Adult Ventricular Assist Device

Question 1

What do you first do if a patient has a ventricular assist device?

Answer 1

Assist ventilation and assess for perfusion

Question 2

What are you looking for for adequate perfusion, and what do you do if there is adequate perfusion?

Answer 2

Normal skin color/ temp
Normal Cap refill

If adequate, assess for other causes of AMS including hypoxia, blood glucose, OD, stroke

follow ACLS protocol and notify ventricular assist device center

Question 3

If a patient does NOT have normal signs of perfusion and has a LVAD, what do you do next?

Answer 3

Assess for LVAD function

1. Look/listen for alarms
2. Listen for LVAD hum

Question 4

What do you do if the LVAD IS functioning?

Answer 4

Assess MAP and PETCO2

Question 5

What is the cutoff for MAP and PETCO2 and how does this change the management?

Answer 5

MAP > 50 and/or PETCO2 > 20 = DO NOT perform chest compressions

If less than that, perform chest compressions

For both, follow ACLS protocol afterwards

Question 6

What do you do if you find the LVAD is NOT functioning?

Answer 6

Attempt to restart, making sure everything is connected

Question 7

What do you do if restart is successful? Unsuccessful?

Answer 7

Successful = follow ACLS guidlines

Unsuccessful: perform chest compressions and then follow ACLS guidlines