LVAD AWARENESS for Paramedics/EMT/EMS Ambulance Companies. 911 PROTOCOL?

[LVADone]

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.

http://emtlife.com/profile.php?do=editsignature

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

 

[LVADone]

WHOA sorry for the LARGE font above... didnt think it would be o large and annoying!

Anyway, i think the bottomline is that the LVAD recipient should be carrying their manuals around with them as they travel. As it is we have to carry spare batteries and an extra controller/computer (worn around the waist) that monitors and powers the implanted LVAD.

Thanks

 

[LVADone]

Would an LVAD affect an EKG?

The EKG is unaffected overall, as it still reading the heart's function/activity, although the LVADis performing its task, the heart is still doing its job of pumping, however to med professionals familiar with the LVAD, they can see a slight difference.

thanks

 

[LVADone]

Oh, and OP correct me if I'm wrong, but these are not the same as the artificial heart. The patient's own heart still has to be working at least a little for these to work. Therefore cardiac drugs would still be indicated, because the patients heart does still have some function left, even if it's very poor function.

CORRECT, IN FACT THE LVAD ALLOWS THE HEART TO REST AND REPAIR ITSELF TO THE POINT THAT SOME RECIPIENTS ARE BLESSED WHERE THEY DONT HAVE TO GET A TRANSPLANT AS THE HEART RETURNED TO NORMAL... they call it hibernation.

Technically its a partial or Half of a mechanical heart!

thanks

 

[reaper]

Excellent website. Thank you for the link. I am halfway through it and it is very informative.

Thanks again for starting this thread.

 

[LVADone]

Excellent website. Thank you for the link. I am halfway through it and it is very informative.

Thanks again for starting this thread.

Glad you are making good use of it, i tried to register and they told me "patients" are prohibited LOL...

Thanks for your passion in saving lives...

 

[reaper]

Yes, they only let you register if you have an email account associated with a hospital or agency! Weird, but I guess they have their reasons. It is a good site though.

 

[LVADone]

Yes, they only let you register if you have an email account associated with a hospital or agency! Weird, but I guess they have their reasons. It is a good site though.

Thoratec sent me 3 emails and called me 2 times to apologize... and explained why... something about it being a online school and the Law with an Attorney General would penalize them LOL i already forgot exactly LOL

But they appreciate what i am doing and eventually I will be able to get in as my Son who is an EMT, will let me look over his shoulder... he will join EMTLIFE soon.

thanks

 

[JPINFV]

I'll see if they'll let me register an account as a medical student. I used my .edu account and listed my job title as a med student.

 

[reaper]

It should, as long as your email is associated with the school.

 

[firecoins]

A 911 call is made. A male patient collapses and seems too sluggish to move. An Ambulance is immediately dispatched to the location. The paramedics arrive and finds the patient sitting on the floor with his wife by his side. The male is conscious and answers the questions the paramedics ask.

He states he became dizzy and passed out. The patient continues to say that he has a Left Ventricular Assist Device (LVAD) implanted and grafted to his heart. The LVAD helps pump oxygen-enriched blood that his damaged heart can not do. The male patient also claims that due to the design of the LVAD, basic equipment WILL NOT detect his Blood Pressure nor Pulse. Special Dopler equipment will detect his vitals.

http://api.ning.com/files/UlNjvG5vp...BxvKB5U9vYh01jHjmXa1k4/HeartMate2THORATEC.jpg

It appears that the patient has lost color and is sweating. What next? There is a titanium heart/blood pump implanted to his heart. If needed, are chest compressions dangerous for this patient? The answer is YES! It can cause the LVAD to dislodge from the heart and the the patient can internally bleed.

I am a 47 yo male with an LVAD implant. I DONT HAVE the conventionally found Blood Pressure and i do not have a Pulse, However i am alive and well
I am trying to raise awareness of LVAD 911 PROTOCOL and to obtain more info from you the experts on how to spread this crucial topic. It is predicted that the LVAD will be as common as dialysis.

WHAT are your questions and or experiences?

I started a blog:

http://www.FromTheBottomOfMyLVAD.blogspot.com

showing the "Day In The Life Of AN LVAD RECIPIENT"

Thanks for your Help and interest.
Josh Morris

PS my son is EMT in NYC

weunder strict orders to take such pts to Columbia Pres.

 

[firecoins]

www.FromTheBottomOfMyLVAD.blogspot.com This hospital then sent me to Columbia Presbyterian Hospital in NYC because it was technologically advanced (its where president Clinton has his heart taken care of).

It is the only hospital in the NYC area that I know that can treat patients with LVADs.

 

[LucidResq]

Mr. Morris -

I think you'll be happy to hear that the famous anatomy exhibition Body Worlds and the Story of the Heart features an LVAD in situ (as it is normally is placed, displayed in a real human heart) and an informational video on how it works. I saw it yesterday when I visited the exhibit at my local museum.

This is an extremely popular world-wide touring exhibition of real human specimens preserved with a ground-breaking technique. I know a lot of health care students and professionals see this exhibit, and although it doesn't give any information as far as assessing or treating a LVAD recipient, at least it is planting the seeds of awareness and curiosity.

 

[mycrofft]

Now THIS is EMNTLIFE at its finest.

Or am I thinking about finding the right knife, window punch, boots, roof lights, sidearm...B)

Here's a supporting quick and dirty. Notice, NO EMS specific material, gotta thik.

OP, have any materials about what CAN be done for LVAD bearers? Jumper cables? Call AAA? (Sorry, see my avatar's caption).

Great post, I'm asking for permission to link to it elsewhere.

 

[LVADone]

It is the only hospital in the NYC area that I know that can treat patients with LVADs.

columbia pres was the 1st and is the most tech advanced... Montifiore hosp in the bronx started an LVAD program recently AND Westcher Hospital has started one too... in fact i hear on 1010wins news radio Westchester hospital is starting to advertise the their LVAD programs... the news and the LVAD is spreading

thanks

 

[mycrofft]

Apologize for reply above.

Link didn't post.

Thanks for permission to cross link to you blog.

 

[LVADone]

Mr. Morris -

I think you'll be happy to hear that the famous anatomy exhibition Body Worlds and the Story of the Heart features an LVAD in situ (as it is normally is placed, displayed in a real human heart) and an informational video on how it works. I saw it yesterday when I visited the exhibit at my local museum.

This is an extremely popular world-wide touring exhibition of real human specimens preserved with a ground-breaking technique. I know a lot of health care students and professionals see this exhibit, and although it doesn't give any information as far as assessing or treating a LVAD recipient, at least it is planting the seeds of awareness and curiosity.

Nice! i didnt know that, but it shows me/us that this LVAD is a serious subject that they thought willing to display... it really is the wave of the future... case in point, a few years ago if i had my heart attack, I WOULDNT be here exchanging info with you, writing my blog or being with my wife and family

BTW i have on my blog VIDEOS on how this LVAD WORKS AND AN early LVAD operation...

http://fromthebottomofmylvad.blogspot.com/2010/02/lvad-videos.html

thanks...

 

[LVADone]

Link didn't post.

Thanks for permission to cross link to you blog.

Thank you... this is my goal to inform and get informed

Thanks again

 

[LVADone]

Link didn't post.

Thanks for permission to cross link to you blog.

sorry, i didnt see this until now... what "Link didnt post"

thanks

 

[Jon]

Josh,

Thanks again for being willing to share... this is a awesome resource.

I've known of LVAD's prehospitaly in my area for over 5 years now. Haven't had the chance to transport a LVAD patient yet... but it is going to happen sooner or later.

Not only does the hosptial notify the primary EMS agency, the hosptial and/or the primary EMS agency notify their backups. In recent months, I've been aware of 3 patients living in my second-due area, and one that attended daily rehab sessions in my first-due.

We've also discussed the potential need for aeromedical transport for these patients to the LVAD center, in at least one case making a helicopter being placed on standby part of the dispatched response for an EMS call at that residence... we are located about 30-45 minutes by ground to the various LVAD centers.

Something I haven't seen yet - when the LVAD recipient leaves the house, they MUST have a trained companion with them - the companion is supposed to know how to troubleshoot the pump and be able to assist responders if needed... MAKE SURE TO LISTEN TO THAT PERSON! They are a subject matter expert... and you aren't.

Jon