Low Battery
If an LVAD patient presents to the ED with a low battery, no backup batteries, and the hospital does not have a power base unit or other way to power the LVAD, the EP should call the patient’s VAD coordinator to assist. Often, the coordinator can identify a local LVAD patient who is willing to transport extra batteries to the ED.
To conserve power, the controller in some LVAD models is programmed to automatically reduce the pump speed when the battery power becomes low. This feature can be a cause of syncope or lightheadedness in in some patients. While some older LVAD models had the capability of being powered by a hand pump in the event of loss of function, the newer devices do not.4,7,8
Cardiac Assessment and Protocols
The presence of an LVAD should not have any effect on electrocardiography studies. When evaluating patients, standard advanced cardiac life support protocols should be followed, but extreme caution should be used before starting chest compressions as this can dislodge the cannula and lead to death. Prior to initiating chest compressions, the patient’s VAD coordinator should be contacted to ensure that any problems with the device itself have been considered, addressed, and ruled out. Defibrillation, cardioversion, and pacing are all acceptable in LVAD patients, but defibrillator or pacer pads should not be placed directly over the patient’s pump.7
Summary
As the number of patients with an implantable cardiac device continues to grow, EPs are likely to encounter an LVAD patient in the ED. An understanding of device function and knowledge of the basic trouble-shooting skills can prove life-saving in many instances. In addition, a familiarity with available LVAD resources, both online and within the health care community, is also essential to ensure the appropriate management and care of these patients.