The patient talking to you without a pulse -lvad

A patient presented with an LVAD (Left ventricular assist device), thankfully the patient was well, but many questions were asked regarding what we would do if the patient was unwell.

An LVAD is a device that is implanted in patients with end stage heart failure, often as a bridge to heart transplantation. The device acts as a pump for the heart and assists cardiac output, with the pump working correctly these patients will be well perfused but may not have a pulse.

Patients with these devices are rare but present a unique challenge when presenting with an LVAD emergency. Life threatening LVAD emergences include device failure, stroke, bleeding, LVAD thrombosis and systemic infection.

National guidelines on the management of patients with these devices are scarce however there is a really helpful article in the EMJ, published by C.Bowels et al in 2017 which is definitely worth a read. Here are the suggested algorithms from the article for an unwell patient with an LVAD: 

The article can be accessed Here
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Bowles CT, Hards R, Wrightson N, et al. Algorithms to guide ambulance clinicians in the management of emergencies in patients with implanted rotary left ventricular assist devices. EMJ 2017;34:842-8