ICD Deactivation

As you can appreciate, training paramedics for ICD deactivation is a complex undertaking. It involves not only increased paramedic education and specific training, but procedures or protocols (Medical Directives), and safety/quality programming.

The primary purpose of ICD deactivation is to prevent painful shocks for patients transitioning to end-of-life care, as their goals shift toward comfort. Studies show that up to 20% of patients receive shocks in the last week of life (1).

In the scenario you described, these discussions should have taken place well before paramedics became involved, ensuring that ICD deactivation was addressed before the patient was discharged home. In fact, the CPSO states that physicians have an obligation to initiate these conversations early (2). While healthcare providers have the right to decline participation in ICD deactivation, they are responsible for arranging an alternate provider who can ensure dignity and comfort at the end of life.

Although planned deactivation is the preferred approach, there may be instances where a patient rapidly deteriorates or experiences a catastrophic event, requiring urgent or unplanned deactivation. This is why temporary deactivation with specialized magnets is sometimes used. However, it's important to note that these magnets do not permanently disable the ICD—its function resumes once the magnet is removed (1, 2). Additionally, prolonged use of these magnets can cause skin damage, making them unsuitable for long-term solutions.

ICD deactivation is a non-invasive process but requires the consent of the patient or designated decision maker and a trained healthcare professional and a manufacturer-specific ICD programmer device (2). With various device models and programming options available, expertise is necessary to ensure proper deactivation.

Given these considerations, we strongly recommend that the patient’s palliative care team take an active role in the deactivation process.