Cerda Tomás, Crispino Luciana, Paredes Alejandro
Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Rev Med Chil. 2023 Oct;151(10):1399-1405. doi: 10.4067/s0034-98872023001001399.
The use of implantable cardioverter-defibrillators (ICDs) has been on the rise. Patients using ICDs inevitably transit towards the end of life at some point, including some who develop terminal illnesses. In this context, it is relevant to discuss and evaluate the deactivation of these devices with the aim of addressing patients' comfort and avoiding shocks during the end-of-life phase. There are multiple communicational and operational barriers when considering ICDs deactivation. Firstly, many patients have not discussed this issue with their physicians despite international guidelines recommending such discussions before device installation. Secondly, there is a significant lack of knowledge among patients, family members, and even doctors about the benefits of ICDs, as well as the deactivation process and ethics considerations, which leads them to believe that immediate death will occur, considering it as euthanasia or assisted suicide. Finally, the management of hospice patients or end-of-life ICDs users is poorly standardized, with low rates of deactivation, resulting in shocks in the last minutes of life, which can cause marked distress to patients and families. It is necessary to address these barriers and discuss these issues with patients to inform and educate them about the functioning of their devices, with the ultimate goal of enabling informed and shared decision-making for patient well-being.
植入式心脏复律除颤器（ICD）的使用一直在增加。使用ICD的患者在某些时候不可避免地会走向生命尽头，包括一些患上绝症的患者。在这种情况下，讨论和评估这些设备的停用具有重要意义，目的是提高患者的舒适度，并避免在生命末期出现电击情况。在考虑停用ICD时存在多种沟通和操作障碍。首先，尽管国际指南建议在设备安装前进行此类讨论，但许多患者并未与医生讨论过这个问题。其次，患者、家庭成员甚至医生对ICD的益处、停用过程以及伦理考量缺乏了解，这导致他们认为停用会导致立即死亡，将其视为安乐死或协助自杀。最后，临终关怀患者或生命末期ICD使用者的管理缺乏标准化，停用率低，导致患者在生命的最后几分钟遭受电击，这会给患者和家属带来极大痛苦。有必要克服这些障碍，并与患者讨论这些问题，让他们了解设备的功能，最终目标是为了患者的福祉实现知情且共同的决策。
