With any technology booming many times things move faster then our education in the medical profession. I think its time to talk about LVAD’s. These devices over the last 20 years has gone from the size of large room to a brief case and then eventually a fanny pack.
Many of these patients are awaiting a heart on the transplant list. These devices work with great efficacy and are now starting to get implanted in patients with congestive heart failure patients. With approx. 5.8 million people in the US with the diagnosis of congestive heart failure, our interactions with these devices are only going to grow.
These devices are pretty simple and straight forward. Its an electric rotary pump connected to assist the left ventricle. The rotary pump spins the blood and uses the centrifugal force to drive the blood through. These pumps usually don’t fail but other medical emergencies arise. The families and patients are very well educated on the device prior to release from the hospital. So them calling 911 is relatively rare.
You don’t need to know everything about the device, just be able to identify it.
So there is a really good guide out there for emergency providers. Put it on your phone, in your ambulance and have it available. The guide from the link below tells you how to care for the device. Its great for trouble shooting it. Many of these devices will not create a pulse or blood pressure. that’s why the guide is so important. These devices have a color tag that coincides with the emergency guide for quick reference. The LVAD Guide.
This guide is a can tell you if you can do CPR without dislodging the device. (With this being attached to the heart it might be an important to know) As well as all the alarms, and even a blood pressure.
Don’t get distracted by the device, treat the patient.
Just like a trauma its easy to get distracted and sucked in. Our assessment always starts with ABC’s. With the mechanical circulatory support devices it becomes Airway, Batteries and Critical alarms. If you don’t find any problems there move on. The device is then working as its supposed to. Treat the patient. Many of the problems with the device can be addressed batteries and critical alarms.
Airway, Batteries and Critical alarms
Not only are we looking at airway in the traditional sense but at the device. When we run into something like the total artificial heart we need to ensure its hoses and air intake is clear of kinks and obstruction. Secondly make sure the device has battery power or external power from an outlet. Lastly look to see if the device has any audible or visible alarms and address accordingly. Oh and don’t remove both batteries at the same time, bad things will happen.
Addressing low flow alarms
Because the LVAD is is a pump it runs into trouble when its not getting enough fluid. A reduced preload by dehydration is the most common cause. As emergency professionals we run into this all the time but in this case the blood pressure isn’t our most reliable means of assessment. A low flow alarm maybe our only indication of this. Many of these patients have spent several years on fluid restricted diet and on diuretics. Since at this time renal failure patients are not candidates for LVADs a fluid bolus is the best remedy for the problem.
Other LVAD problems to look for
Due to the nature of blood spinning thru a rotary pump it can cause some damage to clotting factors. Nose and GI bleeding can be common in these patients as well as hemorrhagic strokes.
The total artificial heart is a totally different ball game.
From design to and function, the total artificial heart is treated differently. For starters in its design it is a pneumatic pump(air powered) and not rotary. Since this acts more like the real thing you will have a pulse and blood pressure. You will not however do CPR as you may dislodge the device. You won’t have you worry about arrythmias as this patient will be asystole on the monitor. You also won’t be administering vasopressors as well.
One of the things to look for is kinked lines since its pneumatic. Other than a little bit of freak out factor its pretty simple care. The most challenging thing you may run into with this device is if it has a total failure. If that occurs patients are sent with a backup driver to power the heart.
In Summary
Many times we run into these patients we have some pucker factor simply due to the unknown. As long as we are aware of the resources like the care field guide and patients family we are in good hands. Address your ABC’s and move on. Lastly make sure when these patients are transported to bring everything including spare batteries and charger.