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.”
