Permanent Pacemakers and Implantable Defibrillators

[What must intensive care physicians know about implantable cardioverter defibrillator?]

The first implantable cardioverter defibrillator (ICD) was implanted in the USA in 1980. After the publication of the landmark studies MADIT I and AVID (primary prevention in high risk patients and secondary prevention after sudden cardiac death) implantation rates dramatically increased worldwide. Due to the increasing number of implantations in elderly patients, intensive care units and emergency departments are confronted more often with patients with ICDs. Therefore, intensive care practitioners have to be familiar with these devices. This article summarizes the current literature and focuses on the management of emergencies and malfunction of ICDs.

Radiography of pacemakers and implantable cardioverter defibrillators

OBJECTIVE

The purpose of this article is to review the normal and abnormal radiographic appearances of cardiac pacemaker and implantable cardioverter defibrillator systems.

CONCLUSION

Chest radiographs showing pacemakers and implantable cardioverter defibrillators contain identifying and clinically relevant information, such as MRI compatibility and possible malfunction. Accurate and timely reporting of these features provides important information that can improve patient care.

"Magnetic attraction" in the pediatric emergency department: the case of a malfunctioning implantable cardioverter-defibrillator

The use of implantable cardioverter-defibrillators (ICDs) in pediatric patients has increased substantially over the past 3 decades. We report the case of a 15-year-old boy with congenital heart disease who presented with recurrent inappropriate ICD shocks due to a lead malfunction. Inaccessibility of a magnet to inactivate shock therapy in the pediatric emergency department (PED) resulted in numerous additional inappropriate shocks. Herein, we provide a brief overview of ICD care relevant to the PED. The complexities of these devices and their associated therapies require pediatric emergency physicians caring for these patients to recognize basic ICD functions and troubleshoot malfunctions to provide timely management. In particular, it is essential that PEDs be equipped with magnets and that physicians are trained in their appropriate use.

[Field 4. Environmental safety practice in the intensive care unit. French-speaking Society of Intensive Care. French Society of Anesthesia and Resuscitation]

Medical devices are known to carry risks from design to scrap. Accident reports in ICU show that medical device account for only 20% of accidents. Formation of users and providing a postmarketing incident reporting are thus essential in health institutions. Clinical and engineering departments should cooperate to produce and secure procedures which should be applied during the lifetime of each clinical device. Several points should be especially fulfilled: close cooperation between clinical departments and biomedical engineering departments with available technicians, computer-based inventory of all devices, evaluation of specifications required before purchasing a new device, education of users on utilisation and maintenance, technical follow-up of devices and keeping maintenance and repair logs, ability to provide users with replacement devices, provision of check-lists before use, forging criteria to decide when device should be discarded. These principles are simple and should be considered as mandatory in order to improve medical device related security.

Care of the pacemaker/implantable cardioverter defibrillator patient in the ED

As the population ages and the prevalence of cardiovascular disease increases, patients with pacemakers and implantable cardioverter defibrillators (ICDs) more commonly present to the emergency department. These patients can have complex medical issues related to and independent of their pacemaker/ICD that require careful management by the emergency physician. This article will review the major diagnostic and therapeutic considerations in the emergency care of patients with pacemakers and ICDs.

Pacientes críticos portadores de marcapasos y desfibriladores automáticos

Pacemakers and automatic defibrillators are being increasingly implanted and thus more patients with these devices are being admitted to our Services. We should recognize these patients and be capable of understanding the functioning of the apparatus implanted. Scheduled when the patient was in a stable situation, its scheduling may not be sufficient in a pathological situation with increase of metabolic demands. It may even contribute to worsening the clinical picture that our patient has. Sufficient knowledge should allow us to recognize this problem and even to propose changes in the programming as part of the patient's treatment. Correct clinical management of these patients requires greater involvement in the understanding of these devices in our daily tasks.