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Discontinuation of Cardiac Devices at or Near an Adult Patient's End of Life
John Arthur McClung1, William H Frishman2, Wilbert S Aronow1
1From the Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY.
Insights
Managing cardiac devices near end-of-life is complex. This review guides decisions on deactivating devices like left ventricular assist devices to benefit patients.
Area of Science:
- Biomedical Engineering
- Medical Ethics
- Cardiology
Background:
- Medical technology advancements blur life/death distinctions and treatment appropriateness.
- Cardiac devices are increasingly used in critical care and end-of-life scenarios.
Purpose of the Study:
- To review the management of cardiac devices at the end of life.
- To summarize current opinions and provide guidance on device deactivation.
- To analyze ethical considerations and outcome data for various devices.
Main Methods:
- Literature review of prior and current opinions on cardiac device management.
- Analysis of ethical viewpoints from multiple commentators.
- Examination of outcome data for relevant cardiac support modalities.
Main Results:
- Cardiac device management at end-of-life presents complex ethical and practical challenges.
- Existing opinions vary, necessitating careful consideration of individual patient circumstances.
- Technological sophistication of devices increases complexity of deactivation decisions.
Conclusions:
- Careful attention and knowledge are crucial for managing cardiac devices at end-of-life.
- Guidance is needed to navigate the complexities of device deactivation ethically and effectively.
- Future technological advancements will require ongoing reevaluation of end-of-life device management strategies.
Abstract:
Advances in medical technology have begun to blur the lines between life and death as well as the lines between appropriate and inappropriate therapy. This review addresses the charged issue of the management of cardiac devices at or near the end of a patient's life, provides a summary of prior and current opinion with some historical context, and attempts to provide some modest guidance as to how to approach the various options to the patient's best advantage. Modalities to be addressed include indwelling electronic devices, the left ventricular assistance device, and extracorporeal mechanical oxygenation, and includes available outcome data as well as ethical analysis from a number of commentators. The expected further increase in technical sophistication of these devices is expected to render the various aspects of device deactivation more and more complex over the course of the next few years such that careful attention to and knowledge about this issue will continue to be more and more necessary.
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