University of Colorado School of Medicine, Aurora, CO 80045, USA.
Prog Cardiovasc Dis. 2012 Nov-Dec;55(3):274-81. doi: 10.1016/j.pcad.2012.10.007.
The new millennium has seen a dramatic increase in use of potentially life-prolonging devices such as implantable cardioverter-defibrillators (ICDs) and ventricular assist devices (VADs) among patients with advanced heart failure. Most patients who receive these devices will have them in place when they die. Clinicians who care for these patients must commit through the entire course of therapy, including the end-of-life. Discussions about device deactivation should be the standard of care and this discussion should take place prior to implantation, during annual heart failure reviews, after major milestones, and when the end-of-life appears to be approaching. Turning off ICDs and turning off VADs in response to patient or proxy requests are legally the same although they may be perceived differently, as disconnection of the VAD is more likely to cause immediate death. This article discusses the evidence around device deactivation at the end-of-life and offers suggestions for improvement.
新千年见证了在患有晚期心力衰竭的患者中，植入式心脏复律除颤器 (ICD) 和心室辅助装置 (VAD) 等潜在延长生命的设备的使用急剧增加。大多数接受这些设备的患者在去世时都会带着这些设备。照顾这些患者的临床医生必须在整个治疗过程中，包括生命末期，做出承诺。关于设备停用的讨论应该是护理标准，并且应该在植入前、每年心力衰竭复查时、重大里程碑事件后以及生命末期临近时进行讨论。根据患者或代理人的请求关闭 ICD 和 VAD 在法律上是相同的，尽管它们可能被不同地感知，因为 VAD 的断开更可能导致立即死亡。本文讨论了生命末期设备停用的证据，并提出了改进建议。
