Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, 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!

 

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

 

My Brother Is Brain Dead In The ICU. Is It True That If A Patient Is Legally Dead, Then His/Her Preference Of Living Will Does Not Matter?

 

You can check out last week’s question by clicking on the link here.

 

In this episode of “YOUR QUESTIONS ANSWERED” I want to answer questions from one of my clients Karina, as part of my 1:1 consulting and advocacy service!  Karina’s mom had a cardiac arrest at home and the ICU doctors are telling that her mom has brain damage so Karina is asking if her mom can recover?

 

My Mom Had a Cardiac Arrest at Home and the ICU Doctors Are Telling Me She Has Brain Damage. Can She Recover?

 

So here is what Karina says.

 

Hi Patrik, how are you doing? I just discovered your intensivecarehotline.com website and your YouTube videos last Saturday. My mother suffered a cardiac arrest on Wednesday. I was at work. My father and brother found her. My brother and her had just had a conversation with her. He went to the bathroom. My dad was in the kitchen and heard my mother make a loud noise. My dad said he can’t describe the sound my mother made but will never forget it.

 

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They try to wake up my mother in intensive care and she wouldn’t respond. They call 911. They came after several minutes. My mother already had a weak heart. She has been in ICU since Wednesday. They are telling us that since she went minutes without oxygen to her brain, that her brain is damaged and won’t respond. They’ve presented us with doom and gloom as you always say, they want us to, quote unquote, make a decision.

 

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I had my doubts. So I started to do some research today and started watching all of your YouTube videos and read your site at intensivecarehotline.com. I am extremely optimistic after your information. All I want to know is there anything else you can tell me about the brain damage?

 

Thanks for your time.

 

Hi Karina,

 

Thank you so much for taking the time to write in and become a client. I know I can help you with this. And I can help you with this very fast. So you’re asking all you want to know, is there anything else you can tell me about the brain damage?

 

Well, there’s probably lots more I can tell you. And one of the things that I can tell you is, well, it’s not certain that there is brain damage. It really depends how long your mom has been without oxygen to the brain, really depends on how long the cardiac arrest lasted. And, you know, this is often being referred to as quote-unquote, downtime.

 

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So basically, how long had the heart stopped? How quickly was CPR being commenced? And also how effective was it? You know, how quickly was the heart restarted?

 

You know, with doing your own research, you might have found that, you know, the brain can’t be without oxygen for longer than three minutes before irreversible brain damage is being caused. So three minutes is sort of the cut off, if you will.

 

And in any cardiac arrest, it’s hard to say how long the downtime has been, how long the heart has stopped unless you have a first responder, medical emergency team taking the time, and you have somebody hooked up to an ECG monitor, you know, and you’re checking vital signs all the time and you’re checking the heart rhythm if there is one.

 

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So that’s the only time you can really adequately say how long the quote unquote downtime has been. So one way for you to find out is potentially to get the ambulance report and see whether they’ve got any accurate information. But the next step in a situation like that is and you haven’t mentioned any of it, that they will do a CT scan of the brain or an MRI scan of the brain to find out is there any further brain damage.

 

Most of the CT scans and MRI scans within sort of 24 to 48 hours come back negative, which means brain damage can’t be confirmed. That’s from my experience, right? So you got to actually wait until your mom can be brought out of the induced coma. So at the moment, your mom would be in an induced coma in intensive care, she’s ventilated.

 

She’s probably on inotropes or vasopressors. She’s on sedative such as propofol, or midazolam  also known as versed and she would be on morphine or on fentanyl most likely to keep her in the induced coma. She might be in a cooling therapy because many patients after cardiac arrest are going into cooling therapy, the body temperatures usually cool down to sort of 30 to 33 degrees for 24 hours to protect the brain and also protect other vital organs to recover from this dramatic and also traumatic event.

 

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Once your mom is being woken up from the induced coma, you know, then you can assess, you know, slowly if there is any brain damage, but even so, you know, there may be no brain damage, and your mom may look like she has brain damage because simply when people come out of an induced coma, they’re often confused. It takes time for them to wake up.

 

Waking up from an induced coma is more of a process rather than an event. It’s like switching on a light with a light demand. Right and you know, even coming out of an induced coma, maybe after pneumonia after a car accident, whatever you name the situations where people are putting In an induced coma, it still takes time for them to wake up.

 

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And even without brain damage, patients can be confused in the beginning. Or they may wake up very slowly. And you know, people think, oh, there is brain damage and often there isn’t. It just simply is a process and it takes time. So from that perspective, nobody can say at the moment with 100% certainty whether your mom will have sustained brain damage or not, she will need to come out of the induced coma, she will need to be hemodynamically stable meaning she will need to be off the inotropes and vasopressors.

 

You know, you haven’t mentioned anything whether your mom would need cardiac surgery, or whether she has had an angiogram or potentially an angioplasty, maybe she had blocked arteries that led to the cardiac arrest. You haven’t mentioned anything like that.

 

You know, you would hopefully have a cardiologist involve potentially a cardiac surgeon involved for your mom’s situation at the moment. And hopefully you also have a neurologist involved because again, the neurologist is probably the person or the neurology team that should be able to tell you more about whether there is or there isn’t any brain damage and what the next steps are.

 

Coming to what you’re referring to doom and gloom and the negativity, it’s quite standard in ICU, it’s the default position. Any ICU team will always be negative. Why is that? Simply, you know, if the ICU team was telling you, oh, yeah, we’ll get your mom out of ICU. It’ll take three weeks and you know, then to get on with her recovery, and they might be promising too much. And you might be holding them accountable for any promises they’re making.

 

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So to play it safe on there and they will always err on the side of caution. And they will always be negative to protect themselves free from any liability.

 

As simple as that, but other reasons why they are negative and why they are painting, the doom and gloom picture is simply, you know, one way to manage ICU beds is simply by being negative, you know, it’s easy by being negative to say, you mom won’t survive, let’s stop life support, you know, and then they can get the next patient in.

 

Unfortunately, I’ve seen all of that, over the 20 years that I worked in ICU, you know, that often life support is being withdrawn prematurely, and patients die because of that. And also another issue is that most families don’t question and they just take everything the ICU team is saying for face value. And they don’t question even if the ICU team wants to withdraw life support and in essence killing their family member. Right? Not many families question so you’re very unique in that aspect. And that’s good. Give yourself a tap on your shoulders just by doing that.

 

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And so, you know, after cardiac arrest, especially out of hospital cardiac arrest, which was the case in your mom’s situation, the prognosis is rather average. But again, that shouldn’t stop you from pursuing all avenues to help your mom and help your mom survive. You know, she’s in ICU. Now she’s stable and it’s way too early to talk about withdrawing life support.

 

It’s only been three or four days. You know, your mom’s heart will need to recover if it can, you know, and again, talk to the cardiologist, talk to the intensive care team, and ask all the relevant questions, find out what her Troponin I levels are, like, you know, for example, find out if she has an infection. Hopefully she doesn’t, because it’s just another complication she won’t need.

 

Find out what ventilation settings she’s on. Find out what sedatives and opiates she’s on, and report back to me because then I can guide you from there, what to do next, what questions to ask. We know we can look at prognosis, you know, if she doesn’t wake up quickly, she may need a tracheostomy. And that’s not necessarily a bad thing.

 

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You know, a tracheostomy often buys people time to wake up and get them off the ventilator in their own time. And you know, and if she can’t be weaned off the ventilator, you may want to look at options such as intensive care at home. You can look up intensivecareathome.com for more information there.

 

And if she survives, you know, maybe she can get on to rehabilitation maybe if she does have brain damage. You know, maybe she needs to get on to neurology rehab. Maybe brain damage is there and and can only be diagnosed down the track. But that’s what you need to monitor and what you will need to find out.

 

But one thing is for sure you shouldn’t give up shouldn’t give up easily and you shouldn’t lose hope at this stage because it’s way too early to predict where this is going and by you asking the right question and by you, having engaged my service, I can guide you every step of the way. We can talk to the doctors in family meetings. I can help you ask all the right questions because most families in intensive care, they don’t know what to look for. They don’t know what questions to ask. And they don’t know how to manage the ICU team and they don’t know how to manage the negativity and the doom and gloom of the intensive care team.

 

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That’s probably one of the biggest challenges, you know, that you don’t know how to manage the dynamics. The dynamics can be so overwhelming in such a high stress situation, and in such a busy stressful and dynamic environment. That is intensive care.

 

So, that’s hopefully helping. I know we’ll get on the phone again tomorrow Karina and then we’ll go from there. So thanks again for being a client.

 

Thanks for detailing your mom situation.

 

I hope that helps.

 

Kind Regards