Management of implantable cardioverter defibrillators in end-of-life care
Management of implantable cardioverter defibrillators in end-of-life care
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DOI：
10.7326/0003-4819-141-11-200412070-00006
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发表时间：
2004-12-07
影响因子：
39.2
通讯作者：
Krumholz, HM
中科院分区：
文献类型：
--
作者：
Goldstein, NE;Lampert, R;Krumholz, HM
背景：植入式心律转复除颤器（ICDs）可以防止心律失常导致的过早死亡，但也可能延长死亡过程，使其更加痛苦。目的：描述关于停用icd的讨论的频率、时间和相关因素。设计：回顾性队列研究。设置：电话调查。参与者：因任何原因死亡的icd患者的近亲。在联系的136名近亲中，有100人（74%）参与了调查。测量：关于停用ICD和ICD最后一次休克时间的讨论发生率。结果：近亲属报告，临床医生在100例中只有27例讨论过停用ICD。大多数讨论发生在生命的最后几天。家庭成员报告说，8名患者在死亡前几分钟因ICD而受到电击。局限性：本回顾性调查依赖于近亲属的报告。结论：近亲属报告临床医生与少数患者讨论过停用icd。选择接受这个装置的人应该有机会在死亡临近时选择停止使用它。
Background: Implantable cardioverter defibrillators (ICDs) can prevent premature death from an arrhythmia but may also prolong the dying process and make it more distressing.Objective: To describe the frequency, timing, and correlates of discussions about deactivating ICDs.Design: Retrospective cohort study.Setting: Telephone survey.Participants: Next of kin of patients with ICDs who died of any cause. Of 136 next of kin contacted, 100 (74%) participated.Measurements: incidence of discussions about deactivating ICDs and timing of last shock from ICD.Results: Next of kin reported that clinicians discussed deactivating the ICD in only 27 of the 100 cases. Most discussions occurred in the last few days of life. Family members reported that 8 patients received a shock from their ICD in the minutes before death.Limitations: This retrospective survey relied on the reports of next of kin.Conclusions: Next of kin reported that clinicians discussed deactivating ICDs with few patients. Individuals who choose to receive this device should have the opportunity to choose to discontinue it as death approaches.