Freemantle Megan, Murtagh Fliss
Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
BMJ Support Palliat Care. 2022 Dec;12(4):359-367. doi: 10.1136/bmjspcare-2021-002894. Epub 2021 May 7.
Implantable cardioverter defibrillators (ICDs) are used to treat life-threatening cardiac arrhythmias and prevent sudden cardiac arrest. As recipients age they may develop greater risk of dying as a result of progressive multimorbidity rather than sudden cardiac death. Defibrillation shocks may prolong an uncomfortable dying process. Deactivation of the defibrillator would prevent this, yet is not always discussed and planned.
To systematically review published evidence on ICD deactivation discussions and make recommendations on when, how and who should facilitate effective and patient-centred deactivation discussions.
Using standard systematic review methods, MEDLINE, EMBASE, CINAHL and PsycInfo were searched for studies published in the English language between 2010 and March 2021. Inclusion criteria were studies of adults (≥18 years) and including discussions on ICD deactivation and/or related communication. Included studies were independently reviewed, data extracted, quality assessed and data synthesised using a deductive approach.
Of the 8893 articles identified, 22 papers met the inclusion criteria. Deductive approach led to identification of five main themes: (1) timing of ICD deactivation discussions, (2) initiation of deactivation discussions, (3) advance directives, (4) barriers to discussions and (5) facilitators of discussions.
Despite available guidelines, conversations on device deactivation are not being undertaken consistently. Evidence suggests lack of professional awareness of guidelines and limited training in communication skills. To prevent distress and promote comfortable dying, there needs to be a proactive clinical and policy initiative in the education of both professionals and patients and their relatives about device deactivation.
植入式心脏复律除颤器（ICD）用于治疗危及生命的心律失常并预防心脏性猝死。随着接受者年龄的增长，他们可能因进行性多种疾病而面临更高的死亡风险，而非心脏性猝死。除颤电击可能会延长不适的死亡过程。停用除颤器可以避免这种情况，但这一问题并不总是得到讨论和规划。
系统回顾已发表的关于ICD停用讨论的证据，并就何时、如何以及由谁来促进有效且以患者为中心的停用讨论提出建议。
采用标准的系统回顾方法，检索MEDLINE、EMBASE、CINAHL和PsycInfo数据库中2010年至2021年3月期间发表的英文研究。纳入标准为针对成年人（≥18岁）的研究，且包括关于ICD停用和/或相关沟通的讨论。对纳入的研究进行独立评审、数据提取、质量评估，并采用演绎法进行数据综合。
在识别出的8893篇文章中，有22篇符合纳入标准。演绎法得出了五个主要主题：（1）ICD停用讨论的时机，（2）停用讨论的发起，（3）预先指示，（4）讨论的障碍，（5）讨论的促进因素。
尽管有可用的指南，但关于设备停用的讨论并未始终进行。证据表明，专业人员对指南的认识不足，沟通技能培训有限。为了防止痛苦并促进安详离世，需要在专业人员、患者及其亲属中开展关于设备停用的积极临床和政策倡议教育。
