Key result
Planned LVAD deactivation requires higher premedication doses and multidisciplinary care given survival is typically minutes to hours.
Why the study?
As patients live longer with LVAD support, many face end-of-life decisions regarding device deactivation. LVAD deactivation has distinct features from other withdrawals of life-sustaining technology, requiring multidisciplinary collaboration, specialized symptom premedication, and structured clinical protocols.
Case Report
No
This paper outlines a multidisciplinary institutional checklist, order set, and clinical protocol for planned in-hospital left ventricular assist device deactivation at the end of life.
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“LVAD therapy has come a long way, but persistent complications, frequent readmissions and caregiver strain make the case for the ongoing need for PC for these patients.”
May inform institutional protocols for LVAD deactivation; leaves open need for prospective validation before broader adoption.
As patients live longer with left ventricular assist device (LVAD) support, many will either suffer an acute event or develop a gradual, progressive disease that results in a terminal prognosis. At the end-of-life, patients, and more often, their families, will be faced with the decision to deactivate the LVAD to allow natural death. The process of LVAD deactivation carries some distinct features that distinguish it from withdrawal of other forms of life-sustaining medical technology: multidisciplinary collaboration is paramount; prognosis after deactivation is short, typically minutes-hours; and premedication doses of symptom-focused medications are typically higher than other situations involving withdrawal of life-sustaining medical technologies given the precipitous decline in cardiac output following LVAD deactivation. In this Case Discussion, we introduce the complexity of planned in-hospital LVAD deactivation through a clinical case, share our detailed institutional checklist and order set for LVAD deactivation, and broach multidisciplinary clinical protocol development processes.
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Rao et al. (2023) conducted a case report in Terminal prognosis in patients with left ventricular assist device (LVAD) support at end of life. Planned in-hospital LVAD deactivation using a multidisciplinary institutional checklist and order set was evaluated. Planned in-hospital LVAD deactivation requires multidisciplinary collaboration and higher premedication doses because survival after deactivation is typically minutes to hours.
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