MacIver Jane, Ross Heather J
Division of Cardiology, Toronto General Hospital, Ontario, Canada.
J Palliat Care. 2005 Autumn;21(3):151-6.
Ventricular assist devices (VAD) are mechanical pumps implanted into patients with advanced heart failure who are at risk of imminent death. VADs are a treatment and not a cure, and mortality on device support remains high. Recognizing the dire nature of the decisions for patients and families and the associated high mortality rates, we actively included processes for device withdrawal as part of our program mandate.
At Toronto General Hospital, from October 2001 to December 2004, 22 patients underwent implantation of a VAD. Seven patients died following device withdrawal.
The average time spent on support prior to device withdrawal was seven days. In four of the seven cases, family members initiated discussions regarding device withdrawal. Family-initiated discussions were more likely to occur if patients were implanted electively, as a bridge to transplantation. Disagreements occurred between the ICU and the transplant teams regarding the timing of device withdrawal and responsibility for stopping the pump.
Establishing a process for device withdrawal has been a key factor in the success of our VAD program. This process relies heavily on pre-implantation preparation, a strategy for resolving disagreements, and a process for withdrawing device support.
心室辅助装置（VAD）是植入晚期心力衰竭且面临猝死风险患者体内的机械泵。VAD是一种治疗手段而非治愈方法，依靠装置支持的患者死亡率仍然很高。认识到患者及其家属所做决定的严峻性质以及相关的高死亡率，我们积极将装置撤机流程纳入我们项目的任务范围。
在多伦多综合医院，从2001年10月至2004年12月，22例患者接受了VAD植入。7例患者在装置撤机后死亡。
装置撤机前接受支持的平均时间为7天。在7例中的4例中，家庭成员发起了关于装置撤机的讨论。如果患者是选择性植入作为移植桥梁，家庭成员发起讨论的可能性更大。在装置撤机时间和停止泵的责任方面，重症监护病房（ICU）和移植团队之间存在分歧。
建立装置撤机流程一直是我们VAD项目成功的关键因素。这个流程严重依赖植入前准备、解决分歧的策略以及撤掉装置支持的流程。
