CONFERENCE NOTES 11-29-2011
DR. TATOOLIS LVAD EMERGENCIES
3 types of LVAD. Most common type is HeartMate 2 which is currently the only FDA approved device.
The pump is valvless. If pump fails, pt has in effect severe AI.
Hi BP decreases the flow in the pump. So most patients have their BP maintained around 80 systolic.
The motor is extremely reliable. The most common failure points are external.
The internal motor cannot be imaged with CT/Xray/Ultrasound
To determine BP in LVAD patient you have 3 choices. Assess mental status, get bp with cuff and Doppler, put in an art line.
You can’t always believe the interrogation info you get from the pump computer. The pump can be clotted and still get nl flow values. To get an assessment of how the pump is working, you need an echo to assess the sizes of the RV and LV.
Common complications: bleeding (20% have GI bleeding to AV malformations/also acquired von willibrand’s dz due to shear forces in pump. Treat GI bleed with FFP and not Vitamin K), clotting, infection (drive line infection/endocarditis), malfunction (treat this like a spine injury and don’t move the patient once you find a position of the patient and the device that works), RV failure
LVAD patient with a severe headache is very likely going to have a head bleed. Get them on Nitroprusside to lower the BP as much as the patient can tolerate.
CT scan is the study to evaluate for infection in the chest around the device. Get study without contrast. You are looking for fluid around device.
In cardiac arrest, CPR should be done as in a normal person.
Sometimes, in cardiac arrest and LVAD is working, the LV can get sucked down like a prune if all the blood has been pumped out of the LV. The RV gets distended like a beach ball. This results in severe dysrythmias. The answer is to turn down pump. If you are having dysrythmias, do a bedside echo to see the size of the ventricles.
Life expectancy of patient with LVAD is 90% at 1 month, 70% 1 year, 60% 2 years, two longest living are 7 years.
Bottom line on sorting thru LVAD emergencies: talk to the patient, figure out their bp with a Doppler, get an echo to assess LV and RV size.
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