End-of-life decision making and implementation in recipients of a destination left ventricular assist device
End-of-life decision making and implementation in recipients of a destination left ventricular assist device
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DOI：
10.1016/j.healun.2010.07.001
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发表时间：
2010-12-01
影响因子：
8.9
通讯作者：
Kfoury, Abdallah G.
中科院分区：
文献类型：
--
作者：
Brush, Sally;Budge, Deborah;Kfoury, Abdallah G.
左心室辅助装置（LVAD）作为目的治疗（DT）的使用正在增加，并且已被证明在延长患有终末期心力衰竭的选定患者的生存期和改善生活质量方面是有益的。寿命终止问题是不可避免的，如何处理这些问题是不可避免的。方法我们的DT数据登记处查询了符合条件的患者，定义为积极参与EOL决策的个人回顾了从早期EOL讨论到缓解和死亡的过程我们记录了导致EOL讨论的原因从EOL决定到退出和从退出到死亡的时间和地点对主要护理人员进行了调查，以确定他们的经验和与此过程相关的身份主题结果在1999年至2009年期间，69名患者植入了92个DT LVAD，其中20名患者符合入选条件（平均支持时间为833天）新发/恶化的合并症导致的生活质量下降通常会引发EOL讨论，11例患者在家中死亡，8例在医院，1例在疗养院，从决定EOL到停用LVAD的时间范围为
BACKGROUND The use of left ventricular assist devices (LVADs) as destination therapy (DT) is increasing and has proven beneficial in prolonging survival and improving quality of life in select patients with end stage heart failure Nonetheless, end of-life (EOL) issues are inevitable and how to approach them underreportedMETHODS Our DT data registry was queried for eligible patients defined as those individuals who actively participated in EOL decision making The process from early EOL discussion to palliation and death was reviewed We recorded the causes leading to EOL discussion time from EOL decision to withdrawal and from withdrawal to death and location Primary caregivers were surveyed to qualify their experience and identity themes relevant to this processRESULTS Between 1999 and 2009 92 DT LVADs were implanted in 69 patients Twenty patients qualified for inclusion (mean length of support 833 days) A decrease in quality of life from new/worsening comorbidities usually prompted EOL discussion Eleven patients died at home 8 in the hospital and 1 in a nursing home Time from EOL decision to LVAD withdrawal ranged from