A Left Ventricular Assist Device (LVAD) is a mechanical pump implanted in the chest to help the failing heart move blood from the left ventricle to the aorta, ensuring continuous blood flow throughout the body. “Coding” refers to cardiac arrest, where the heart stops effectively pumping blood. Responding to cardiac arrest in an LVAD patient requires specialized knowledge because the device fundamentally changes circulation. Standard resuscitation protocols are significantly modified for a person with an LVAD. This guidance outlines foundational steps for this specialized emergency, but it is not a substitute for the specific emergency plan provided by the patient’s LVAD center.
Recognizing the Emergency State
Assessing an LVAD patient in an emergency focuses on signs of poor perfusion rather than the presence of a pulse. Continuous-flow LVADs, the most common type, typically eliminate the pulsatile blood flow needed to create a palpable pulse, meaning a pulse may be absent even when the device is working. Therefore, clinicians must check for clinical signs indicating that the body’s tissues are not receiving enough oxygenated blood.
Signs of inadequate perfusion include a sudden change in mental status, such as unresponsiveness or confusion. Other signs include changes in skin color, like a dusky, pale, or mottled appearance. The extremities may feel cold to the touch, and capillary refill time will be prolonged, taking longer than two seconds for color to return after pressure is applied.
Attention must also turn to the LVAD system itself, which provides real-time diagnostic information. The external controller connects to the implanted pump via a driveline and displays vital operational data, including pump speed (RPM), flow rate, and power consumption. High-priority alarms, often indicated by an auditory signal or flashing red light, suggest a critical device or physiological problem. These alarms may signal issues like low flow, a power source problem, or a driveline disconnection, all demanding an immediate response.
Immediate Steps and Device Checks
Once an emergency state is recognized, the first action is to call Emergency Medical Services (EMS). The operator must be clearly informed that the patient has an LVAD and, if known, the specific model. This alerts the responding team to the need for specialized protocols.
It is crucial to quickly manage the device’s power source to ensure the pump continues to operate, as power interruption is a common cause of pump failure. If the patient is near an outlet, the controller should be immediately connected to a primary power source using the AC adapter. Otherwise, check the batteries to ensure they are securely connected and adequately charged.
Next, rapidly assess the external device components to rule out easily correctable issues. Check the driveline connection to ensure it is securely plugged into the controller without damage. Note the controller screen for any active alarms, and record or verbally relay the displayed information (flow, RPM, power) to medical professionals.
Locating the patient’s emergency LVAD packet is a high priority. This document is an invaluable resource for the incoming EMS team. It contains:
- The patient’s specific device settings.
- Contact information for the LVAD coordinator.
- A pre-printed emergency medical information card.
The patient’s caregiver, who is trained on the device, can also provide immediate guidance regarding the device’s normal operation.
Understanding Resuscitation Protocols
The decision to initiate Cardiopulmonary Resuscitation (CPR) in a continuous-flow LVAD patient differs markedly from standard practice. The primary concern with chest compressions is the risk of catastrophic internal injury, such as dislodging the internal pump or cannulas, which can cause massive bleeding. Historically, CPR was often withheld due to this risk.
Current guidelines recommend initiating chest compressions only if there is definitive evidence of inadequate systemic perfusion. This may be indicated by an unresponsive patient whose LVAD is not functioning, or if other clinical indicators of no circulation are present. These indicators are typically assessed by medical professionals and include a critically low mean arterial pressure (MAP) or a very low end-tidal carbon dioxide (ETCO2) level. For the general public, CPR should be initiated only under the direct instruction of the LVAD care team or EMS personnel who are aware the patient has a device.
If the patient is unresponsive but the LVAD pump is confirmed to be working (indicated by an audible hum and stable controller parameters), the focus shifts to treating reversible causes of collapse, such as severe dehydration or a massive arrhythmia. Defibrillation is generally considered safe if a shockable rhythm is identified. However, the pads must be placed away from the internal pump’s location and the external battery pack or controller to avoid damaging the device or disrupting its function.
Documentation and Transfer of Care
Detailed information gathering must begin as soon as the acute emergency is addressed and professional help arrives. The caregiver or first responder should document the precise time the patient was found unresponsive and any interventions performed, such as connecting to a power source or changing a battery.
Any changes noted on the LVAD controller display (pump speed, flow rate, and power consumption) are important data points that must be recorded. This information is crucial for the receiving medical team to understand the sequence of events leading up to the crisis. The patient’s specific LVAD emergency packet must be handed directly to the EMS crew so the hospital team can quickly contact the patient’s LVAD coordinator for expert guidance.
Transporting the patient requires continuous monitoring of the LVAD and its power supply. All external components, including the backup controller, extra batteries, and charging unit, must accompany the patient to the hospital. A smooth hand-off to the emergency department staff, including a verbal summary of the event and the transfer of all documentation, ensures continuity of specialized care.