This document provides information on ventricular assist devices (VADs) for emergency personnel. It describes the different types of VADs, including LVADs, RVADs, and BIVADs. An LVAD takes blood from the left ventricle to the aorta, an RVAD from the right ventricle to the pulmonary artery. A VAD has internal pump, driveline, and batteries/controller components. The controller operates the pump and monitors for alarms. Proper care of a VAD patient includes bringing extra batteries, connecting to AC power, listening for pump sounds, and treating alarms based on the specific device. Vital signs may be difficult to obtain due to continuous flow devices, so

2. OBJECTIVES
Understand the types of VADs
Describe indications for and
components of a ventricular assist
device.
Discern assessment findings of pts with
a VAD from other emergency pts
Be proficient in the care of a pt with a
VAD

3.  A mechanical circulatory assist device is used to support
heart function and blood flow in people who have
weakened hearts. Most common are LVADS (left
ventricular assist device) there are also RVADS (right
ventricular assist device) and BIVAD (biventricular assist
device).
 The LVAD is for left side heart failure, takes blood from
the left ventricle to the aorta and then to the body and
vital organs, just as a normal healthy heart would.
 The RVAD is for right heart failure, takes the blood from
the right ventricle pump blood to the pulmonary artery.
 A BIVAD for patients suffering from end-stage heart
failure affecting both sides of the heart.

4.  The LVAD device is FDA approved for long term and
short term treatment situation
 1. "Bridge to Transplant" for those patients awaiting
a heart transplant
 2. To "rest" a damaged left ventricle after a surgical
procedure, or major heart attack.
 3. "Destination Therapy" for those who have severe
end stage heart failure, but are not candidates for a
heart transplant

5. LVADS ARE
Mechanical devices
Surgically implanted
Improves cardiac output
Shands is our closest VAD center
They use the Heartmate 2 most
commonly

6. An LVAD has four components that
are internal and external
1.The pump
2.The driveline
3.The controller
4.The batteries

7. The pump is internal It
is connected to your
left ventricle that pulls
blood into the pump
which then sends the
blood to the aorta
which sends the blood
to your body with your
heart having to do
minimal work.

8. The
Driveline
The driveline is
internal and
external. It is a
percutaneous lead
that connects the
pump to the
controller. It
contains necessary
power and
electronic cables. It
exits through the
skin, on either the
right or left side of
the abdomen.

9. THE CONTROLLER
Is EXTERNAL and it operates the pump and has lights,
messages, and/or alarms if the power is low or if it is not
functioning properly. It can be worn around the waist or
over the shoulder. Look at the color of the tag on the
controller so you can refer to the EMS guide on how to treat
your pt with an LVAD. The
EMS guide is in our protocols.

10. Options for Power
Batteries AC power sources
 The batteries are charged using
a device specific battery charger.
The controller and/or batteries
will show you how much power
the batteries have left and alert
you when they need to be
changed. When the patient is
outside of their home they need
to have extra fully charged
batteries with them. Depending
on their specific VAD device, the
batteries may be in a pack along
with the controller or carried in
a holster over their shoulders.
 When the patient sleeping or
about to sleep, they need to
connect the VAD to the device-
specific electrical power source
to eliminate the chance of
battery power loss while
sleeping. The electrical power
source should include a backup
battery (possibly internal) in
case there is a power outage. The
device may also come with a DC
adaptor, which will allow them
to power their VAD in a car.

11. In shortIf you
have a pt with
an LVAD make
sure you
•Bring their
extra
batteries
•Be sure
you have
their AC
power cord

12. LVADS can
be pulsatile
or
continuous
flow
Continuous
flow LVADs
you will not
feel a pulse
and may not
be able to
obtain a b/p

13. When assessing a pt with an LVAD
start with your normal assessment
intervene as necessary
 Initial
assessment
• Airway
assessment
• Attach cardiac
monitor and
pulse ox

14. PULSE OX MAY NOT DETECT AN O2 SAT

15. To assess specifically for the
VAD
1. Auscultate heart sounds to determine if the device is
functioning. If it is a continuous flow device you should hear a
“whirling sound”
2. Assess the device for any alarms
3. Find the color tag on the controller so you can identify the
specific device in the ems guide for LVAD devices
4. Intervene appropriately based on the type of alarm, color tag
and what the EMS guide says for that VAD
5. Initiate IV of NS or LR
6. Assess v/s if possible
7. Optimal way to assess v/s is us the mean b/p with a doppler if
no doppler is available and you are able to obtain one with the
NIBP then us the MEAN of that.
8. You may or might not be able to detect a b/p which can be
normal. Pulse also may or may not be palpable.

16. Best indicator with LVAD pts is:
Their LOC and
the skin color
and condition.

17. Cardiac Arrest LVAD PT
If your pt is unconscious,
unresponsive to stimuli and
pulseless listen to the pts chest. If
you hear the whirling sound of the
LVAD, DO NOT PREFORM CPR. If
you cannot hear the device then
CPR should be performed per
cardiac arrest protocol.

18. MORE INFORMATION
 Yes you can do a 12 lead and defibrillate as you would given the
situation
 Treat all STEMI and chest pain complaints as you would using
the Chest Pain Protocol but be mindful that pt may be on viagra
to reduce chances of right heart failure (male or female).
 Due to the closest LVAD center we have is Shands Gainesville,
you may take the pt to the local hospital of their choice, TMH or
CRMC.
 If you suspect the pt is dehydrated bolus 250cc of NS with a max
of 500cc until pt is improving . Be sure to continuously check
lung sounds and watch for signs of CHF. If pt starts to have signs
of CHF discontinue fluid bolus. Pt will have a low or no b/p
reading DO NOT treat the b/p. Treat the PT not the monitor.

19. LVAD pt should have all
medications that a non LVAD
pt with heart failure would
have including blood
thinners to help prevent the
development of clots.

20. Special Considerations
1. Be careful not to twist, cut or bend the
driveline coming out of the abdomen (this
is the lifeline and if it disconnects they will
die).
2. Most common complications are bleeding
and thromboembolism
3. Do not get tunnel vision, LVAD pts will call
for reasons unrelated to their LVAD

21. Always Treat dysrhythmias in
accordance with the appropriate
dysrhythmia protocol

22. Remember
ALL VAD pt and their families/caretakers have been
well educated on the VAD and the care along with
it. If you have any questions ask the pt or the
family. If it is an emergent situation or the pt is
unable to answer questions bring a family member
with you.