Electrical activity with LVAD

[zzyzx]

The recommendation used to be not to do CPR with LVAD's, but just this year the recommendation has changed and I'm told we should do CPR. This is coming from an LVAD program director at my hospital job. I did not get a chance to ask her why the change. Follow your own protocols if you have one related to LVAD's.
Realistically though, if someone with a VAD is in arrest, they are dead.

 

[chaz90]

The latest review I read on CPR in pulseless LVAD patients only had 8 patients enrolled, but reported return of neurological function in 4 of them. The device was not dislodged in any of the 8 cases. It does beg the question of how "arrested" each patient was though as that can be so difficult to assess in this population.

 

[zzyzx]

Do you have a link? Thanks

 

[Aprz]

If you guys check out my earlier post, I put a link from Alameda County, CA on the different types of LVADs. Some of them are OK to CPR on and some of them are not. I believe not all areas are gonna have all different types of LVAD, but maybe one or two types. There are also not that many LVAD patients either. So I imagine the hospital or agency knows how many LVAD patients there are (a handful?), who they are, and what type of LVAD they are. In your guys area, they probably have LVADs that are safe to do CPR on.

That would be my guess as to why they changed their recommendation.

http://emtlife.com/threads/electrical-activity-with-lvad.42378/#post-590780

 

[chaz90]

Do you have a link? Thanks

http://www.resuscitationjournal.com/article/S0300-9572(14)00017-3/abstract

 

[zzyzx]

That's an interesting study. I do wonder what the details of the four successful resuscitations were.

 

[Seirende]

I had originally heard that LVADs came with hand pumps that you could use instead of chest compressions; EMCrit just told me that newer ones don't. Anyone know what the benefit of a design sans hand pump would be? Intuitively, seems like a good backup to have.

 

[EMT11KDL]

interesting podcast speaking about LVAD
http://emcrit.org/wee/left-ventricular-assist-devices-lvads-2/

 

[evantheEMT]

Can't get a palpable bp or pulse. It's important to be careful of the wire that's coming out of the pt as well.

 

[zzyzx]

Can't get a palpable bp or pulse. It's important to be careful of the wire that's coming out of the pt as well.

Unless it's a total artificial heart, in which case, since it's pulsatile, you will get both a BP and a pulse. However, you won't have any electrical activity since the heart has been removed (except for part of the atria). Artificial hearts are bridge devices like LVAD's, and they are becoming more common for people with heart failure waiting for a heart transplant to become available.

 

[evantheEMT]

Unless it's a total artificial heart, in which case, since it's pulsatile, you will get both a BP and a pulse. However, you won't have any electrical activity since the heart has been removed (except for part of the atria). Artificial hearts are bridge devices like LVAD's, and they are becoming more common for people with heart failure waiting for a heart transplant to become available.

True, but every pt is different and we may not be able to feel a pulse. Ems providers have to listen for the humming or feel for it. I've never actually had a pt with one yet but it would be interesting to do an assessment on them.

 

[zzyzx]

LVAD: often no palpable pulse. If you get a BP, my understanding is that it will not be accurate. ECG normal as for patient. Quiet operation, but you can auscultate the hum of the implanted pump. Defib and ALS meds ok. Most will recommend no CPR, but check local protocols.

Total artificial heart: palpable pulse and BP, but no electrical activity; no ECG. Very loud galloping sound from external pump; you will hear it before you walk into their room. No CPR, no defib or ECG possible.

 

[evantheEMT]

LVAD: often no palpable pulse. If you get a BP, my understanding is that it will not be accurate. ECG normal as for patient. Quiet operation, but you can auscultate the hum of the implanted pump. Defib and ALS meds ok. Most will recommend no CPR, but check local protocols.

Total artificial heart: palpable pulse and BP, but no electrical activity; no ECG. Very loud galloping sound from external pump; you will hear it before you walk into their room. No CPR, no defib or ECG possible.

Thank you sir

 

[Bullets]

We had a LVAD patient in town for a few months while he was waiting for a heart transplant. The facility that did the implantation and eventual transplant came down and ran multiple educational sessions for all our EMS and PD so we would be familiar with him, his condition and best treatment. At that time we were told no compression due to the concern for tearing out the connections. He has since received his transplant and is living well, so if there has been a change in the "No Compressions" rule then thats interesting. During his time with the LVAD he began having some chest pain and we called the director and decided to fly him to the home hospital. It was notable because we have a Level II hospital in town, so its the only outgoing medevac in the towns history.

It was a great example of the system, from heart transplant surgeon all the way down to street EMT working together for the best outcome of a patient. I really enjoyed the whole process