University College London, 250 Euston Road, London, UK.
Department of Cardiology, Barts Hospital, London, UK.
J Med Case Rep. 2024 Aug 3;18(1):360. doi: 10.1186/s13256-024-04573-5.
Our case report provides the first clinical evaluation of autopsy practices for a patient death that occurs on the cloud. We question how autopsy practices may require adaptation for a death that presents via the 'Internet of Things', examining how existing guidelines capture data related to death which is no longer confined to the patient's body.
The patient was a British man in his 50s, who came to the attention of the medical team via an alert on the cloud-based platform that monitored his implanted cardioverter defibrillator (ICD). The patient had a background of congenital heart disease, with previous ventricular fibrillation cardiac arrest, for which the ICD had been implanted two years earlier. Retrospective analysis of the cloud data demonstrated a gradually decreasing nocturnal heart rate over the previous three months, falling to a final transmission of 24 beats per minute (bpm). In the patient post-mortem the ICD was treated as medical waste, structural tissue changes precluded the effective evaluation of device hardware, potential issues related to device software were not investigated and the cause of death was assigned to underlying heart failure. The documentation from the attending law enforcement officials did not consider possible digital causes of harm and relevant technology was not collected from the scene of death.
Through this patient case we explore novel challenges associated with digital deaths including; (1) device hardware issues (difficult extraction processes, impact of pathological tissue changes), (2) software and data limitations (impact of negative body temperatures and mortuary radio-imaging on devices, lack of retrospective cloud data analysis), (3) guideline limitations (missing digital components in autopsy instruction and death certification), and (4) changes to clinical management (emotional impact of communicating deaths occurring over the internet to members of family). We consider the implications of our findings for public health services, the security and intelligence community, and patients and their families. In sharing this report we seek to raise awareness of digital medical cases, to draw attention to how the nature of dying is changing through technology, and to motivate the development of digitally appropriate clinical practice.
本病例报告首次对云端发生的患者死亡进行尸检实践评估。我们质疑尸检实践如何适应通过“物联网”呈现的死亡，以及如何检查现有指南如何捕捉与不再局限于患者身体的死亡相关的数据。
患者是一名 50 多岁的英国男性，他通过监测其植入式心脏复律除颤器（ICD）的云平台警报引起了医疗团队的注意。该患者患有先天性心脏病，曾因室颤性心脏骤停而植入 ICD，两年前植入。对云数据的回顾性分析显示，过去三个月夜间心率逐渐下降，最后一次传输为 24 次/分钟（bpm）。在患者死后，ICD 被视为医疗废物，结构组织变化使设备硬件的有效评估变得不可能，未对设备软件的潜在问题进行调查，死因被归为心力衰竭。执法官员提供的文件没有考虑可能的数字伤害原因，也没有从死亡现场收集相关技术。
通过本病例，我们探讨了与数字死亡相关的新挑战，包括：（1）设备硬件问题（提取过程困难，病理性组织变化的影响）；（2）软件和数据限制（对设备的负面体温和太平间放射成像的影响，缺乏对云数据的回顾性分析）；（3）指南限制（尸检指导和死亡证明中缺少数字组件）；（4）临床管理变化（通过互联网向家属传达互联网上发生的死亡事件的情绪影响）。我们考虑了这些发现对公共卫生服务、安全和情报界以及患者及其家属的影响。我们分享这份报告的目的是提高对数字医疗案例的认识，引起人们对技术改变死亡性质的关注，并促使制定适当的数字临床实践。
