It’s every traveller’s worst nightmare: You’re taking a red-eye back into the US
after going out of the country on business, when suddenly, disaster strikes.
Half way through the in-flight movie and the complimentary glass of champagne, the plane
goes down, hurtling towards the ground at hundreds of miles an hour.
As the plane’s nose hits the concrete, you’re positive that you’re about to die.
But…you don’t.
By some amazing miracle, you’ve survived the ordeal.
The downside?
Your injuries are severe – you’re in a coma, and you’ve suffered from multiple
organ failures.
In the early days of aviation, a problem like this would mean you’re pretty much a goner,
but not today.
You’ll be put on life support, keeping you alive while doctors can try to expedite your
recovery.
“Life Support” is a phrase that gets thrown around a lot by figures in the media and characters
in every prime-time medical drama.
You probably picture a mangled patient connected to a bunch of wires and beeping machines.
But what actually is all this, and what is it like to be on the receiving end of life
support treatment?
Well, let’s start with the basics.
Life support is a broad umbrella term for the machines, medication, and treatment used
to keep a patient alive after catastrophic organ failure.
Typically, it’s a stopgap until the organs can be repaired or replaced, or – in more
tragic cases – to ease a patient’s passing towards the end of their life.
For some, life support machines are a permanent part of life, such as in the case of kidney
dialysis for people with kidney failure and portable ventilators to assist those with
breathing problems.
Because life support is a diverse collection of treatments meant to work for a range of
health issues, we’ll explore each one, and take a look at what it might be like to experience
it.
First, mechanical ventilators, also known as respirators.
These are typically short-term solutions for conditions that make it difficult to breathe
independently, including pneumonia, edema, Chronic Obstructive Pulmonary Disease, and
other miscellaneous lung damage.
If you suffered a collapsed or punctured lung during the crash, you’d be hooked up to
this machine.
The respirator facilitates gas exchange and provides breaths to the sufferer while their
body – and the healthcare professionals – work on healing you.
While a respirator is typically only used for short-term conditions, they are sometimes
employed during the later stages of debilitating chronic illnesses – such as paralysing spiral
injuries and Lou Gehrig’s Disease.
Ventilators are more likely to be a permanent necessity in this case.
So, what exactly does being hooked up to a ventilator mean?
Well, if the doctors deem the threat to your respiratory system sufficient, you’ll be
sedated and administered with an Endotracheal Tube, or ET for short.
This is a tube fed in through your nose or mouth down into the trachea, or windpipe.
The ET is then connected to the ventilator and used to perform a variety of tasks, from
injecting high concentrations of oxygen into oxygen-starved lungs to equalising pressure
to prevent collapsed lungs.
That last one is a process known as Positive End-Expiratory Pressure, or PEEP.
If the trachea is obstructed by, say, a tumour, the doctors will do things slightly differently.
Rather than going in via the nose or mouth, they’ll access the trachea by way of a tracheostomy.
In this case, the doctors will puncture a hole into your trachea, and insert a tracheostomy
tube into the throat to allow for breathing.
Patients will be closely monitored in the Intensive Care Unit, and hooked up to diagnostic
machines that track heart rate, respiratory rate, blood pressure, and oxygen saturation.
Patients on a ventilator will be entirely unconscious, so you won’t even really know
what’s happening to you.
Though if you’re lucky enough to wake up, but you still need a ventilator, you may feel
slight discomfort from the tubes.
If you’ve been administered with an Endotracheal Tube, you won’t be able to talk or eat until
it’s removed, but that’s a pretty small price to pay for your next breath.
If, however, you remain unconscious or hooked up to a ventilator for an extended period
of time, you don’t need to worry about starvation.
That’s because of a process often used to supplement artificial respiration: Artificial
nutrition, sometimes colloquially known as “tube feeding.”
Artificial nutrition is used in a number of contexts – such as feeding injured patients
on life support that obstructs the mouth, comatose or mentally ill patients unable to
feed themselves, and terminally ill patients experiencing a loss of appetite.
There are three different varieties of artificial nutrition – Total Parenteral Nutrition (also
known as TPN), Nasogastric Tubes (also known as NG Tubes), and Gastrostomy Tubes, also
known as G-Tubes and PEG Tubes.
There’s also Intravenous Hydration, which keeps your liquids at the correct, healthy
levels when you’re unable to drink.
Total Parenteral Nutrition is a short-term measure that passes the nutrients a patient
would normally achieve through eating directly into the bloodstream.
Nutrients are drip-fed into the patient’s blood via a tube, typically inserted in the
neck or armpit, that threads through the circulatory system towards the heart.
Part of the reason this method is so often purely short-term is that the irritation and
infection risk is quite high.
Nasogastric Tubes are a little less complicated and risky.
A feeding tube is inserted into the nose, and threaded through the patient’s nasal
passage, down the throat, and directly into the stomach.
This is excellent for patients who, for whatever reason, can’t swallow.
Patients are fed a liquid food solution from this tube, either continuously over a period
of days or in several larger bursts with spaces in between.
Admittedly, despite the lower infection rate, conscious patients do still tend to report
that these tubes are extremely uncomfortable.
Gastrostomy Tubes come in two varieties: G-Tubes and PEG Tubes.
G-Tubes are feeding tubes installed directly into the stomach itself with a surgical procedure
on the patient’s abdomen.
PEG Tubes – which stands for Percutaneous Endoscopic Gastrostomy Tubes – are installed
endoscopically, and are therefore a little less invasive.
Intravenous Hydration involves inserting additional fluids into a patient through tubing inserted
into the patient’s veins via a needle, typically in the wrist.
Of course, like a lot of the procedures in this video, artificial nutrition comes with
real risks and isn’t ever employed lightly.
Any invasive procedure, even in a sterile hospital environment, comes with considerable
infection risks that can lead to life-threatening conditions like pneumonia.
Incidentally, lung malfunctions lead us quite nicely into our next form of life support.
Cardiopulmonary resuscitation, or CPR.
Surprised?
Yeah, the simple act of performing CPR on someone technically counts as life support,
as the purpose of the technique is helping someone who has stopped breathing – as a
result of Cardiac Arrest, suffocation, or drowning.
CPR takes the form of a steady series of chest compressions meant to keep the blood flowing
through the body while the victim is unconscious, almost like an artificial, external heartbeat.
CPR is typically performed by a civilian trained in first aid while waiting for a professional
doctor or first-responder to arrive.
If you were given CPR, it was likely right after the crash, when terrified civilians
came to inspect the wreckage.
You were lucky enough to be found by a civilian who knew some basic first aid, and as a result,
you’ve lived to tell the tale.
You may experience some fractured ribs and bruising as a result of the chest compressions,
but trust us, a couple weeks of chest pain in the aftermath is a lot nicer than a stopped
heart.
And considering you just fell out of the sky, it’s really the least of your worries right
now.
Another common piece of medical technology that you might be surprised counts as life
support is the humble defibrillator.
That’s right, this handy device is famous for bringing people back from the brink of
death.
You may have seen upwards of a thousand movie scenes where a frantic paramedic yells “Clear!”
and shoves two electrified paddles onto a patient’s chest, but what exactly is happening
here?
Well, defibrillators are used in the event of cardiac arrest and arrhythmia in order
to return the heart back to its normal rhythm.
It does this by passing a high intensity electric shock directly through the heart.
It’s not unlike using jumper cables to restart a stopped car, and typically, the only side
effect is some electrical burning on the skin of the chest.
While defibrillation is typically performed by medical professionals, it’s not uncommon
to see defibrillation kits – complete with instructions – posted around public areas
for emergency situations.
However, not all heart conditions call for a return to rhythm – some are a little more
severe.
In cases of life-threatening heart failure, the life support device you’ll need is the
Left Ventricular Assist Device, also known as the LVAD.
The LVAD acts as a kind of artificial pump connected to the left ventricle of the damaged
heart, leading through to the aorta.
The machine is wired out of the body with a cable called the driveline to an external
controller operated by the patient.
It keeps blood pumping when the heart is too damaged to do so on its own.
Even having the LVAD installed involves a major surgery, and it’s typically considered
a temporary measure while the patient is on the heart transplant waiting list – which,
like many waiting lists, is frustratingly slow.
Moving down through the torso, next comes the Kidney Dialysis Machine.
Kidneys perform a vital role in the body by filtering waste materials and toxins out of
the blood.
So, when someone experiences kidney failure and they’re placed at the back of another
extremely long organ transplant waiting list, the dialysis machine steps in to lighten the
load.
The machine acts as an artificial, external kidney, filtering the blood out of the body
and removing waste products and excess water.
The blood is then diffused with a saline solution called dialysate, before that solution is
then diffused with the blood, before returning the blood to a patient’s body.
This process can be incredibly arduous and time-consuming for the patient, especially
considering that dialysis needs to be repeated frequently until the patient can eventually
get a kidney transplant.
Finally, in our tour of life support equipment, we have Extracorporeal Membrane Oxygenation,
or ECMO.
This treatment, typically used on incredibly sick new-borns and infants, uses a pump and
an artificial lung to replace the functions of a failing heart and/or respiratory system
– usually with two catheter tubes connected at the neck and groin.
ECMO is often employed for ailments like congenital heart defects and pneumonia, where the patient’s
cardiopulmonary system has been compromised and requires a bypass.
As you could probably predict at this point, it does come with its own risks, like infection
and the possibility of causing blood clots.
Though in many cases of the ECMO being used, the health of the patient is often so severely
compromised that doctors don’t have time for apprehension.
So, those are a selection of the life support machines and treatments you may find yourself
connected to after your horrific plane crash.
If your run of luck continues, in time you’ll begin a slow but steady process towards full
recovery.
You’ll regain consciousness, and your damaged organs will be either repaired or replaced.
A true happy ending.
But what if you don’t get better?
What if your odds of survival, even on protracted life support, are looking bleak?
What if it seems like you might be in a coma you probably won’t wake up from?
Well, this is a hotly debated ethical issue, but there are a few possible paths to what
is ultimately the same outcome.
If you left Do Not Resuscitate orders before you were incapacitated, if you happen to stop
breathing or experience cardiac arrest, the doctors will simply allow you to pass.
If you leave an Allow Natural Death order, the doctors will not administer medical procedures
to try to prevent your death in the event of a condition warranting life support, and
will instead focus on easing your passing – making sure you die as comfortably and
painlessly as possible.
However, things will get slightly more complicated if you haven’t left any written orders in
the event of being incapacitated and going on life support.
This duty will then pass to the doctors and your next of kin.
If you cease brain activity, and the doctors determine through tests that you’re unlikely
to recover, they will recommend turning off life support to your next of kin.
This typically involves switching off the respirator and artificial nutrition of a comatose
patient.
Should your next of kin choose this option, you’ll be dead within a few minutes due
to lack of oxygen to the brain.
Sadly, not everyone who receives life support is able to return to life afterwards, but
if it’s any consolation, you won’t even be aware that it happened.
Now go check out “What Happens To You Just Before You Die” and “What Doctors Wish
Their Patients Knew About Death.”