No pulse, no problem! What EMS teams need to know about LVAD patients
When EMS arrives on the scene of a medical emergency, the first things they often check are patients’ pulse and blood pressure. But patients with left ventricular assist devices (LVADs) don't have either!
An LVAD is a heart pump that takes over the function of pumping blood to the body for individuals with heart failure. In the mid-1990’s, LVADs were a new treatment for patients with heart failure who were waiting for a transplant. Back then, we had just a few LVAD patients—our surgeons implanted about five to 10 LVADs per year. LVADs were used as a bridge therapy to keep patients with heart failure alive until they got a heart transplant. After 2001, we started to implant LVADs into patients who are not going on to heart transplant as a way to keep heart failure patients alive.
Today, our surgeons implant about 90 LVADs a year, and these patients require special care in the event of medical emergencies. I’ve been a VAD coordinator for more than 20 years, and a large part of my role is to train emergency medical services (EMS), or first responders, in techniques to care for LVAD patients.
Related reading: LVAD origins: A lifesaving heart device, 30 years in the making
Why do LVAD patients need special EMS care?
Today’s LVAD pumps are palm-sized and have a cable that connects to leads outside the body. An impeller within the pump spins thousands of times a minute, resulting in continuous blood flow, which means LVAD patients don’t have a pulse or measurable blood pressure. The external components include a controller—the brains of the system—and batteries, which power the system.
It’s crucial that our EMS providers appropriately assess these patients. For example, if an LVAD patient became unconscious due to low blood sugar, that patient would not have a pulse. Usually an EMS provider would give chest compressions to a patient without a pulse, but an LVAD patient doesn’t need chest compressions. The LVAD is circulating the blood around the body continuously.
How we train EMS providers in LVAD protocol
There are only about 500 VAD coordinators in the world and about 155 hospitals in the United States that implant LVADs, so it is challenging to train community providers. The mission now is to inform EMS providers that a pulseless state is normal for LVAD patients, which is unique from nearly any other condition. This task was easier when we had a small volume of patients. But as our patient volume grew, my original goal to get out to every fire station, on all three shifts, and train EMS providers and paramedics became impossible.
Recognizing this gap in education for EMS, MedStar Heart & Vascular Institute and other heart care centers collaborated to create EMS field guides and quick reference cards for EMS providers to help them respond appropriately when they encounter VAD patients. Some of these LVAD fast facts and materials include:
- The patient won’t have a pulse or blood pressure
- Pictures of the external components and how to interface with them
- Steps to change the battery on five devices
This information is also posted on MyLVAD.com, a website we created for the LVAD community championed by Dr. Steven Boyce, surgical director, Advanced Heart Failure Program at MedStar Heart & Vascular Institute.
When I train first responders at regional EMS meetings, I always promote the field guides, so EMS leaders can prepare their teams to care for LVAD patients. We run on-site simulations with actual VAD patients and use debriefing to discuss what worked and what didn’t. Our team strives to provide best practices to our EMS partners in the community.
We also train and follow up with our LVAD patients to prepare them to care for themselves when they go home or when they travel. We see patients in clinic routinely and keep their addresses current to communicate to first responders should an emergency arise.
As LVAD patient volumes increase, my VAD coordinator colleagues and I continue to keep a finger on the pulse—or lack thereof!—of LVAD awareness among EMS providers. Together, we’re working to help more patients get appropriate emergency care.