Ventricular assist devices in palliative care

Ventricular assist devices prolong survival and improve quality of life in some patients with advanced heart failure.

If deactivation of a ventricular assist device is considered, seek specialist advice from the team managing the patient’s device (usually the cardiology team).

Deactivation of ventricular assist devices is performed by specialist units; it usually results in heart failure decompensation and death, which can occur within minutes to daysGafford, 2013. The speed of deterioration depends on several factors, including the patient’s initial condition (whether it is deteriorating or stable), and the degree and type of support the ventricular assist device has been providing.

For general principles of planning deactivation of an implantable cardiac device, see General considerations when deactivating implantable cardiac devices in palliative care. In addition to these general principles, additional caveats for ventricular assist devices include the following:

• Discussions about deactivating ventricular assist devices are likely to be highly distressing; they usually occur when a patient is no longer a candidate for transplantation. Deactivation planning should include support for the patient, their family and carer(s), and healthcare professionals involved in care.
• A plan is required to manage the rapid increase in symptoms after deactivation (eg breathlessness, pain), including consideration of pre-emptive sedation. If death is expected imminently, see Catastrophic terminal events in palliative care. If death is likely to occur in the next few days, see Principles of care in the last days of life.