Title: VAD Troubleshooting<br/>Author: Mark Sutherland<br/><a href='http://umem.org/profiles/resident/1396/'>[Click to email author]</a><hr/><p>
        It's important to remember the differential for the patient with Ventricular Assist Device (VAD) difficulties, as these patients are likely to show up in your ED. </p>
<p>
         </p>
<p>
        1) Assess the patient as you usually would (signs of life, mental status, breathing, arrhythmias on monitor, etc). Listen for a hum over the chest.  Don't expect to feel a pulse.</p>
<p>
        2) Look at the VAD including controller, driveline, and power source for alarms, disconnections, signs of infection, and other obvious issues.</p>
<p>
        3) Look at the power (displayed flow), pulsatility index, and pump speed on the controller to help determine the cause of the issue (see attached chart).  Once you have a suspected etiology, typical management of these issues is usually similar to non-VAD patients (i.e. gentle IVF for hypovolemia, vasodilators if low flow is due to afterload/hypertension, defibrillation/CPR for arresting pts, etc).</p>
<p>
        Don't forget to call your VAD coordinator when able.  Consider a-line placement for precise evaluation of blood pressure (focus on MAP).</p>
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         </p>
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        <strong><u>Bottom Line:</u></strong> <strong>Consider obstruction/thrombosis, bleeding, infection, hypovolemia, afterload/hypertension, arrhythmia, worsening LV function, and suction events when troubleshooting VADs.  The power, pulsatility index, and pump speed help differentiate these conditions.</strong></p>
<fieldset><legend>References</legend>

                <p>
        <a href="http://maryland.ccproject.com/2013/12/12/introduction-ventricular-assist-devices/">http://maryland.ccproject.com/2013/12/12/introduction-ventricular-assist-devices/</a></p>
<div class="highwire-cite-authors" font-size:="" helvetica="" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; display: inline; color: rgb(51, 51, 51); font-family: interfaceregular, HelveticaNeue, ">
        <span class="highwire-citation-authors" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; display: inline;"><span class="highwire-citation-author first" data-delta="0" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; display: inline;"><span class="nlm-surname" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; display: inline;">Bowles</span> CT</span>, <span class="highwire-citation-author" data-delta="1" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; display: inline;"><span class="nlm-surname" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; display: inline;">Hards</span> R</span>, <span class="highwire-citation-author" data-delta="2" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; display: inline;"><span class="nlm-surname" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; display: inline;">Wrightson</span> N</span></span><span class="citation-et" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; font-style: italic; margin-right: -2px; display: inline;">, et al</span></div>
<div class="highwire-cite-title" font-size:="" helvetica="" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; display: inline; color: rgb(51, 51, 51); font-family: interfaceregular, HelveticaNeue, ">
        Algorithms to guide ambulance clinicians in the management of emergencies in patients with implanted rotary left ventricular assist devices</div>
<div class="highwire-cite-metadata bmjj-citation-metadata" font-size:="" helvetica="" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; display: inline; color: rgb(51, 51, 51); font-family: interfaceregular, HelveticaNeue, ">
        <span class="highwire-cite-metadata-journal highwire-cite-metadata" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; display: inline; font-style: italic;">Emergency Medicine Journal </span><span class="highwire-cite-metadata-year highwire-cite-metadata" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; display: inline;">2017;</span><span class="highwire-cite-metadata-volume highwire-cite-metadata" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; display: inline; font-weight: bold;">34:</span><span class="highwire-cite-metadata-pages highwire-cite-metadata" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; display: inline;">842-850.</span></div>
</fieldset><fieldset><legend>Attachments</legend>
                        VAD_Differential.jpg (134 Kb)<br/><a href='http://umem.org/files/uploads/1909092328_VAD_Differential.jpg' target='_blank'>http://umem.org/files/uploads/1909092328_VAD_Differential.jpg</a><br/><br/></fieldset>