LVAD 

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Use approved reference document for medication dosing, electrical therapy, and equipment sizes. 

□ Focus on rapid and early BLS airway and ventilation tools. Intubation may not be the best option for these patients. 		□ Cardiovascular compromise  
□ Cardiac arrest  
□ Medical or injury-related event not involving the cardiovascular system or □ VAD malfunction		□ Infection  
□ Stroke/TIA  
□ Bleeding  
□ Arrhythmias  
□ Cardiac tamponade  
□ CHF  
□ Aortic insufficiency  
□ LV thrombus

Clinical Management Options

EMT-B
• Oxygen, target SpO2 92 – 96% 
• Basic Airway Management as needed 
• Bring batteries/equipment with the patient
• Assess for Pump Malfunction and contact VAD coordinator 
• BJH VAD Nurse Coordinator: 314-454-7687 
• If Pump not working and in cardiac arrest, start CPR 
Paramedic
• Vascular access 
• 12 lead ECG
• Consider IV Fluid Bolus if the patient appears dehydrated/history consistent with fluid loss
• Epinephrine for signs of poor perfusion that is not improved with IV fluid boluses
Consult Online Medical Control as Needed

Pearls

  • Transport patients to the hospital that placed the LVAD
  • Patients with LVADS can have medical issues NOT related to the LVAD (such as the stomach flu). Take a thorough history and physical, treat the cause 
    • Low volume should be given volume
    • Avoid volume and move straight to push-dose pressors if the patient has a history and exam related to elevated volume
  • Patients should go to the center that placed the VAD in them whenever possible. 
  • You do not need to disconnect the controller or batteries to: 
    • Defibrillate or cardiovert  
    • Acquire a 12-lead EKG  
  • Automatic non-invasive cuff blood pressures may be difficult to obtain due to the narrow pulse pressure created by the continuous flow pump.  
  • Flow though many VAD devices is not pulsatile, and patients may not have a palpable pulse or accurate pulse oximetry. 
  • The blood pressure, if measurable, may not be an accurate measure of perfusion.  
  • Ventricular fibrillation, ventricular tachycardia, or asystole/PEA may be the patient’s “normal” underlying rhythm. Evaluate clinical condition and provide care in consultation with VAD coordinator. 
    • Do not shock Vtach/Vfib if the patient appears well-perfused
  • The patient’s travel bag should always accompany them with back-up controller and spare batteries  
  • If feasible, bring the patient’s power module, cable, and display module to the hospital. 
  • All patients should carry a spare pump controller with them. 
  • The most common cause for VAD alarms is low batteries or battery failures. 
  • Although automatic non-invasive blood pressure cuffs are often ineffective in measuring systolic and diastolic pressure, if they do obtain a measurement, the MAP is usually accurate.