Management of Patients with LVADs

Questions and Answers

What is the primary reason for proceeding with chest compressions in LVAD patients experiencing out-of-hospital circulatory arrest?

It eliminates the need for additional medical equipment.

It ensures the elimination of potential hypovolaemia.

It manages the patient's anxiety during the procedure.

It is associated with a low risk of harm and improves outcomes. (correct)

What is the role of ECG monitoring in patients receiving CPR, particularly those with an LVAD?

It provides reassurance to bystanders that care is being taken.

It is optional and not required if compressions are effective.

It is mainly for recording purposes for future audits.

It allows for the detection and management of arrhythmias like VF or VT. (correct)

In which circumstance should chest compressions be prioritized over the assessment of hypovolaemia in LVAD patients?

When LVAD flow is critically low and needs attention immediately. (correct)

When the patient is responsive and communicating well.

When the patient's vitals are stable and steady.

When the patient has a history of high blood pressure.

What is the appropriate action to take when witnessing recurrent VF or VT in an LVAD patient during CPR?

Commence defibrillation immediately. Signup and view all the answers

Why is adherence to ALS guidelines recommended during CPR for LVAD recipients?

They outline the protocols for restoring and maintaining effective circulation. Signup and view all the answers

What is a normal finding regarding blood pressure in patients with LVADs?

Hypotension is a normal finding. Signup and view all the answers

What should be transported with an LVAD patient to the hospital?

All emergency LVAD equipment including spare batteries. Signup and view all the answers

Which of the following is true regarding the management of a responsive LVAD patient with VT or VF?

The VAD center should be consulted before transportation. Signup and view all the answers

Which statement best describes how LVADs function?

They supplement cardiac function by draining blood from the left ventricle. Signup and view all the answers

As of January 2016, how many adult patients were receiving LVAD therapy in the UK?

207 patients. Signup and view all the answers

What has led to an increase in LVAD implantations?

Advancements in LVAD technology and limited donor hearts. Signup and view all the answers

Which of the following best describes the typical arrangement of LVAD components?

The pump is implanted and requires external batteries and a controller. Signup and view all the answers

Why is the measurement of blood pressure and arterial saturation described as challenging in LVAD patients?

Hypotension is common among LVAD recipients. Signup and view all the answers

What is a critical risk associated with restarting a non-functional LVAD after a prolonged period?

Release of thrombus leading to embolic stroke Signup and view all the answers

What should clinicians first do when they assess the circulation of an LVAD recipient who is unresponsive?

Check if the LVAD is running Signup and view all the answers

What equipment must LVAD patients take with them to the hospital?

Spare batteries and a spare control unit Signup and view all the answers

What is an essential aspect of the training provided to patients discharged with an LVAD?

Familiarization of friends or family with the device Signup and view all the answers

What is often true about LVAD recipients regarding their mobility post-discharge?

They are highly active within their communities Signup and view all the answers

What should be done immediately if an LVAD is discovered to have stopped?

Attempt to restart it without delay Signup and view all the answers

What is the purpose of the patient-specific protocol (PSP) provided to LVAD patients upon discharge?

To share with local ambulance services for reference Signup and view all the answers

What should clinicians avoid in assessing LVAD recipients to prevent delays?

Assessing for pulse Signup and view all the answers

Why might a loud alarm signal from the LVAD controller be an important indicator?

Indicates a stopped LVAD Signup and view all the answers

Which complication are LVAD recipients particularly vulnerable to?

Systemic infections Signup and view all the answers

What might prevent an appropriate assessment of pulse in LVAD patients?

Difficulty in detecting blood flow due to the device Signup and view all the answers

What is the typical time frame for LVAD non-function that raises concern for a patient?

More than a few minutes Signup and view all the answers

What design feature of the LVAD eliminates the possibility of using valves?

The rotary pump design Signup and view all the answers

Where does the percutaneous driveline typically exit the body?

Over the abdomen near the umbilicus Signup and view all the answers

What is the first step a clinician should take when dealing with an LVAD bag before troubleshooting?

Open the LVAD bag and check all connections to the controller. Signup and view all the answers

When should a clinician suspect that the LVAD controller is defective?

If both battery and mains power supply fail to restart the LVAD. Signup and view all the answers

What is a primary consideration if an LVAD patient is found unresponsive?

Contact the VAD centre for guidance. Signup and view all the answers

What should be assessed to ensure adequate circulation in an LVAD patient?

Cardiac rhythm and signs of adequate perfusion. Signup and view all the answers

What should be the first action taken if an LVAD recipient shows signs of ventricular fibrillation (VF)?

Attempt immediate defibrillation. Signup and view all the answers

What is the acceptable mean arterial blood pressure range for LVAD recipients?

60 to 90 mmHg. Signup and view all the answers

In the event of suspected cable fracture within the driveline, what action may help restore LVAD operation?

Gently manipulate the driveline. Signup and view all the answers

What is the controversy surrounding the application of chest compressions in LVAD recipients primarily based on?

Safety, efficacy, and timing of initiation. Signup and view all the answers

Which components of cardiac therapy may be installed in many LVAD recipients?

A combination of CRT pacemakers and ICDs. Signup and view all the answers

What should clinicians primarily look for to assess clinical signs of adequate circulation?

Capillary refill time and skin color. Signup and view all the answers

What should happen when active LVAD alarms are triggered?

They should be immediately reported to the VAD centre co-ordinator. Signup and view all the answers

What is a common misbelief about the management of patients with LVAD during emergencies?

Chest compressions are always effective. Signup and view all the answers

What is the role of the spare controller that patients with LVAD are advised to carry?

To connect when the main controller is presumed defective. Signup and view all the answers

Study Notes

Management and Resuscitation of LVAD Patients

The prevalence of patients with LVADs is rising, with management centralized in six UK adult cardiac transplant centers.
LVAD failure presents a critical emergency; responsive patients with ventricular tachycardia (VT) or ventricular fibrillation (VF) must be promptly transported for treatment.
Blood pressure (BP) and arterial saturation assessment can be difficult; hypotension is common in LVAD recipients, with mean arterial BP acceptable between 60-90 mmHg.
Dialogue with the VAD center is essential to determine the appropriate hospital for transport.
All emergency LVAD equipment, including controllers and batteries, must accompany the patient to the hospital.

Overview of LVADs

LVADs are internal pumps that aid cardiac function by drawing blood from the left ventricle into the aorta.
These devices are powered externally, requiring batteries or mains electricity and an external controller.
As of January 2016, 207 adults were on LVAD therapy in the UK, predominantly outpatient.
LVAD recipients are primarily ambulatory adults who may travel frequently, although they face risks like stroke, bleeding, infection, and thrombosis.
Upon discharge, patients and families receive extensive training regarding the LVAD, including emergency protocols.

Assessment Protocols

Assessment begins with evaluating the patient’s responsiveness and breathing; unresponsiveness may indicate LVAD failure.
For breathing patients, oxygen should be administered while identifying any other respiratory conditions.
Identification of LVAD function is crucial; clinicians should avoid unnecessary attempts to palpate pulses in severely ill patients, as conventional methods may fail.

LVAD Troubleshooting

If an LVAD is found not operating, immediate attempts to restart are prioritized.
Proper power connection and charged batteries are essential for LVAD function; a working controller is crucial for restarting.
If the primary controller fails, a spare controller should be employed; address potential cable fractures if issues persist.

Circulatory Status and Interventions

Circulation assessment involves checking the underlying cardiac rhythm and perfusion signs, with immediate action if any issues arise.
Many LVAD users may also have CRT pacemakers and ICDs; appropriate interventions for arrhythmias must be executed swiftly.
Constant assessment of circulation through clinical signs is essential; hypotension can be normal in LVAD patients.

Chest Compressions and Hypovolaemia Considerations

There is ongoing debate regarding the effectiveness of chest compressions in LVAD patients; however, short, high-quality compressions may be beneficial if traditional resuscitation fails.
Hypovolaemia must be addressed promptly, as it can significantly impair LVAD function, necessitating rapid assessment and intervention.

Emergency Protocols

Contact with the VAD center is critical in emergencies; patients should have identification cards that facilitate communication with the center.
Alarm signals from the LVAD controller should be reported to the VAD center for guidance on further actions.
Effective intervention hinges on maintaining clinical assessment standards while managing the unique challenges posed by LVAD therapy.

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Description

This quiz reviews the key points in the management and resuscitation of patients with Left Ventricular Assist Devices (LVADs). With the increasing number of LVAD implantations, understanding the urgent treatment protocols is vital for healthcare professionals. Test your knowledge on the protocols and emergency responses associated with LVAD care.