search terms: VAD, LVAD, code, controller, alarms

Background: Copy Link

 The left ventricular assist device (LVAD) is a mechanical internal heart pump used to treat heart failure. The pump provides continuous blood flow from the left ventricle to the aorta and requires an external controller and power source to run the pump.   In 2018, the UR VAD Program adopted AHA commendations: E xternal chest compressions are advised for LVAD patients with signs of inadequate perfusion even when the pump is noted to be working (+ hum in chest). 

Assessment of the LVAD Patient Copy Link

Continuous-flow physiology and the resulting narrow arterial pulse pressure create a challenge in assessing and measuring vital signs with traditional methods.   

• Patient may have a weak or absent radial pulse
• Assess adequate perfusion: mentation, skin color and adequate capillary refill
• Listen for a VAD humming sound where the heart is
• Measure blood pressure by Doppler if the patient does not have a palpable radial pulse
  • Find arterial flow with Doppler
  • Increase cuff pressure until signal goes away
  • Decrease pressure until signal returns
  • Opening sound is surrogate for MAP
  • May utilize manual cuff and calculate MAP if patient has a palpable radial pulse
• Pulse oximetry reading can be inaccurate: 
  • Normal pulse ox reading is likely true
  • Low pulse ox reading may not indicate true hypoxemia and the probe shall be repositioned
• Identify and treat life-threatening events as you would with any other patient
• Cardioversion/defibrillation can be performed on an LVAD patient
• Consider ECPR in this patient population 

Assessment of the LVAD System Copy Link

• Find the percutaneous lead (the driveline exiting the abdomen) and ensure it is connected to the controller
• Verify controller is connected to adequate power
• Review controller for Advisory or Alarm Messages
  • See attachments for LVAD alarm guides
• Listen for a VAD humming sound where the heart is
• If unable to auscultate VAD hum after thorough check of  connections and change of power source
  • Change to backup controller (see controller changeout video below)

SMH VAD ACLS Algorithm for Respiratory and/or Cardiac Arrest Copy Link

Call Code Team alert by dialing x5-STAT or (x5-7828). Identify the unit, room, and notate LVAD patient. A Code Team page is used to indicate a cardiac or pulmonary arrest in an inpatient , outpatient, or visitor area. As LVAD pump provides continuous blood flow, palpable pulses are often absent in these patients and blood pressure measurement by an automated cuff may be inaccurate. Utilize algorithm below in addition to the UR CPR guideline 2.01 Code Team Response – Adult and Pediatric

• The use of an external compression (LUCAS) device on VAD patients is permitted 

Controller Change Out Videos: Copy Link

HMII/Hm3 Change out video: https ://vimeo.com/256842958

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HVAD Change out: https://vimeo.com/256850229

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Emergency Providers Resources: see attachments Copy Link

References: Copy Link

1. Givertz, M., Bonnell, M. et al. Consensus Statement HFSA/SAEM/ISHLT clinical expert consensus document on the emergency management of patients with ventricular assist devices. JHLT 2019 Vol 38(7) 677-698.  https://doi.org/10.1016/j.healun.2019.05.004

2. Peberdy, M. et a. Cardiopulmonary Resuscitation in Adults and Children with MCS. Circulation 2017; 135e1115-e1134.

3. Yuzelfpolskaya, M et al. Advanced cardiovascular life support algorithm for the management of the hospitalized unresponsive patient on CFLVAD support outside the intensive care unit. European Heart Journal: Acute Cardiovascular Care 2016 Vol. 5(8) 522-526.