Does anyone know...

A distant and elderly family friend has suffered from a heart attack. He has had triple bypass surgery and a pacermaker fitted some time ago. He was unconcious when he recieved treatment and then placed on life support. The life support has now been removed ( he is still in an unconcious state - not expected to recover), the family are expecting him to pass away.
My questions are.... Is the pacemaker still keeping him alive? Do the doctors turn it off or slow it down so that nature takes it's natural course?
I feel quite concerned. How would you pass away if your heart continues to beat????
Maybe it's more complicated than that but any clarification would be appreciated.
Kind regards,
Helen

4 Comments

I think----

by SMITTY - 2008-01-28 11:01:30

Hi Helen,

A pacemaker will not keep a person form dying. A pacemaker can keep a person alive only when it has the help of many parts of the body. The pacemaker is only supplying the electrical impulse to make the heart chamber contract. There are many processes involved in keeping us alive at any time. Only one of them is the heart's natural pacemaker that will normally supply those impulses. The are many body organs, in addition to the heart, that must keep functioning to keep a person alive and that pacemaker will have no effect on any of them but the heart. If you friend dies because of the shut down of some organ, such as kidney or the liver failure, well since I'm not a doctor I'll stop guessing there, but your friend’s heart may follow suit shortly thereafter. The pacemaker may continue to send an impulse to the heart, but the heart will be nothing more than a mass of body tissue trying to react to that impulse, Even if the pacemaker could still make the heart pump blood without one of the critical organs working, then the blood may contain toxins that were lethal to other parts of the body, such as the brain.

I like to think of my body as a very complicated chemical processing facility. We have a fuel processing unit (stomach), waste removal facilities (liver, kidneys and large intestine) a pump (heart) that keeps the blood flowing to all parts of the body with the necessary nutrients and oxygen. Of course there are many other parts of the body involved, and let one of the vital units shut down and death is inevitable. I feel reasonably sure the doctors will not turn off the pacemaker until there is no longer any discernable brain function.

I hope I have not confused the issue beyond hope. When I started, my plan was to only write that first sentence but it didn't seem right to say that and not even try to offer some explanation of what must transpire for a person to die when they have a pacemaker.

I offer my condolences to the family.

Smitty

Does anyone know?

by Stepford_Wife - 2008-01-28 11:01:47

Hi Helen.

I am so sorry to hear of your friend's illness. Please know that my prayers and thoughts are with you and his family.
I don't really know how to answer your question right off the top of my head, so I searched for some help. This is what I was able to come up with. I hope it helps a little.

Dominique ~

Cardiac Pacemaker and Implantable Defibrillators in Terminal Care.

The use of cardiac pacemakers and arrhythmia control devices is increasingly common. The presence of a previously placed pacemaker or implantable cardioverter–defibrillator (ICD) in a terminally ill patient may result in medical and ethical issues for the patient, family, and healthcare provider. It is likely that the disabling of a previously placed pacemaker will neither hasten nor prolong the natural history of the underlying illness in most instances. There are uncommon but potentially severe adverse effects of disabling the pacemaker; therefore, pacemakers should generally be left intact in terminally ill patients. It is more difficult to generalize as to whether deactivation of an ICD is appropriate; in this case death may be hastened and the decision concerning an ICD will depend on the specific clinical scenario. Patient and family education regarding palliative care treatment goals and the function of pacemakers and other implanted arrhythmia control devices can help to alleviate anxiety surrounding the impact of this technology at the end of life.

So Very Sorry....

by Carol - 2008-01-28 11:01:57

First I'd like to say I'm very sorry about your friend.

I can tell you that while I am not a Hospice Nurse, I have worked closely with Hospice Care and many of their patients had pacemakers. I don't believe a regular Pacemaker will keep your friend alive or his heart beating as his condition worsens ... however, if he has an ICD... it WILL need to be turned off so that it will not deliver therapeutic shock as his heart fails. I can't recall that the Hospice nurses ever needed to have a technician turn a regular PM off. I hope this helps and my condolences to your friends family. Carol

My Dad's PM

by MHCHAMPION - 2008-01-29 10:01:44

My Dad had a PM when he passed away in 2001. One of the questions I specifically remember asking the doctor when he suggested installing the PM, was, "Would it extend his life when it was time to go?" and got a no answer. My Dad was not in the best of health when he rec'd the PM as he already had Alzheimers and I was concerned about what you are.
He passed quietly and went on to His Reward in Heaven!
I pray that your family member does well.
Margaret

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