Topics

Zoll LifeVest
 What
it is
 Who
it treats
 How
does EMS handle these patients?
Topics

Ventricular Assist Devices
 What
they are
 What
they do
 How
to treat these patients
Video
Zoll LifeVest

Wearable AED
 Harness
 Control
Module
 Battery
 Three
Pads
 Electrodes
Who Uses Them?

ICD Removal

Potential for SCA

Current or old MI

Cardiomyopathy Patients
Statistics

Over 25,000 Patients

358 Saves

Dupage County

1 Save

200+% increase
How Do We Treat These Patients?

Normal AED Patient

Alarm will sound

45 seconds

Disable Vest
How Do We Treat These Patients?

Remove Battery
How Do We Treat These Patients?
Remove the vest
Itself

Ventricular Assist Devices
Video
Pulsatile Vs. Non-Pulsatile

Pulsatile
 Older

first generation models
Non-Pulsatile
 Second
/ Third Generation Models
VAD’s

Ventricular Assist Devices
 LVAD
 RVAD
 Bi-Vad
VAD
Who uses VAD’s?

7318 people were waiting for a heart

2210 received one

623 died waiting

~1200-1500 VAD implanted in 2008
Who uses VAD’s?

Bridge to Transplant

Bridge to Recovery

Destination Therapy
Field Considerations

Treat patient as an adult with special
health care needs.

Find family member or aide who is familiar
with equipment

Always treat the patient!
Field Considerations
If patient has an LVAD and it is working
properly, it is providing patient's cardiac
output and is not in time with patient's real
heart.
 Patient’s EKG rate will not equal pulse
rate. Instead pulse should be at rate of the
LVAD pump

Field Considerations



All VADs are dependant on adequate preload in
order to maintain proper functioning
Pump can “cavitate” if there is a decreased
preload
Volume resuscitation in an unstable VAD patient
is the first line of therapy before vasopressors
but be cautious with fluid as to not over load the
right ventricle in LVADs only
Field Considerations

Nitrates can be detrimental to a VAD
patient because of the reduction in preload
 Results
in decreased pump efficiency
 Consult with medical control before
administering nitrates per protocol

Initiate IV therapy with all VAD patients if
possible
Field Considerations
A patient can be in a lethal arrhythmia and
be asymptomatic. Treat the patient not the
monitor.
 Do not cardiovert/defib unless the patient
is unstable with the arrhythmia.
 Electrical shock from cardiovert/defib will
not damage any of the VAD equipment

Field Considerations

Chest Compressions are NOT
recommended. Chest compressions can
disrupt the implanted equipment causing
massive hemorrhaging.
Transport Consideration

If able, transport the patient with any other
pertinent equipment needed for the VAD
pump.
 Batteries
 Charging
unit
 Hand pump (if available)
Questions???
Sources
http://www.mayoclinic.org/hearttransplant/vad.html
 http://www.medicinenet.com/left_ventricula
r_assist_device_lvad/page2.htm
 www.mfri.org/dom/Drill_pdf/DM_0911.ppt
 http://www.uchospitals.edu/specialties/hea
rt/services/heart-failure/assist-devices.html
