ANSWERED and in last week's episode I answered another question from one of our readers and the question last week was

"My 80 year old father is in Intensive Care with Myeloma! The Intensive Care team HAS ASKED ME TO SIGN A DNR AND I REFUSED! What are MY OPTIONS?"

You can check out last week's question here.

In this week's episode of "YOUR QUESTIONS ANSWERED" I want to answer another question that we get asked quite frequently and the question this week is

HOW LONG can a critically ill Patient stay on ECMO?

Now if your loved one is critically ill in Intensive Care and requires ECMO(Extracorporeal membrane oxygenation) for either heart failure(heart attack, Cardiomyopathy, cardiac arrest, cardiogenic shock or as a bridge to LVAD and/or heart transplant) or lung failure(ARDS, Cystic fibrosis and as a bridge to lung transplant) you might be wondering how long your critically ill loved one can stay on the ECMO machine.

It's a fair, reasonable and very important question to ask and many of our readers want to know about it.

First of all, your critically ill loved one has either heart failure or lung failure and therefore requires the ECMO therapy.

ECMO for heart failure is also being referred to as VA-(Veno- Arterial) ECMO and ECMO for lung failure is being referred to as VV(Veno- venous) ECMO.

The difference is simply that the big cannulas being used for ECMO are either going from the vein to the artery in ECMO for heart failure and in ECMO for lung failure, the big cannulas for blood extraction and blood return are from vein to vein.

ECMO is a relatively new therapy in Intensive Care

In any case, you and your family need to keep in mind at all times that ECMO is a relatively new therapy in the bigger scheme of things and has only been around for the last 10- 15 years.

It's therefore a relatively new therapy.

Therefore you could expect that there is still a lot of testing and "trial and error" going on, given that it's such a new therapy in the Intensive Care/ Critical Care world.

If your critically ill loved one is on ECMO for either heart failure or lung failure, the purpose for both ECMO variations is generally speaking to give the sick organ(heart or lung) a rest and let them recover.

In either, VA- ECMO(for heart failure) or VV- ECMO(for lung failure) the purpose of either is to let the heart or the lungs rest and let the ECMO machine take over the function of either the heart or the lung.

That's being achieved by having the gas exchange taking place in the ECMO machine. Oxygen(O2) is being delivered into the blood via the ECMO machine and carbon dioxide(CO2) is being removed via the ECMO machine.

In either VA- ECMO for heart failure or VV- ECMO for lung failure your critically ill loved one is most likely being ventilated and in an induced coma.

Sometimes being awake on ECMO is a rare option

There is the option, especially for critically ill Patients in heart failure and therefore on VA- ECMO to be breathing spontaneously and without the ventilator, therefore being awake and not in an induced coma.

This can be the preferred option, especially given that ventilation and induced coma come with massive side effects and high risks.

However being awake and on ECMO can also be challenging, as Patients are awake and fully aware of their often difficult situation.

This can have other psychological challenges as Patients may get depressed and/or panicky about their critical situation.

Withdrawal of treatment can be morally and ethically challenging in ECMO Patients

It could get particularly challenging(morally, ethically and clinically) if treatment would be withdrawn on an awake Patient.

If your critically ill loved one requires ECMO for lung failure(VV- ECMO) it is less likely that your critically ill loved one is being awake and off the ventilator. Whilst this may be possible in some critically ill Patients, it is less likely to occur on VV- ECMO for lung failure.

It's also more likely that f if your critically ill loved one requires VV- ECMO for lung failure that they may end up with or already have a Tracheostomy.

Tracheostomy may be an option

A Tracheostomy may be required if a prolonged weaning off the ventilator is expected. In a critically ill Patient on VV- ECMO for lung failure a prolonged weaning off the ventilator after ECMO has been discontinued is often likely and therefore a Tracheostomy necessary.

In any case, a Tracheostomy is often the better option for your critically ill loved one if prolonged ventilation is required, as the ventilation therapy can be easier tolerated with a Tracheostomy.

Having said that if a Tracheostomy is required for either VV-ECMO(for lung failure) or VA- ECMO(for heart failure) the procedure for a Tracheostomy might get delayed as both variations of ECMO require high doses of Heparin(a blood thinning medication) and therefore increase the risk for severe bleeding if a Tracheostomy was to be performed.

Finally, in either VV-ECMO(for lung failure) or VA- ECMO(for heart failure) the length of time a critically ill Patient can stay on ECMO depends on the severity of the heart or lung failure and can also depend on other factors such as age, pre- medical history or the co-morbidities your critically ill loved one may have.

2-3 weeks on ECMO is generally speaking the maximum time

[strong style="font-weight: bold;"] As a rule of thumb, 2-3 weeks is probably the longest I have seen for a critically ill Patient to be on either VV-ECMO(for lung failure) or VA- ECMO(for heart failure).

The risks being on either VV-ECMO(for lung failure) or VA- ECMO(for heart failure) tend to be pretty significant, with large cannulas being inserted into the body and other risks such as ventilation, sedation, induced coma, inotropes, immobilisation, anticoagulation therapy(i.e. Heparin for blood thinning) often put a strict time limit on the high- risk therapy.

If two to three weeks don't give the heart or the lungs enough time to recover from their initial disease or weakness, in heart failure, an insertion of an LVAD would be the logical next step or a heart transplant.

If your critically ill loved one suffers from lung failure and requires prolonged and high risk VV- ECMO therapy and can't be weaned off the machine, a lung transplant might be the next possible step.

Again, in either VV-ECMO(for lung failure) or VA- ECMO(for heart failure) your critically ill loved one would have to undergo a weaning process so that either the heart or the lung can recover and take over their normal or physiological function and then the ECMO can be gradually weaned and then removed.

In VV-ECMO(for lung failure) the weaning process would go hand in hand with chest x-rays and with checking of arterial blood gases to check and monitor the adequacy of the gas exchange in the lungs.

In VA- ECMO(for heart failure) the weaning process goes hand in hand with more formal weaning studies such as an Echoecardiography of the heart and/or TOE.

A reduction of Inotropes(medication for low blood pressure management) would be necessary as well.

You should also be having some strategies in place if the Intensive Care team suggests to withdraw treatment and to withdraw the ECMO therapy on your critically ill loved one, as you need to be prepared for any challenges in Intensive Care.

Sometimes the Intensive Care team suggests the [strong style="font-weight: bold;"]withdrawal of treatment or the withdrawal of life support as being [strong style="font-weight: bold;"]"in the best interest" of your critically ill loved one.

The reality and the fact of the matter is that if you are not prepared for those situations you will have no PEACE OF MIND, no control, no power and no influence.

If you don't understand what's happening in Intensive Care "BEHIND THE SCENES" and if you don't understand how the Intensive Care team is making decisions that often go way beyond your critically ill loved one's diagnosis and prognosis, you will have a hard time to have PEACE OF MIND, control, power and influence!

Related articles:

The 5 questions you need to ask when the Intensive Care team is talking about "Futility of treatment", "Withdrawal of life support" or about "Withdrawal of treatment"!

Why decision making in Intensive Care GOES WAY BEYOND your critically ill loved one's DIAGNOSIS AND PROGNOSIS!

You should in any case continue doing your own research whilst your loved one is critically ill in Intensive Care.

You should also not take anything the Intensive Care team is telling you for "FACE VALUE"!

You should continue to look for strategies how you can proactively manage the Intensive Care team that when it comes to difficult and challenging situations that you have bargaining power, PEACE OF MIND, control, power and influence!

Sincerely,

YOUR FRIEND

Patrik Hutzel

If you want your questions answered just hit reply to this email or email me at support@intensivecarehotline.com and I'll answer your questions!

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FREE Video Mini- Course out now!

If you are interested in more FREE education and information if your loved one is critically ill in Intensive Care, I have created a FREE mini- course

A BLUEPRINT for PEACE OF MIND, CONTROL, POWER& INFLUENCE whilst your loved one is critically ill in Intensive Care!

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Also, our cutting edge new information PRODUCT will be released soon! We are NOW finalizing our first cutting edge information PRODUCT that will help Families of critically ill Patients MASTER, take control, have power and influence in all of the most challenging situations in Intensive Care, even if their loved one is dying!

The information product will be an "IN-DEPTH" education product for Families of critically ill Patients in Intensive Care and a SHORTCUT for Families to have PEACE OF MIND, control, power& influence! The focus of the education product will be on PEACE OF MIND, control, power and influence during the following situations in Intensive Care

long-term stays in Intensive Care
end- of- life situations
Family meetings with the Intensive Care team
withdrawal of treatment situations and/or perceived medical futility
what to do if your critically ill loved one is THREATENED with an "NFR"(Not for resuscitation) or "DNR"(Do not resuscitate) order
severe head and brain injuries

The information product will be made available in Ebook, Video and Audio format so that our Customers can consume the information product in their chosen medium!

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If you have any questions about our upcoming products or if you have any suggestions

please let me know at support@intensivecarehotline.com

Your Friend

Patrik Hutzel

Critical Care Nurse

Founder& Editor