What is an LVAD and how does it work?

• An LVAD is a left ventricular assist device, which increases cardiac output by pumping blood directly into the aorta. These have been approved for both destination therapy and bridge therapy.
• They now use frictionless electromagnetic pumps that reduce complications such as thrombosis and hemolysis.

Problems with LVADs that you need to know about

• LVADs run on batteries… some to run the pump but also batteries to sound the alarm for device failure. Red alarm means pump failure, yellow means call to the patient’s LVAD coordinator immediately (check the external controller)!
• Majority of LVAD patients will have no palpable pulse, which is necessary for automated blood pressure measurements. Instead, check it manually and use ultrasound doppler to measure MAP (normal should be 70-90 mmHg).
• Common problems that patients will need emergent treatment and evaluation for include but are not limited to GI bleed, LVAD infections, RV failure, Aortic regurgitation, arrhythmias, shock, pump failure, and cardiac arrest.
• Chest compressions in these patients is controversial as it can theoretically dislodge the pump, but the benefits vs risks have to be weighed individually and if possible, in conjunction with the LVAD coordinator.

Resource

• Shinar, Z., Gosain, P., Heimowitz, T. Treatment of Mechanical Circulatory Support Devices in the Emergency Department. In: Marshall JP, Farcy DA, Chiu WC et al. Critical Care Emergency Medicine, Second Edition. McGraw-Hill Education / Medical; 2016.