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Paramedic students need more training in left ventricular assist device — a pilot simulation study
, 2, 2, 2, 1, 3, 4, 1, 14
Affiliations- Department of Medical Rescue, Poznan University of Medical Sciences, Poznan, Poland
- Department of Medical Rescue, Institute of Health Sciences, Pomeranian University, Slupsk, Poland
- Medical Simulation Center, Poznan University of Medical Sciences, Poland
- Department of Medical Rescue and Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poland
open access
Abstract
INTRODUCTION: Mechanical Circulation Systems are a promising therapy for patients with end-stage of heart failure. Left ventricular assist device (LVAD) enforces using of concomitant anticoagulant therapy. This may lead to severe complications. LVAD patients are more and more frequent users of the emergency department. There are several differences in cardiovascular function in these patients, as well as on examination. Its interpretation may be challenging and result in potentially fatal conclusions. The aim of this research was to assess the skills of paramedic students in assessing patients with LVAD
MATERIAL AND METHODS: The study was designed as a simulation study. The aim of this scenario was to provide a full primary survey of an unconscious, spontaneously breathing person with an LVAD pump implanted. Ten groups of paramedic students from Polish medical universities took part in this study.
RESULTS: Four teams started chest compressions unnecessarily. Of them, only one had contacted LVAD local coordinator and discontinued after short instructions. Four teams completed the driveline and device check and six checked only the line without moving the controller. No major errors were noted in the field of airway assessment and management as well as assessment of consciousness, breathing, and circulation.
CONCLUSIONS: More attention should be paid to educating paramedic students in LVAD therapy. Educators should focus mainly on differences in cardiovascular function and pay attention to complete perfusion assessment. Medical simulation seems to be a good tool for assessing difficult clinical cases rarely encountered in practice.
Abstract
INTRODUCTION: Mechanical Circulation Systems are a promising therapy for patients with end-stage of heart failure. Left ventricular assist device (LVAD) enforces using of concomitant anticoagulant therapy. This may lead to severe complications. LVAD patients are more and more frequent users of the emergency department. There are several differences in cardiovascular function in these patients, as well as on examination. Its interpretation may be challenging and result in potentially fatal conclusions. The aim of this research was to assess the skills of paramedic students in assessing patients with LVAD
MATERIAL AND METHODS: The study was designed as a simulation study. The aim of this scenario was to provide a full primary survey of an unconscious, spontaneously breathing person with an LVAD pump implanted. Ten groups of paramedic students from Polish medical universities took part in this study.
RESULTS: Four teams started chest compressions unnecessarily. Of them, only one had contacted LVAD local coordinator and discontinued after short instructions. Four teams completed the driveline and device check and six checked only the line without moving the controller. No major errors were noted in the field of airway assessment and management as well as assessment of consciousness, breathing, and circulation.
CONCLUSIONS: More attention should be paid to educating paramedic students in LVAD therapy. Educators should focus mainly on differences in cardiovascular function and pay attention to complete perfusion assessment. Medical simulation seems to be a good tool for assessing difficult clinical cases rarely encountered in practice.
Keywords
mechanical circulation systems; resuscitation; physical examination; simulation study; paramedics
About this articleTitle
Paramedic students need more training in left ventricular assist device — a pilot simulation study
Journal
Disaster and Emergency Medicine Journal
Issue
Article type
Research paper
Pages
83-88
Published online
2023-04-20
Page views
1245
Article views/downloads
256
DOI
Bibliographic record
Disaster Emerg Med J 2023;8(2):83-88.
Keywords
mechanical circulation systems
resuscitation
physical examination
simulation study
paramedics
Authors
Tomasz Klosiewicz
Monika Rut
Sylwia Jaltuszewska
Andrzej Rut
Radoslaw Zalewski
Piotr Ziemak
Malgorzata Ladzinska
Roland Podlewski
Mateusz Puslecki
References (20)- Groenewegen A, Rutten FH, Mosterd A, et al. Epidemiology of heart failure. Eur J Heart Fail. 2020; 22(8): 1342–1356.
- Jones NR, Roalfe AK, Adoki I, et al. Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis. Eur J Heart Fail. 2019; 21(11): 1306–1325.
- Lampropulos JF, Kim N, Wang Y, et al. Trends in left ventricular assist device use and outcomes among Medicare beneficiaries, 2004-2011. Open Heart. 2014; 1(1): e000109.
- Long B, Robertson J, Koyfman A, et al. Left ventricular assist devices and their complications: A review for emergency clinicians. Am J Emerg Med. 2019; 37(8): 1562–1570.
- Shore S, Geng Z, Adusumalli S, et al. Hospitalization Rate among LVAD Patients during the Last Decade in the United States. The Journal of Heart and Lung Transplantation. 2019; 38(4): S262.
- Guglin M. Approach to Unresponsive Patient with LVAD. The VAD Journal. 2018.
- Olasveengen TM, Semeraro F, Ristagno G, et al. European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation. 2021; 161: 98–114.
- Friberg N, Schmidbauer S, Walther C, et al. Skeletal and soft tissue injuries after manual and mechanical chest compressions. Eur Heart J Qual Care Clin Outcomes. 2019; 5(3): 259–265.
- Kirklin JK, Pagani FD, Kormos RL, et al. Eighth annual INTERMACS report: Special focus on framing the impact of adverse events. J Heart Lung Transplant. 2017; 36(10): 1080–1086.
- Frontera JA, Starling R, Cho SM, et al. Risk factors, mortality, and timing of ischemic and hemorrhagic stroke with left ventricular assist devices. J Heart Lung Transplant. 2017; 36(6): 673–683.
- Acharya D, Loyaga-Rendon R, Morgan CJ, et al. INTERMACS Analysis of Stroke During Support With Continuous-Flow Left Ventricular Assist Devices: Risk Factors and Outcomes. JACC Heart Fail. 2017; 5(10): 703–711.
- Mabvuure NT, Rodrigues JN. External cardiac compression during cardiopulmonary resuscitation of patients with left ventricular assist devices. Interact Cardiovasc Thorac Surg. 2014; 19(2): 286–289.
- Shinar Z, Bellezzo J, Stahovich M, et al. Chest compressions may be safe in arresting patients with left ventricular assist devices (LVADs). Resuscitation. 2014; 85(5): 702–704.
- Prete J, Pelka M, Liebo M. ACLS and Chest Compressions in Patients with Durable LVADs. Journal of Cardiac Failure. 2018; 24(8): S123.
- Kłosiewicz T, Zalewski R, Podlewski R, et al. Examination of a patient with left ventricular assist device in an emergency condition — proposal for adaptation of the ABCDE examination algorithm. Medical Research Journal. 2022; 7(1): 3–9.
- Schweiger M, Vierecke J, Stiegler P, et al. Prehospital care of left ventricular assist device patients by emergency medical services. Prehosp Emerg Care. 2012; 16(4): 560–563.
- Municinò A, Torriglia A. 764 Is There Adequate Knowledge about LVAD Patients among First Responders? A Survey from North Western Italy. The Journal of Heart and Lung Transplantation. 2012; 31(4): S260–S261.
- Sip M, Puslecki M, Dabrowski M, et al. Extended cardiopulmonary resuscitation: from high fidelity simulation scenario to the first clinical applications in Poznan out-of-hospital cardiac arrest program. Perfusion. 2022; 37(1): 46–55.
- Telec W, Kłosiewicz T, Zalewski R, et al. Impact of Postshock Transcutaneous Pacing on Chest Compression Quality during Resuscitation: A Simulation-Based Pilot Study. Emerg Med Int. 2021; 2021: 5584632.
- Turkelson C, Keiser M. Using Checklists and Repetitive Simulation to Improve Patient Safety: A Pilot Project with the Impella® Left Ventricular Assist Device. Clinical Simulation in Nursing. 2017; 13(2): 53–63.