What parameters should be monitored in a patient with a life vest (Automated External Defibrillator)?

Monitoring Parameters for Patients with a Life Vest (Wearable Cardioverter-Defibrillator)

Patients with a life vest should be monitored for device functionality, proper wear time compliance, cardiac rhythm abnormalities, and any signs of clinical deterioration. 1

Device Functionality Monitoring

• Check the indicator lights on the device daily to ensure proper functioning and battery status 2
• Regularly inspect the expiration dates of consumable components (batteries, electrode pads) 2
• Ensure the monitor/defibrillator unit is properly charged and operational 1
• Verify that electrode pads maintain proper contact with the skin to ensure effective shock delivery if needed 1

Patient Compliance Monitoring

• Track daily wear time - greater benefit has been demonstrated in patients who are compliant with wearing the device 1
• In the VEST trial, only 12 of 48 patients were wearing the device at the time of death, highlighting the importance of compliance monitoring 1
• Document any periods of non-compliance and address barriers to proper usage 1

Cardiac Monitoring Parameters

• Monitor for ventricular arrhythmias, particularly ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT), which are the primary arrhythmias the life vest is designed to treat 1
• Pay special attention to patients with left ventricular ejection fraction (LVEF) ≤35%, as they are at higher risk for life-threatening arrhythmias 1
• Track any recorded events or shocks delivered by the device 1
• Document any symptoms that occurred during recorded arrhythmia episodes 1

Clinical Status Monitoring

• Monitor for signs of worsening heart failure, particularly in patients with reduced LVEF 1
• Assess for symptoms of cardiac ischemia, as the risk of ventricular arrhythmias and sudden cardiac death is highest early after myocardial infarction 1
• Monitor electrolyte levels, particularly potassium and magnesium, as imbalances can trigger arrhythmias 1
• Track medication compliance, especially beta-blockers and antiarrhythmic therapy in patients with ventricular arrhythmias 1

Special Considerations

• For patients who have recently experienced myocardial infarction with LVEF ≤35%, more intensive monitoring may be warranted as they are at highest risk in the first month 1
• The life vest is often used as a bridge to ICD implantation, so regular reassessment of ICD candidacy is important 1
• If the patient has a history of high-degree atrioventricular block, additional monitoring for bradyarrhythmias may be necessary 1

Responding to Life Vest Alarms or Shocks

• After a shock is delivered, perform a thorough assessment including vital signs, ECG, and symptom evaluation 1
• Document the rhythm before and after shock delivery 1
• Check for proper pad placement and skin contact after a shock 1
• Review the stored event data from the device to confirm appropriate shock delivery 3

Pitfalls to Avoid

• Do not rely solely on the life vest for monitoring - it is designed primarily for treatment rather than continuous monitoring 1
• Be aware that the shock advisement algorithms may vary between different manufacturers, with discordance rates ranging from 6% to 11% 3
• Ensure patients understand that the life vest is not a substitute for seeking medical attention when experiencing cardiac symptoms 1
• Remember that transdermal medication patches should be removed from areas where defibrillator pads will be placed to prevent electrical arcing 1