2017 Volume 5 Pages 45-52
[Case] A 69-years-old man was suffering from end-stage renal failure and had received hemodialysis for 10 years. His past medical history included successful resuscitation after cardiopulmonary arrest that occurred at home in October, X year. [Present History] The patient lost consciousness before hemodialysis and was taken to the emergency center of our hospital by ambulance in March, X+2 year. He was in a state of cardiopulmonary arrest on arrival, was resuscitated by critical care, and was started on continuous hemodiafiltration with a circulation assist device after coronary intervention. Consequently, his cardio dynamics became partially stable but clinical signs predicted poor outcomes due to hypoxic encephalopathy, electroencephalogram and head computed tomography.
[Course/Discussion] Specialists of emergency medicine, cardiovascular medicine and blood purification conferred to adapt the “Guidelines for End-of-Life Care in Emergency/Intensive Care Medicine (JAAM, JSCIM & JCS, 2014)” and the “Proposal for the Shared Decision-Making Process Regarding Initiation and Continuation of Maintenance Hemodialysis (JSDT, 2014)”. After deciding the treatment policy with his family and ceasing renal replacement therapy, the patient died. This case reveals the difference between emergency/intensive care physicians and blood purification professionals in terms of ceasing renal replacement therapy and the basic stance toward end-of-life treatment.
