Future cardiology
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It is inevitable that all patients with implantable cardioverter-defibrillators (ICDs) will die during extended follow-up. End-of-life care planning may become appropriate as a patient's condition deteriorates. There is concern about multiple futile shocks in the final hours of life, although the incidence of this problem has been estimated at only 8-16%. ⋯ As such, ICD deactivation is often discussed late or not at all. The management of ICDs in patients approaching death is likely to become a major problem in the coming years. This article will discuss directions in which clinical practice might develop and areas for future research.
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The previously published randomized trials of mechanical versus manual resuscitation of patients with cardiac arrest are inconclusive, but a recent systematic review concluded: "There is no evidence that mechanical cardiopulmonary resuscitation devices improve survival; to the contrary they may worsen neurological outcome." However, in our view, none of the randomized trials to date are definitive as the manual groups with primary cardiac arrest have not been treated optimally; that is, with minimally interrupted manual chest compressions, as advocated with cardiocerebral resuscitation. Since the mechanical chest compression devices work on different principles, it is possible that, while they may not be as effective and may even be worse in some subsets of patients, they may be preferable in others. Nevertheless, there are situations where manual chest compressions are not practical and, in these, mechanical devices may well be preferable. ⋯ The original LUCAS device had the potential of active decompression as well as compression. To market in the USA, holes had to be placed in the 'suction cup'. It would be informative to know whether the original LUCAS device is more effective than the device in which the active decompression has been deactivated.