LVAD PowerPoint/training?

OkEMT

Forum Crew Member
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I was wondering if anyone had an LVAD PP that they would be willing to share? The audience will be a mix of EMTs and paramedics. I've searched quite a bit through the Googlesphere and most of the presentations I've found are either in-hospital management or much older stuff that's lost relevancy. Any help would be greatly appreciated! Thanks guys.
 

VFlutter

Flight Nurse
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Do you actually have an LVAD patient in your district or will be transporting these patients? Best bet is to contact the LVAD Coordinator at your hospital and see if they can set up a hands-on class. Much of the critical skills like changing batteries or controllers is best learned in person. Print out the specific reference for the type of LVAD the patient has or that is placed by the hospital and keep it on the ambulances.

https://www.mylvad.com/medical-professionals/resource-library/ems-field-guides/ems-guide-full-document

Besides that only thing you can do for these patient's is fluid, fluid, and more fluid. Doppler for MAP. Basic assessment skills of mental status, skin, etc. Make sure they are truly dead and not just unresponsive with non-pulsatile flow before doing CPR. Pretty basic. Actual issues with the LVAD are pretty rare and most of the time you will be called for unrelated medical issues and co-morbidities. If it happens to be an actual pump issue, that you can fix, then you really need to be familiar with that specific model/brand or you likely won't be able to quickly correct the issues under stress.

The LVAD should have a phone number to the coordinator or hospital for any issues. Family members are usually well trained.
 

Peak

ED/Prehospital Registered Nurse
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Like @VFlutter said you really need to contact whichever local programs are placing LVADs.

Different surgeons have huge differences in which LVADs they like to place. We see a lot more membrane pumps like the Berlin heart in pediatrics, and these still produce a pulse (although it is extremely rare to see pediatric LVADs, RVAD, or BiVADs outside of the hospital).

There is also a very limited amount we can do to correct problems with LVADs in the field, so short of an easy problem like replacing battery packs if they are having a real cardiac issue transport is essentially mandatory.

It is also imperative that these patients be taken to a hospital that at a minimum has a cardiothoracic surgery program, should be a facility that can place VADs, and ideally the hospital that placed the VAD in the first place.

Also keep in mind that VADs are temporizing measures for the sickest of heart failure patients. While there are many patients who successfully bridge to transplant there are many who do not. When these patients further deteriorate there is often a very poor prognosis. They also increase the risk for carditis, stroke, and a myriad of other complications. Compressions are generally considered contraindicated as they can dislodge the device, but this certainly is approached on a case to case basis.

For centrifugal pumps you should hear a hum on ascultatuon that suggests if the pump is functioning internally, this is certainly not exclusionary for pump failure or other complication but is about the most your going to get in the field. These patients are at high risk for VF/VT, so an EKG and consideration of electricity or drugs should be made.
 
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