Implantierbarer Kardioverter-Defibrillator am Ende des Lebens

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• 作者：Prof. D. Pfeiffer ; A. Hagendorff ; C. Kühne…
• 关键词：Defibrillator ; Implantierbarer Kardioverter ; Defibrillator ; Palliativmedizin ; Inaktivierung ; Lebenswille ; Defibrillator ; implantable ; Implantable cardioverters ; defibrillators ; Terminal care ; Deactivation ; Living wills
• 刊名：Herzschrittmachertherapie und Elektrophysiologie
• 出版年：2015
• 出版时间：June 2015
• 年：2015
• 卷：26
• 期：2
• 页码：134-140
• 全文大小：472 KB
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• 作者单位：Prof. D. Pfeiffer (1)
  A. Hagendorff (1)
  C. Kühne (1)
  S. Reinhardt (1)
  N. Klein (1)
  
  1. Abt. Kardiologie & Angiologie, Dept. Innere Medizin, Neurologie und Dermatologie, Universit?t Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Cardiology
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1435-1544

文摘

Brady- and tachyarrhythmias at the end of life are common observations. Implantable cardioverter–defibrillators answer with antibrady and antitachycardia pacing, which will not be associated with any complaints of the dying patient. In contrast, defibrillation and cardioversion shocks are extremely painful. Therefore shocks should be inactivated at the end of life. Family doctors, internists, emergency physicians and paramedics are unable to inactivate shocks. Deactivation of shocks at the end of life is not comparable to euthanasia or assisted suicide, but allow the patient to die at the end of an uncurable endstage disease. Deactivation of shocks should be discussed with the patient before initial implantation of the devices. The precise moment of the inactivation at the end of life should be discussed with patients and relatives. There is no common recommendation for the time schedule of this decision; therefore it should be based on the individual situation of the patient. Emergency health care physicians need magnets and sufficient information to inactivate defibrillators. The wishes of the patient have priority in the decision process and should be written in the patient's advance directive, which must be available in the final situation. However the physician must not necessarily follow every wish of the patient. As long as the laws in the European Union are not uniform, German recommendations are needed.