LVADS

[kevmacc]

I was wondering how many of you out there are familar with VADs in Patients.Im 43 yrs young and had a heart attack in Dec08.Now I have an LVAD in me.I am always willing to talk about it teaching about etc.Feel free to talk to me about it.Im also a Pa EMT.

[itku2er]

Maybe you can start by giving us some insight as to what happened durning your MI that lead you to have a LVAD.

[spenac]

http://www.jems.com/news_and_articles/articles/jems/3208/the_high-tech_heart.html

http://www.chfpatients.com/implants/lvads.htm

CPR & other treatment: Due to the location of the LVAD and its proximity to the heart, there may be risks associated with performing chest compressions. CPR may damage the LVAD itself or dislodge tubing, resulting in massive hemorrhage. The use of hand pumping in place of CPR is possible and may be indicated in some situations. Decisions on whether or not to use CPR should be left to medical control.11

Further treatment considerations focus on physiologic changes related to their underlying disease process, such as dysrhythmias, electrical therapy (defibrillation/cardioversion), ACLS or trauma care. The use of electrical therapy depends on the make/brand of the LVAD. Keep in mind that the patient and family will be well versed in emergency procedures and know how to manipulate the LVAD system in case of an emergency.

The patient and family will also be educated on which kind of therapy the patient can or cannot receive, so emergency care providers should always keep the patient and their caregivers together during treatment and transport.

[VentMedic]

I was wondering how many of you out there are familar with VADs in Patients.Im 43 yrs young and had a heart attack in Dec08.Now I have an LVAD in me.I am always willing to talk about it teaching about etc.Feel free to talk to me about it.Im also a Pa EMT.

What make and model?

Continuous flow or pulsatile?

Battery pack?

Ejection fraction before implantation and after?

Mobility restrictions?

Full time knowledgeable caregiver and/or instructions to EMS accessible?

Specific EMS considerations for your situation such as medications?

Future plans?

Don't feel obligated to answer any questions you consider too personal.

[HERBIE1]

Went to an all day seminar a couple weeks ago about LVAD's. Turns out we have a couple patients in our area on the devices and I wanted to become more familiar with them. Amazing stuff.

Learned a lot, and the future is even brighter. The latest model, still in clinical trials but implanted in patients in Germany, is about the size of a hockey puck and is completely implanted within the chest.

Some of the devices are temporary while awaiting a transplant, while others are destination devices, designed for people who are not transplant candidates.

Take away points-

Use the LVAD coordinator, who is always assigned to LVAD patients. The patient/family/caregiver will have the number of this person and they are a great resource. They are familiar with the patient as well as the device and are more than happy to assist.

No CPR. These devices supplement or completely take over the heart's pumping, so compressions aren't really necessary. As was noted, compressions will probably damage the hoses. These devices are attached by boring a hole directly in the heart muscle and if the hoses are torn, the person will bleed out. Also, any problems you see will be from the patient, not the device, so treat the patient.

In the unlikely event of a pump/battery failure, some models also have manual devices which fit over the hoses to take over the pumping, and essentially look like esophageal detector devices used to confirm ET placement.

Vitals signs are also different- a lower systolic pressure is actually desirable- higher BP's and it may cause problems.

Probably the most interesting- and strange- a person may be in Vtach or Vfib. Unless they are symptomatic, immediate defibrillation or cardioversion may not be needed, especially if the person is conscious and awake. Take time, evaluate the person and their complaints and discuss with the LVAD coordinator and your medical control as to what you should do. Since they will be perfusing regardless of their rhythm, you have time to take a step back and see what other problems may need to be addressed- hypovolemia, electrolyte imbalances, fluid retention, etc .

Also, bring ALL the equipment with the patient- including back up devices and spare batteries.

There's more, but these are probably the biggies.

Fascinating devices, and truly life savers for people. We met 6 people who had these devices, one for nearly 5 years. They can lead relatively normal lives when before getting out of a chair was a struggle. One guy has traveled all over the world since having hi LVAd implanted 2 years ago,

I'm certainly no expert in LVAD's but at least I have a familiarity with these devices now.

Edited October 10, 2009 by HERBIE1

[fireflymedic]

Went to an all day seminar a couple weeks ago about LVAD's. Turns out we have a couple patients in our area on the devices and I wanted to become more familiar with them. Amazing stuff.

Learned a lot, and the future is even brighter. The latest model, still in clinical trials but implanted in patients in Germany, is about the size of a hockey puck and is completely implanted within the chest.

Some of the devices are temporary while awaiting a transplant, while others are destination devices, designed for people who are not transplant candidates.

Take away points-

Use the LVAD coordinator, who is always assigned to LVAD patients. The patient/family/caregiver will have the number of this person and they are a great resource. They are familiar with the patient as well as the device and are more than happy to assist.

No CPR. These devices supplement or completely take over the heart's pumping, so compressions aren't really necessary. As was noted, compressions will probably damage the hoses. These devices are attached by boring a hole directly in the heart muscle and if the hoses are torn, the person will bleed out. Also, any problems you see will be from the patient, not the device, so treat the patient.

In the unlikely event of a pump/battery failure, some models also have manual devices which fit over the hoses to take over the pumping, and essentially look like esophageal detector devices used to confirm ET placement.

Vitals signs are also different- a lower systolic pressure is actually desirable- higher BP's and it may cause problems.

Probably the most interesting- and strange- a person may be in Vtach or Vfib. Unless they are symptomatic, immediate defibrillation or cardioversion may not be needed, especially if the person is conscious and awake. Take time, evaluate the person and their complaints and discuss with the LVAD coordinator and your medical control as to what you should do. Since they will be perfusing regardless of their rhythm, you have time to take a step back and see what other problems may need to be addressed- hypovolemia, electrolyte imbalances, fluid retention, etc .

Also, bring ALL the equipment with the patient- including back up devices and spare batteries.

There's more, but these are probably the biggies.

Fascinating devices, and truly life savers for people. We met 6 people who had these devices, one for nearly 5 years. They can lead relatively normal lives when before getting out of a chair was a struggle. One guy has traveled all over the world since having hi LVAd implanted 2 years ago,

I'm certainly no expert in LVAD's but at least I have a familiarity with these devices now.

Wonder if you were at the same thing I was at...got quite the education that's for sure and a ton of take home stuff to study further and the guy that does the implants for university gave us his card and contact number that he or someone affiliated with their LVAD program could always be reached at with questions. Really awesome and learned alot. I'm still learning, cardiac stuff fascinates me without question as does neuro stuff so right now I'm digging into some of the things that have perked my interest lately, especially a couple things that I've seen in patients.

[HERBIE1]

Wonder if you were at the same thing I was at...got quite the education that's for sure and a ton of take home stuff to study further and the guy that does the implants for university gave us his card and contact number that he or someone affiliated with their LVAD program could always be reached at with questions. Really awesome and learned alot. I'm still learning, cardiac stuff fascinates me without question as does neuro stuff so right now I'm digging into some of the things that have perked my interest lately, especially a couple things that I've seen in patients.

Went to Oak Lawn, Illinois.

We got to play with the various models- learned how they work, how to change batteries, etc. Hands on stations with the company reps as well as the LVAD coordinators. Since they are on call 24/7 and very anxious for us to utilize them. I actually have their phone numbers programmed in my personal cell phone. If I know we are going to an LVAD patient, I will be on the phone with them before we even arrive on the scene.

[itku2er]

We have had a couple of people in the NH with them but not much we can do normally they are DNRS.

*Is still watiting on Kev to tell me his story if you dont want to share it here you can always PM me with it.*

[chbare]

Strange, LVAD patients who are DNR. They must be destination therapy patients.

Take care,

chbare.

[VentMedic]

We have had a couple of people in the NH with them but not much we can do normally they are DNRS.

Some of our LVAD patients have been DNRs but they are still treated within reason. It only means they want no further heroic measures if they code especially outside of the hospital environment. Others who are a DNR are those that are no longer on a transplant list for whatever reasons. A DNR of any type can be reversed for surgery and some DNRs are also of a limited type depending on the state and local paperwork.

Edited October 10, 2009 by VentMedic