Notes – Implantable Ventricular Assist Devices

Implantable Ventricular Assist Devices

Notes/Educational Pearls

  1. You do not need to disconnect the controller or batteries in order to:
    1. Defibrillate or cardiovert
    2. Acquire a 12-lead EKG
  2. Automatic non-invasive cuff blood pressures may be difficult to obtain due to the narrow pulse pressure created by the continuous flow pump
  3. Flow though many VAD devices is not pulsatile and patients may not have a palpable pulse or accurate pulse oximetry
  4. The blood pressure, if measurable, may not be an accurate measure of perfusion.
  5. 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
  6. The patient’s travel bag should accompany them at all times with back-up controller and spare batteries
  7. If feasible, bring the patient’s power module, cable, and display module to the hospital
  8. All patients should carry a spare pump controller with them
  9. The most common cause for VAD alarms are low batteries or battery failures
  10. 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
  11. Other VAD complications:
    1. Infection
    2. Stroke/TIA
    3. Bleeding
    4. Arrhythmias
    5. Cardiac tamponade
    6. CHF
    7. Aortic insufficiency

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914069 – General-Medical Device Malfunction
  • 9914065 – General-Indwelling Medical Devices/Equipment

Key Documentation Elements

  • Information gained from the VAD control box indicating any specific device malfunctions
  • Interventions performed to restore a malfunctioning VAD to normal function
  • Time of notification to and instructions from VAD-trained companion and/or VAD coordinator

Performance Measures

  • Identify and mitigate any correctable VAD malfunctions
  • Perform CPR for patients in cardiac arrest when indicated

References

  1. Garg S, Ayers CR, Fitzsimmons C, et al. In-hospital cardiopulmonary arrests in patients with left ventricular assist devices. J Card Fail. 2014;20(12):899-904.
  2. Mabvuure NT, Rodrigues JN. External cardiac compression during cardiopulmonary resuscitation with left ventricular assist devices. Interact Cardiovasc Thorac Surg. 2014;19(2):286-9.
  3. Mechem M. Prehospital assessment and management of patients with ventricular-assist devices. Prehosp Emerg Care. 2013;17(2):223-9.
  4. Shinar Z, Bellezzo J, Stahovich M, Cheskes S, Chillcott S, Dembitsky W. Chest compressions may be safe in arresting patients with left ventricular assist devices (LVADs). Resuscitation. 2014;85(5):702-4.