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- Clinical decisions
- Terminal care
- Heart failure
- Withdrawal of life-sustaining medical devices
- Ventricular assist devices
Decision making around discontinuation of life-sustaining medical devices (LSMDs) at the end of life, is likely to become an increasingly common scenario within hospitals and hospices, as medical advances continue within an ageing population. Optimal end of life care planning should include practical considerations with regard to the device itself, as well as the emotional and legal decisions common to such situations. Within a cardiothoracic tertiary centre, our hospital specialist palliative care team was involved in the withdrawal of a left ventricular assist device (LVAD), in a complex patient who developed concomitant metastatic rectal cancer, while awaiting cardiac transplantation. The lack of a clear plan resulted in a rushed and unsatisfactory withdrawal, but prompted discussions with the cardiothoracic team and other teams using LSMDs.
LVADs and implantable cardiac defibrillators (ICDs) are an example of the challenges created by prolonged …
Contributors The authors NW and CR were involved clinically in the case. The concept for this work was envisaged by SC. The letter was first drafted by MM. The algorithm was created by SC and CR. All authors were involved in editing and reviewed the final version of the letter. The author SC will act as guarantor for this work.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.