Transcript Video Marci Ebberts: Caring for the TTM Patient's Family Marci Ebberts: Caring for the TTM Patient's Family May 19, 2025 Hello, I am Marcie Eberts. I am a nurse at Saint Luke's Hospital in Kansas City, and I support nurses in research opportunities now, but my background where I grew up was in the cardiac ICU, and I've been there for about 25 years, and I have seen the cardiac arrest care evolve over that time. And targeted temperature management has come a long way in those 25 years and we have seen different studies come out and there's a lot of research on the path of fizz and the treatment and and the goals of treatment and the goals of temperature management today we're gonna talk about neuroprognostication and how we can support families during this difficult time in the ICU. So neuroprognostication is a mouthful. It is a fun word to use that basically just means predicting an outcome just like our weatherman might prognosticate the rain coming later this week. We are often asked to prognosticate about our patients' outcomes. How can we know what is going to happen? What is the outcome going to be? And who wants to know that the most is the family at the bedside. Often these patients were just fine yesterday. This is the the stories that we hear of well we were just playing golf yesterday how could this be happening? And now after this cardiac arrest has happened and we have return of spontaneous circulation, the families have questions what's going to happen? Why isn't he waking up? When is he gonna wake up? How's he going to be after he wakes up? And our guidelines from our American College of Cardiology and the American Heart Association tell us that we need to wait, wait 72 hours before we begin to predict the outcome of our patient and even so that 72 hours is a little bit in question because does that mean 72 hours after return of spontaneous circulation? Or should we delay that start of the 72 hours till after the patient is rewarmed? There's some question about that because if we are needing to give sedation or a neuromuscular blockade during cooling or during targeted temperature management, that could complicate whether our patient is able to. Wake up and respond and we certainly don't want to diminish any possible response so that delay of prognostication is so important we have seen that if we start making predictions immediately based on whether it was a shockable or non-shockable rhythm. How much down time, all those things we know can influence the factors, but we also know that some people survive even when the odds are stacked against them. So we want to give them the best chance of recovering before we predict that maybe they won't recover. This is complicated for us as clinicians when we're caring for our patient, but imagine the family, the family who is at the bedside asking so many questions, and all we can do is tell them we have to wait, we have to wait and how long we're not exactly sure, but we have to wait at least a few days before we can even begin. To answer these questions, once prognostication begins, it's a multimodal process that might involve multiple EEGs looking at the brain waves, neuro exams, using fancy pupilometers to gauge the minute reactions of the pupils and. Even some blood tests that can show us by a biomarker how much brain damage that patient might have. There's so much research being done in this space that hopefully someday we'll be able to predict sooner, but right now we have this uniquely nursing opportunity to support families at the bedside. Part of the support for our families is immediate and clear communication. So communication from the beginning that tells them nobody is going to try and predict till Thursday. And here we are on Monday afternoon and we aren't going to give you any answers yet and just to make sure that that is clear so that they aren't trying to ask different people and getting different answers so very clear communication is. Such an important part. I heard Ben Abella from Mount Sinai Hospital speak on targeted temperature management once, and he talked about the entire process as if you're boarding a plane from the beginning when you get return of spontaneous circulation. You're getting on a plane that won't land for several days, and we can't just hop off that plane in the middle. So once we decide that we are going to target temperature and keep our patient comfortable from shivering, keep them sedated. If they need it, then delay prognostication for 72 hours before we will begin the tests that will tell us if the chance of survival and meaningful survival is worth pursuing any further. This is boarding a plane language is what I often use when I talk to families right at the beginning of our process is this is like boarding a plane, and we have to wait till we land to start making those decisions. We won't make any predictions while we're in the air. So while we're taking care of our patient and making sure their temperature is in the right range and they're not shivering and they're comfortable and they're clean and we're preventing any ICU complications that can happen, we are also in charge of caring for that family at the bedside and while we've tried our best to have clear communication about this long waiting period, it's just torture for families to have to wait and not know. And so what can we do? Well, there is some literature that helps us support our families in this case, and part of it is involving the families in the care of the patient and some families are different than others, but if a family wants to help participate in basic hygiene, if they want to rub lotion on the patient's hands or feet, that might be a way to help them connect in those moments. Sometimes it's giving them really clear information. About the alarms that are going off and the monitors and everything we're doing and of course different families want different amounts of education and information but giving them a little bit of clear information can really help them feel like they have a little bit of control back in this trying time. ICU journaling or keeping a diary can help in so many ways for our families, it honestly may be a part of early bereavement because chances are the patient may not survive and if the patient doesn't survive, being able to start that process of bereavement early in the care of a patient may help with their grieving as time goes on. So keeping a diary or a journal in the ICU is not only good for our patients and families, it's also may have benefits for our nurses and sometimes our nurses can even write entries into these diaries, and these are so appreciated by families and maybe patients who survive so. Talk about our ICU survivors, the survivors that have survived through their cardiac arrest and CPR and all of the things that we've done to them while we've been trying to keep them alive all through their ICU stay, they've landed the plane and now they are surviving those patients who do wake up. Those patients when they survive their ICU stay and they wake up and they're piecing their lives back together, sometimes these patients can suffer from post-ICU syndrome. This has been in the literature a lot lately, and we see that this is a complex physical and psychological process that can affect many of our ICU. Especially those who have had a cardiac arrest and have a period of time that they don't remember. Post ICU syndrome can be very distressing to our survivors in that period of amnesia where they may clearly remember playing golf with their friend and wasn't that just yesterday? No, that was a week ago. What did I miss in that week? Well, having an ICU diary that has been kept by family, maybe even nurses who have jotted some things in there helps put those pieces back together and can help our patients, our survivors recover more wholly. So taking care of our patients and our families and not just focusing so much on those individual little tasks and the numbers but looking at that family and patient as a whole we can really make a difference not only in the ICU but in the life after. So in closing neuroprognostication where we have to wait 72 hours maybe. More before we make sure that we are making the right decision on this outcome of a life and the family's life how can we best support our families during this time where we're providing excellent care to the patients, maybe including family and cares of our patients, adding some physical touch, giving them bits and pieces of information that they can process and control. And then ICU diaries or journaling, keeping a record of the feelings and thoughts and procedures that are happening and this can help not only the patient's family during this trying time but also may help our patient put the pieces back together when they survive and live out the other side. 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