Guidance from the Resuscitation Council (UK), the British Cardiovascular Society and the National Council for Palliative Care.
Each year, many thousands of people have electronic devices implanted, including pacemakers, implantable defibrillators and small recorders to monitor the heart’s rhythm. The reason for each device is individual to the person and their particular medical problem. The increasing use of such devices has provided huge benefit but also has created new challenges for patients and those close to them, and for healthcare professionals.
Clear challenges arise when people with an implanted device approach or reach the end of their life. What many people want in that situation is care and treatment to maintain their comfort and quality of life for whatever time they have left. Receiving treatment (for example electric shocks from an implanted defibrillator) as they are dying may provide no benefit but may cause them pain and may cause distress both to them and to those who care about them.
So as to provide the best care for people in the last days, weeks or months of their life it is important to consider deactivation of some of these devices. This requires informed and sensitive discussion with patients and those close to them. Healthcare professionals caring for such people may be faced with practical questions about the exact nature and purpose of each device, how the device can be deactivated and what arrangements are in place in their locality to provide the equipment and the expert support and advice needed. It is important also that healthcare professionals know what actions should be taken when someone has died with an implanted device in place.
Quite distinct from those circumstances, an implanted device may lead to uncertainty when someone with one in place suffers cardiac arrest, and cardiopulmonary resuscitation (CPR) is attempted. Those involved may not have detailed information about the implanted device and may be unsure whether they should modify their approach to CPR.
Dr David Pitcher, President of the Resuscitation Council (UK) says, “This important new document provides comprehensive guidance on what should be done when someone with one of these implanted electronic devices is approaching the end of their life, suffers sudden cardiac arrest or has died. It emphasises the importance of good communication and of patients and their healthcare teams making shared decisions about their care whenever possible. The detailed guidance is supported also by a practical guide for health professionals on deactivation of implantable defibrillators and by an information leaflet for patients and carers.”
Simon Chapman, Director of Policy, Intelligence and Public Affairs at the National Council for Palliative Care said, “Everyone with an implanted electronic device should be supported to discuss their end of life wishes including options around the device’s deactivation where this is likely to enhance their quality of life. The possibility of considering deactivation in the future should also be explained to people as part of the consent process. These are very important conversations, which must be handled sensitively and clearly. That’s why this new guidance is so important and why it should be required reading for all healthcare professionals who are involved in any aspect of caring for people with these devices. Talking more openly about end of life issues and supporting people to plan ahead can make a vital difference and enable people to live well until they die, and to get the care and support that is right for them.”
Dr Iain Simpson, President of the British Cardiovascular society says, “We welcome the publication of this important guidance on the management of people with a cardiovascular implanted electronic device. The guidance documents will be of interest to all clinicians working in cardiovascular medicine, and implementation of the guidance will enhance the care of people with an implanted electronic device who are approaching the end of life, or who have had a sudden cardiac arrest.”