Silver Cross EMSS
March 2013 EMD CE
LVAD
Anatomy of the Heart
• The heart can be thought of as 2 pumps in one
• The right atrium and ventricle is a low pressure
pump because it only has to pump blood to the
lungs for oxygenation
• The left atrium and ventricle is a high pressure
pump because it has to pump all of the
oxygenated blood from the lungs to the rest of
the body
• A VAD or Ventricular Assist Device can assist the
Left Ventricle, Right Ventricle or both ventricles in
pumping blood when the ventricles need help
The Heart
Low pressure pump
High pressure pump
Before VADs
• In the old days, when someone needed a heart
transplant, they were often stuck in the hospital.
• They were hooked up
to large heart pumps.
• Their life-spans were
very short.
• They often died before
a new heart became
available.
A Ventricular assist device, or VAD, is a mechanical circulatory device that is used
to partially or completely replace the function of a failing heart. Some VADs are
intended for short term use, typically for patients recovering from heart attacks or
heart surgery, while others are intended for long term use (months to years and in
some cases for life), typically for patients suffering from congestive heart failure.
VADs need to be clearly distinguished from artificial hearts, which are designed to
completely take over cardiac function and generally require the removal of the
patient's heart. The unit below is for in-hospital use.
Ventricular Assist Device or VAD: Is an artificial device
implanted in the chest to assist a damaged or weakened heart.
An LVAD is a LEFT Ventricular Assist Device
Sometimes also referred to as an LVAS (Left Ventricular Assist System).
There are Right Ventricular (RVAD) and Bi-ventricular (BiVAD) devices too,
but the Left is the most common.
Due to its design, basic equipment will not detect a blood pressure or pulse
even when the unit is working and the
patient is alive and talking.
Special Dopler equipment is necessary
and 60–90 mmHg is the acceptable range.
VADs are designed to assist either the right (RVAD) or left (LVAD) ventricle, or
both at once (BiVAD). Which of these types is used depends primarily on the
underlying heart disease and the pulmonary arterial resistance that determines
the load on the right ventricle.
Why the LVAD
• The LVAD is, in effect, a portable heart pump.
•Connected to the left ventricle, which does the major work of
pumping blood through the body.
•Worn with chest harness and fanny pack.
•So advanced, patients can wear them for years if necessary
•Until a donor heart is available or as an end treatment
A short video
• One of the most commonly used LVADs in the area
is the Thoratec HeartMate II.
• The Thoratec company has released a training film
for EMS responders.
• Click here ↓ for the LVAD video from Thoratec:
http://www.thoratec.com/videos/pc-considering-vad.aspx?id=pc_hm_xveLvasPatEduProg
• There are other brands on the market.
– If you have patients with LVADs in your community,
confirm with them which models they carry and how
EMS instructions may differ.
Popularity of LVAD
• So advanced that many patients now use
them not while waiting for a heart, but as an
end-treatment.
• Research suggests releasing patients home
with LVAD contributes to positive outcomes.
• Studies show depression and co-morbidities
normally linked to heart surgery and
transplants are much lower with the LVAD.
VP Dick Chaney has one
DO NOT PERFORM CPR
IF PATIENT HAS A
Ventricular Assist Device
While the patient may appear unconscious and not seem to have a pulse the
pump is still circulating blood and can keeping the patient in a viable condition.
Pressure on the chest (chest compressions) may cause the tubing to detach
from the heart or damage the device itself causing severe internal blood loss
and the patient could bleed to death.
Unless the patient is in obvious cardiac arrest and the pump isn’t working, then
use the assistance of the VAD coordinator or Medical Control to figure this out
before any compressions are performed.
Special Care Considerations
• Let patient and/or caregiver lead/advise. They will be the
experts.
• Defibrillation/cardioversion may be performed as normal,
but pads should not go over the device that is under the
patient’s skin.
• Advise EMS these patients typically have an extremely
reduced pulse rate or none at all.
• Advise EMS to be careful no cords are cut, kinked, or
twisted.
• Advise EMS to take the patient’s emergency travel bag
when leaving the scene. It has an extra controller,
batteries and the VAD coordinator’s emergency contact
number.
Transport Considerations
• Use of aeromedical transport may be
considered, depending on the length of
transport and the patient's condition. Every
attempt should be made to contact the
patient's doctor or emergency contact person
to identify the nearest implant or transplant
center. Patients should then be transported to
that identified center by the most appropriate
means of transportation.
An example of a call
- 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.
Another call example
• On arrival at the scene, Ambulance 1 finds First Responders are
preparing to start CPR. In a tense and somewhat confused voice,
the Officer says, “He has no pulse, but his wife won’t let us do
CPR. What should we do?” An EMS member from Ambulance 1
immediately feels for his pulses and finds none. Then he hears
the man’s wife repeatedly saying, “He has a VAD.” The medic sees
a cord coming out of the patient’s abdomen, connected to a small
electronic pack attached to the patient’s belt. His ECG shows
ventricular tachycardia (v tach), and his wife hands you a card and
says, “Call this special ventricular assist device consultation line;
they will tell you what to do.”
• In this case, the patient is lucky his wife is present to stop the
responders from starting compressions and causing further harm.
LVAD wrap-up
• LVAD patients usually contact local fire departments
and ambulance services to offer training.
• If unsure how to treat an LVAD patient on scene,
contact medical control and the patient’s hospital
liaison (VAD Coordinator) as soon as possible.
• Again, remember this CME only covered the most
common LVAD in the Chicago area.
– Other models may require different procedures for CPR,
for example hand-pumps, etc.
EMD Instructions
The EMS System has no protocol for LVAD
patients and there’s nothing in the EMDPRS to
address these patients. You can refer the caller
to the patient’s doctor or LVAD coordinator for
further instructions and send an ambulance.
If callers are asking for specific help (i.e. CPR,
bleeding control, etc.) refer to the proper
protocol. Advise EMS that there’s an LVAD
patient and pass along any other pertinent
information to responders.
SUGGESTION
Work with your fire departments and
community to identify “Special Needs”
patients, before they call 9-1-1.
Keep a database or CAD notes on these patients,
with considerations for special situations.
Additional Info
http://www.mylvad.com/ems
Visit this web site for additional information on
EMS treatment of LVAD patients and a
complete guide of the various models.
YouTube has many inspirational stories and
training videos on LVAD patients also.