Here’s Dr. DiMare with today’s Morning Report!
WTF? = What the …fanny-pack?
What is an LVAD?
– Left ventricular assist device
– Basically an extracardiac pump
– The LV goes from being a pumping device to just a filling chamber
– Cannula inserted into apex of the heart pumps blood directly into the aorta via a continuous pump
- Older models are pulsatile but are rarely used now
Who gets an LVAD?
– Those who, despite optimum medical management, cannot attain the minimal necessary cardiac output
– Those with acute cardiac injury, ie. s/p MI
– General categories:
- Bridge to transplant
- Destination therapy
- Long term support, end stage heart failure, NOT transplant candidate, will never be transplant candidate
- Bridge to recovery
- Most often post MI, give native heart time to recover
- Bridge to candidacy
- Generally younger patients after acute catastrophic illness, used in conjunction with other means of life support
- Attempt to allow recovery to the point of being eligible for transplant
What do I need to know in the ED?
– If you’re not in an LVAD center, get the patient to an LVAD center
- All LVADs have a number where an MD/NP/PA can be reached 24/7
– Patients may only have femoral pulses
– No systolic/diastolic BP –> almost all LVADs are continous flow
- MAP is KEY 60 – 90 mmHg
- Arterial line
- Can use Doppler plus manual sphygmomanometer
“Quick” fixes:
– Hypotensive?
- Give volume, pumps need fuel in the tank
- Listen for the motor, check the indicator light –> dead battery?
- Think clot if the motor feels warm –> heparin bolus
- Anemic –> GI bleed until proven otherwise
– Altered?
- If febrile –> infection
- If afebrile –> ICH
– Bleeding?
- All of these patients are on coumadin and aspirin
- Platelets and FFP or prothrombin complex concentrate
Check the patient’s bag/pockets/family for “Rescue Cards”
– device specific
– walk you through mechanical failure fixes
Jay Khadpe MD
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