Defibrillator patients should not be denied a peaceful death

Westerdahl, Annika Kinch; Sutton, Richard; Frykman, Viveka

doi:10.1016/j.ijcard.2015.01.012

Cited by 29 publications

(22 citation statements)

References 32 publications

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“…Many reports describe patient and family distress as shocks are administered during the active dying phase, even when a 'do not resuscitate' order is in place. 35 For those with left ventricular assist devices, implanted either as a bridge to transplantation or as destination therapy, liaison with palliative care is appropriate. 34 Interprofessional discussion is relevant pre-implantation, and palliative care involvement is certainly critical when withdrawing therapy.…”

Section: Implanted Electronic and Mechanical Assist Devicesmentioning

confidence: 99%

Palliative care in heart failure: facts and numbers

Riley

Beattie

2016

ESC Heart Failure

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Millions of people worldwide have heart failure. Despite enormous advances in care that have improved outcome, heart failure remains associated with a poor prognosis. Worldwide, there is poor short‐term and long‐term survival. The 1 year survival following a heart failure admission is in the range of 20–40% with between‐country variation. For those living with heart failure, the symptom burden is high. Studies report that 55 to 95% of patients experience shortness of breath and 63 to 93% experience tiredness. These symptoms are associated with a high level of distress (43–89%). Fewer patients experience symptoms such as constipation (25–30%) or dry mouth (35–74%). However, when they do, such symptoms are associated with high levels of distress (constipation: 15–39%; dry mouth: 14–33%). Psychological symptoms also predominate with possibly as many as 50% experiencing depression. Palliative care services in heart failure are not widely available. Even in countries with well‐developed services, only around 4% of patients are referred for specialist palliative care. Many patients and their families would benefit from receiving specialist palliative care support.

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Section: Implanted Electronic and Mechanical Assist Devicesmentioning

confidence: 99%

Palliative care in heart failure: facts and numbers

Riley

Beattie

2016

ESC Heart Failure

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“…Another study 25 confirmed that the patients' wishes about DNR were usually met, and, when they were not evident, it was the physician's responsibility to take the decision. On the other hand, the good communication between relatives and multidisciplinary team members can be established with training and it constitutes a determining factor for the families' satisfaction with patients in ITU and for the compliance with of the patient's will 26 .…”

Section: Discussionmentioning

confidence: 94%

Ordem de não reanimar pacientes em fase terminal sob a perspectiva de médicos

2016

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The do-not-resuscitate order is the explicit statement by patients with advanced disease in progression refusing cardiopulmonary resuscitation. This study aimed to describe the attitude of physicians in relation to the this order and the need for its regulation. A questionnaire was applied to 80 physicians in the medical bureau of the Regional Council of Medicine of Joacaba/SC, Brazil. It was found that 90% of the respondents knew the meaning of do-not-resuscitate, 86.2% agreed to respect it, 91.2% considered it important to be registered in medical records and 92.5% understood as opportune the issuance of a regulation in this regard. It was concluded that most doctors knew about the do-not-resuscitate order, agreed to respect it, valued its registration in medical records and wanted its regulation by the relevant bodies. Keywords: Terminally ill. Bioethics. Resuscitation orders. Heart massage. Respiration, artificial. Medical futility. ResumoOrdem de não reanimar pacientes em fase terminal sob a perspectiva de médicos Ordem de não reanimar consiste na manifestação expressa da recusa de reanimação cardiopulmonar por paciente com doença avançada em progressão. Objetivou-se descrever a atitude dos médicos em relação à ordem de não reanimar e à necessidade de sua normatização. Foi aplicado questionário a 80 médicos inscritos na delegacia do Conselho Regional de Medicina de Joaçaba/SC, Brasil. Verificou-se que 90% dos participantes conheciam o significado dessa ordem, 86,2% concordavam em acatá-la, 91,2% consideravam importante seu registro em prontuário e 92,5% consideravam oportuna a emissão de normatização a respeito. Concluiu-se que a maioria dos médicos tinha conhecimento sobre Ordem de Não Reanimar, concordava em respeitá-la, valorizava seu registro em prontuário e desejava a normatização por parte dos órgãos competentes. Palavras-chave: Doente terminal. Bioética. Ordens de não ressuscitar. Massagem cardíaca. Respiração artificial. Futilidade médica. ResumenLa orden de no reanimar a los pacientes en fase terminal bajo la perspectiva de los médicos La orden de no reanimar es la manifestación expresa de rechazo de la reanimación cardiopulmonar por parte de pacientes portadores de una enfermedad avanzada en progresión. Este estudio tuvo como objetivo describir la actitud de los médicos con respecto a esta orden y la necesidad de su regulación. Se aplicó un cuestionario a 80 médicos inscriptos en el distrito del Consejo Regional de Medicina de Joaçaba/SC, Brasil. Se encontró que el 90% de los encuestados conocían el significado de esta orden, el 86,2% estaban de acuerdo en cumplirla, el 91,2% consideraban importante el registro en el historial médico y el 92,5% juzgaban oportuna la existencia de una regulación al respecto. Se concluyó que la mayoría de los médicos tenía conocimiento de la orden de no reanimar, estaba de acuerdo en respetarla, valoraba su registro en el historial médico y deseaba su regulación por parte de las instituciones competentes. Palabras clave: Enfermo terminal. Bioética. Órdenes de...

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“…In six studies, the type of death was not specified. 8 , 18 – 22 Year of publication ranged from 2004–2015 and all studies scored moderate to high on methodological quality. Three of these studies reported that 17–32% of patients experienced shocks in the last month of life.…”

Section: Resultsmentioning

confidence: 99%

“… 8 , 19 , 21 Four studies showed that in the last 24 hours of life, 3–32% of patients experienced shocks. 18 – 20 , 22 Two studies showed that in the last hour of life, 8% and 31% of patients experienced shocks. 8 , 20 Two studies reported on the appropriateness of the shocks.…”

Section: Resultsmentioning

confidence: 99%

The incidence and impact of implantable cardioverter defibrillator shocks in the last phase of life: An integrated review

Stoevelaar¹,

Brinkman-Stoppelenburg²,

Bhagwandien

et al. 2018

European Journal of Cardiovascular Nursing

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Background:Although the implantable cardioverter defibrillator is successful in terminating life threatening arrhythmias, it might give unwanted shocks in the last phase of life if not deactivated in a timely manner.Aims:This integrated review aimed to provide an overview of studies reporting on implantable cardioverter defibrillator shock incidence and impact in the last phase of life.Methods and results:We systematically searched five electronic databases. Studies reporting on the incidence and/or impact of implantable cardioverter defibrillator shocks in the last month of life were included. Fifteen studies were included. Two American studies published in 1996 and 1998 reported on the incidence of shocks in patients who died non-suddenly: incidences were 24% and 33%, respectively, in the last 24 hours, and 7% and 14%, respectively, in the last hour of life. Six American studies and one Danish study published between 1991–1999 reported on patients dying suddenly: incidences were 41% and 68% in the last 24 hours and 22–66% in the last hour. Four American studies and two Swedish studies published between 2004–2015 did not distinguish the cause of death: incidences were 17–32% in the last month, 3–32% in the last 24 hours, and 8% and 31% in the last hour of life. Three American studies published between 2004–2011 reported that shocks in dying patients are painful and distressing for patients, and distressing for relatives and professional caregivers.Conclusion:If the implantable cardioverter defibrillator is not deactivated in a timely manner, a potentially significant proportion of implantable cardioverter defibrillator patients experience painful and distressing shocks in their last phase of life.

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Defibrillator patients should not be denied a peaceful death

Cited by 29 publications

References 32 publications

Palliative care in heart failure: facts and numbers

Palliative care in heart failure: facts and numbers

Ordem de não reanimar pacientes em fase terminal sob a perspectiva de médicos

The incidence and impact of implantable cardioverter defibrillator shocks in the last phase of life: An integrated review

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