LVADone
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I'm wondering, what are providers supposed to do if they find an LVAD patient unresponsive and apneic?
Since they have no pulse, they could be in... arrest, as in their machine stopped working, and in that case, you are not supposed to compressions... so what, you just call it a day, pack up, and go home?
?
Awesome, thanks for the info. I will pass this along to everyone in my fire department and the ambulance crew.
Hmm... couldn't find anything specific to LVADs in cardiac arrest either on Up-To-Date or EMedicine.
I'm definitely interested in the 911 protocol in place to revive LVAD patients. Please post it when you find it!
I would suggest a bracelet for ID. More likely to be noticed right away.
do you wear medical id?
Those were the same questions I had (well, except for the shower thing! ). And cardiac drugs won't help, right, because the patient's heart is already effectively damaged beyond repair, or they wouldn't have the LVAD in the first place?
Maybe as these devices become more common, we will start to be equipped with the proper tools to measure vital signs in LVAD patients - if they ever do become that common (look how common diabetes is - and most of the time EMT-Bs don't use glucometers).
Ok, I stopped being lazy and went and looked up the protocol. Yes, it does have instructions for 3 separate LAVD devices. Two for different versions of the HeartMate, and one for VentrAssist.
It gives specific instructions in how to deal with failure in each, including how to hand pump and what to look for when hand pumping. This also includes indications that the device itself has broken some how. It looks like only one of the 3 has hand pump instructions, so I'm guessing it is the only one that has that feature. For that one it says DO NOT to compressions, for the other 2 it says you can.
Our protocols also allow for diverting to the pts "home base" to pick up back up equipment before transporting to the hospital. We do have to bring these patients to a specific hospital, and we are to notify the LAVD on call person ASAP. Even if the pt is being transported for a non cardiac issue, like a broken arm.
There is an on-call "mechanical heart specialist" that we have a direct phone number for, and from what the protocol says, call them and they will talk us through anything we need to do. I'm guessing the person is a doctor, and can give online med direction for what we should and shouldn't do.
Good question. I'll see if Up-To-Date has anything on it when I get home later tonight.
We have a LAVD program at one of our local hospitals, and we also have about 10 pages of LAVD protocols in our books, including step by step instructions on how to run the thing, complications etc. It's actually so long because I think it covers 3 different devices. I admit I would have to look. It's not a protocol I tried to memorize because if I need to use it I'm going to have the protocol book out.
As explained in said protocols, the LAVD should be equipped with a manual pump. From what it sounds like it would look similar to a BP cuff pump, and you can manually run the device in the event it fails. I'm assuming that is what you would do if CPR was needed. Everything else would be run the same, but instead of compressions you would manually pump the device.
Well,
I have done some reading up on LVAD's and emergency situations.
First you have two types of LVAD's. You have the Heartmate design, like the OP has. That is a continuous flow pump and does not produce pulse or BP.
Then you have a Pulsatile pump. These do have pulses and BP's.
Almost all pumps come with a manual pump, for back up. This is to be tried before Compressions are used. If it comes to that point, compressions may be used as last resort.
A pt with an LVAD will still show a sinus rhythm on the monitor. The left ventricle is the only part effected by the pump.
This is something that each provider needs to research and talk to you system about the treatment of these pt's.
Thanks ALL for your research and offering the info you have... much appreciated.
Showers are allowed once the entry point in the abdomen heals "enough" around the driveline that powers the LVAD. BATHS and SWIMMING are not permitted.
MY Model LVAD is the newest one called the HeartMate ll. It is a constant flow pump which causes me not to have a pulse. ALSO my LVAD/Heartmate ll is not outfitted for a hand pump.
With that said, my LVAD model is already the most popular, because it is a small device so it will fit inside all types of bodies; where the older models are too large to fit smaller framed people... especially women. Another point why this LVAD is the most common is because it has only 1 moving part, reducing the risk of breakdown.
My hospital told me that THORATEC does have a website called thoratecU.com where medical professionals can register/take FREE online courses/download material etc. It also offers a Emergency Response program.
thanks.
Again...
www.thoratecU.com for FREE online courses and training material