Another procedure has come up that takes precedence over Riley's ECMO circuit. They are planning to start this other procedure around 10am, and we were told it might take a couple of hours. So we wait. In the meantime, Riley has been functioning this morning on 50% assistance from the ECMO.
Also, I spoke with someone to get specifics on what it meant to expect Riley to be very sick after being taken off the ECMO. And, as we expected, it means erratic blood pressure, pulse, O2 stats, etc. Basically his vitals likely to be all over the map while they try and find a good balance of medications to (hopefully) stabilize him. Finding this balance could take 24 hours or longer. But the ECMO will stay in place so that they can turn it back on immediately, if needed.
Monday, March 27, 2006
ECMO wean delayed
Posted by Mother in Chief at 3/27/2006 09:52:00 AM
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5 comments:
I am so glad you are keeping us so up to date on Riley's condition. Just know that you are constantly in our thoughts and prayers. We love you guys. I will be up to visit again as soon as I can.
Paul, Lisa and Matthew
The delays must be maddening for you guys... but maybe it's for the best, giving him some more time to get used to 50% ECMO before they wean...
We hope you're at least able to get some rest during all these delays.
suzanne and ken, i think it's great you are making these updates. in a way it is kind of nice to be able to write about it. and it's great for us to be able to read about it. well, this is a big day for y'all. i got my fingers crossed.
also, since my son was on the ecmo last summer and i was keeping a blog, then... if people wanted to read about our experience, you are more than welcome. isaac went on the ecmo on June 28th. http://lilisaac.blogspot.com/2005_06_01_lilisaac_archive.html
Fingers are crossed.
Like you said, the things they are going to be looking for during this wean is how well Riley's heart can handle the exta work load. While on ECMO all of his
vital signs (blood pressure, heart rate etc.) are stable because they are being assisted by ECMO, so the
antiarrhythmic and antihypertensive drugs have been weaned or changed due to this temporary stability
while on the pump. So they will need to be titrated up or down depending on how he does during the wean and off the pump. The good news is that he has
tolerated a %50 wean well so far and was off the pump briefly. I'm a little confused when you said they had to change a 'canister' on the ECMO and he was off pump. (which he did well with and is another plus on our side). Did you mean they changed out the ECMO "lung"? Let me know.
Anyway, ike you said, as they wean the pump more, they will have to respond to
the fluctuations (or hopefully lack of) in his intrisic blood pressure, heart rate and rhythem with the medications he was on before. (Dobutamine to help
with how forcefull his heart contracts,A Vasopressor agent like Dopamine to help with the low blood pressure, Amioderone or another antiarrhymic drug to prevent any arrhythmias, Nitroglycerine to help open the coronary arteries etc... The hope is that he will not experience the same level of variations in blood
pressure (hypotension) and vital signs and will do better this time around. The ECMO circuit has the
capability to be "clamped" off completely after being slowley weaned, but still be attached to the cannulas in his Carotid artery and Superior vena cava incase
there is any acute changes. I suspect that if he tolerates being weaned and even clamped off, they may "rest him" again overnight and "decannulate" or take him of ECMO in the morning after
another brief weaning/clamping trial.
Sending lots of love from Boston
-Dave and Marisa
Hi guys,
Sorry we've been off the radar but I just got internet access today. Our prayers are and have been with you and we've been thinking about you often - Hopefully I'll be able to come up on Wed. Please let me know if there is anything you need or want. Looking forward to giving you a big hug.
Jennifer & the gang
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