What are the emergency management steps for a patient with a Left Ventricular Assist Device (LVAD)?

From the Guidelines

Emergency management of a patient with a Left Ventricular Assist Device (LVAD) should start with checking for responsiveness and activating the emergency response system, followed by assessing the device and initiating CPR if necessary, as outlined in the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. When managing an LVAD patient in an emergency, it's crucial to remember that traditional vital signs may not be reliable due to the continuous flow nature of the device.

• Check for signs of consciousness and perfusion rather than relying on traditional vital signs.
• Assess the device by inspecting the driveline for damage or infection, listening for the mechanical hum of the pump, and checking the controller for alarms or low battery warnings.
• If the patient is unresponsive with no signs of perfusion, begin CPR with chest compressions while avoiding dislodging the driveline, using cycles of 30 compressions and 2 breaths, and utilizing an AED as soon as it is available 1. Key considerations in LVAD emergency management include:
• Potential complications such as pump thrombosis, driveline infection, and device malfunction, which may require specific interventions like anticoagulation, antibiotics, or immediate contact with the LVAD center.
• The importance of cautious fluid resuscitation in cases of right ventricular failure.
• Carrying backup batteries and a controller as instructed during training.
• Contacting the patient's LVAD coordinator or center immediately for specific guidance on the patient's device model. Understanding the unique aspects of LVAD function and the potential for device-related complications is essential for providing effective emergency care 1.

From the Research

LVAD Emergency Preparedness

• LVAD patients are susceptible to various emergency medical conditions that require prompt recognition and intervention 2
• Emergency management steps for LVAD patients include:
  • Assessment of LVAD function, patient perfusion, and mean arterial pressure upon presentation 3
  • Electrocardiogram and bedside ultrasound as key evaluations in the ED 3
  • Team-based approach with consultation from an LVAD specialist 3
• Common complications in LVAD patients include:
  • Device malfunction/failure, pump thrombosis, and suction event (LVAD-specific) 3
  • Bleeding, cerebrovascular event, infection, right ventricular failure, dysrhythmia, and aortic regurgitation (LVAD-associated) 3
• Prehospital care for LVAD patients by emergency medical services (EMS) is crucial, with recommendations for emergency reference cards, training programs, and a 24-hour emergency hotline for the local VAD team 4
• Antiplatelet and anticoagulation strategies play a crucial role in LVAD management, with a thorough understanding of device, patient, and management necessary to optimize outcomes 5
• Emergency department evaluation and management of LVAD patients require a basic understanding of LVAD mechanics, a specific approach to patient evaluation, and awareness of potential complications and their management 6