Medical Student Rosalind Franklin University of Medicine and Science Chicago, Illinois, United States
Introduction: Pediatric patients sometimes die with implanted neurosurgical devices still in situ. Post-mortem protocols for these devices remain unclear. Consequences of retained devices are explosion on cremation, and continued end of service or refill alarms. Such events can be distressing for family and friends of the deceased. Many neurosurgeons are unaware of manufacturer safety recommendations for indwelling devices. We present a survey of post-mortem protocols for industry partners and hope to provide a resource for general distribution to pediatric neurosurgical providers.
Methods: Nine companies providing indwelling devices used in pediatric neurosurgical populations in the US were surveyed via phone and email on post-mortem protocols. Cybernetic devices included intrathecal pumps, cerebrospinal fluid (CSF) shunts, deep brain stimulators, spinal cord stimulators, and vagus nerve stimulators (VNS).
Results: Two companies reported on intrathecal pumps and one company on VNS therapy systems. VNS systems must be explanted due to its sealed chemical battery that risks exploding at high temperatures. Both intrathecal pump manufacturers recommend explantation prior to cremation and to contact company representatives to deactivate the device, thus preventing future alarms. From the CSF shunt manufacturer replies, there were no post-mortem concerns and the device did not require explantation.
Conclusion : Standard recommendations and safety protocols for post-mortem indwelling devices are similar regardless of manufacturer. Intrathecal pumps used in pediatric neurosurgical populations should be explanted if cremation is desired. Contacting the manufacturer to deactivate the pump will prevent the pump’s alarm from sounding after the patient’s death. Shunts lack batteries, thus not posing a risk in cremation and lack alarm systems. With the results of this survey, we hope to create a public reference for neurosurgical providers to avoid added unnecessary distress for grieving families.
