A left ventricular assist device (LVAD) is a surgically implanted pump that moves blood from the left ventricle to the aorta in advanced heart failure. Because flow is continuous, patients often have no palpable pulse, so assessment relies on perfusion, pump sounds and controller alarms.
Key symptoms
- Alarms on the device controller
- Dizziness, fainting or weakness
- Shortness of breath or leg swelling
- Fever or drainage at the driveline site
- Stroke symptoms, bleeding or black stools
What you find on exam
- Listen over the heart for the pump hum
- Mental status, skin color and capillary refill to judge perfusion
- Mean arterial pressure by Doppler, usually 60 to 90 mmHg
- Controller, batteries and driveline connections
- Driveline exit site for infection
Tests
- Call the LVAD coordinator number on the device
- ECG and cardiac monitoring; arrhythmias are common
- Glucose
- In hospital: LDH for pump clot, INR and echocardiogram
Treatment basics
- Bring all equipment and spare batteries; trained family members can help
- Low flow: IV fluids and a search for bleeding or arrhythmia
- Defibrillation and cardioversion are safe with the device
- Chest compressions if unresponsive with poor perfusion and a stopped pump, per protocol
- Transport to an LVAD center when possible
Red flags
- Unresponsive with no pump hum
- Persistent alarms or low flow
- Stroke signs or major bleeding, since patients take anticoagulants
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); NCCPA PANCE Content Blueprint. Written by Making Synapses. Making Synapses is not affiliated with these organizations.