Heart Patients want to share their Shocking Devices

Almost everyone has seen a doctor on television, yelling “Clear!”, then applying paddles to the chest of a patient to shock him “back to life”.

As dramatic, as the scene may be, defibrillation can only be used for the deadliest forms of arrhythmias – ventricular tachycardia (V-Tach) and ventricular fibrillation (V-Fib) and not for patients who have “flat-lined” (asystole).

For those who are at high risk of V-Fib and V-Tach  an internal “shocking” device may provide the best defense against sudden cardiac arrest. Such a device, known as an implantable cardiac defibrillator (ICD), is considered effective in fighting cardiac arrest over 90% of the time.

Each year, more than 100,000 patients in the U.S. undergo implantation of an ICD. This number constitutes a 20-fold increase over the last 15 years.

Current medical guidelines advocate discussion of end of life care of these medical devices, including deactivation. Now, researchers at the University of Pennsylvania School of Medicine say that discussions should also address post-mortem donation of ICDs for product improvement or reuse overseas as pacemakers, to help reduce global health disparities.

Penn researchers conducted a phone survey of 153 ICD patients concerning advance directives and ICD handling at the end of life. The study results which were reported at the 2011 American College of Cardiology meeting in New Orleans showed that half of the patients that were questioned said they would like their ICD deactivated in an end of life illness. Most also thought that a do not resuscitate (DNR) order justified ICD deactivation.

Although 17% reported ever thinking about ICDs in an end of life illness; just two patients had actually addressed the topic in an advance directive arrangement and only 5% of the patients had ever discussed ICD deactivation directly with their doctor.

Regarding donation of ICDs for reuse or review of the device for improvement purposes, 88% said they would donate their device to facilitate product improvement, 87% would donate for reuse overseas, and 80% for reuse in animals. When asked to choose just one donation option, the majority of patients would donate their devices for reuse in patients overseas.

Shocking or sensible?  SRxA’s Word on Health would love to hear your thoughts on this.

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