Alice Sacco is a physician, Cardiac Intensive Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Matteo Pagnesi is a physician, Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
Am J Crit Care. 2024 Mar 1;33(2):145-148. doi: 10.4037/ajcc2024535.
Recent data indicate that end-of-life management for patients affected by acute decompensated heart failure in cardiac intensive care units is aggressive, with late or no engagement of palliative care teams.
To assess current palliative care and end-of-life practices in a contemporary Italian multicenter registry of patients with cardiogenic shock due to acute decompensated heart failure.
A survey-based approach was used to collect data on palliative care and end-of-life management practices. The AltShock-2 registry enrolled patients with cardiogenic shock from 12 participating centers. A subset of 153 patients with cardiogenic shock due to acute decompensated heart failure enrolled between March 2020 and March 2023 was analyzed, with a focus on early engagement of palliative care teams and deactivation of implantable cardioverter-defibrillators (ICDs).
"Do not resuscitate" orders were documented in patient records in only 5 of 12 centers (42%). Palliative care teams were engaged for 21 of 153 enrolled patients (13.7%). Among the 51 patients with ICDs, 6 of 17 patients who died (35%) had defibrillator deactivation. Of the 17 patients who died, 13 died in the hospital and 4 died within 6 months after discharge; 1 patient had ICD deactivation supported by palliative care services at home.
Therapy-limiting practices, including ICD deactivation, are not routine in the Italian centers participating in this study. The results emphasize the importance of integrating palliative care as a simultaneous process with intensive care to address the unmet needs of these patients and their families.
最近的数据表明，在心脏重症监护病房中，患有急性失代偿性心力衰竭的患者的临终管理较为积极，但姑息治疗团队的参与较晚或根本没有参与。
评估意大利当代多中心注册中心中因急性失代偿性心力衰竭导致心源性休克患者的姑息治疗和临终实践现状。
采用基于调查的方法收集姑息治疗和临终管理实践的数据。AltShock-2 注册中心纳入了来自 12 个参与中心的因心源性休克的患者。分析了在 2020 年 3 月至 2023 年 3 月期间因急性失代偿性心力衰竭而纳入的 153 例心源性休克患者中的亚组，重点关注姑息治疗团队的早期参与和植入式心脏复律除颤器（ICD）的停用。
仅有 5 个中心（42%）的患者记录中有“不复苏”医嘱。姑息治疗团队参与了 153 名纳入患者中的 21 名（13.7%）。在 51 例 ICD 患者中，17 例死亡患者中有 6 例（35%）的除颤器已停用。在 17 名死亡患者中，13 名在医院死亡，4 名在出院后 6 个月内死亡；1 名患者在家中接受姑息治疗服务支持的 ICD 停用。
限制治疗的措施，包括 ICD 停用，在参与这项研究的意大利中心并非常规做法。这些结果强调了将姑息治疗作为一个与重症监护同时进行的过程的重要性，以满足这些患者及其家属的未满足需求。
