General Approach to All Patients

Left Ventricular-Assist Devices - LVADs

General Approach to Patients with LVADs

Left Ventricular-Assist Devices (LVADs) are surgically implanted circulatory support devices designed to assist the pumping action of the heart. Caring for these patients is complicated, and every effort should be made to contact the patient’s primary caretaker (spouse, guardian, etc) and LVAD coordinator during your evaluation. Patients with properly functioning LVADs may not have a detectable pulse, normal blood pressure or oxygen saturation.

  • Treat non-LVAD associated conditions in accordance with the appropriate Orange County EMS System protocol
    • If patient meets Trauma or Stroke Alert criteria, transport them to the appropriate receiving facility
    • If a patient meets STEMI Alert criteria, transport them to a PCI capable LVAD Center
  • Contact the patient's LVAD coordinator (if patient or caretaker does not have this information, look on the device for a phone number)
    • For any condition that is suspected to be related to the LVAD, transport to the patient's requested LVAD Center
  • Always bring all available LVAD equipment to the Emergency Department with the transported patient

Basic Life Support

  • Establish patent airway
  • Supplemental 100% oxygen
  • Record blood glucose level if any weakness, altered mental status or history of diabetes
  • Assist patient in replacing the device's batteries or cables

Advanced Life Support

  • Full ALS Assessment and Treatment
    • Monitor capnography to assess ventilation and perfusion
    • Administer boluses of 0.9% NaCl at 250 ml if signs of hypoperfusion
  • Evaluate unresponsive patients carefully for reversible causes prior to initiation of CPR - chest compressions may cause irreversible damage to devices
  • Expedite transport and treat other conditions as per appropriate protocols

General Approach to Patients with LVADs Flowchart