Vol 7, No 1 (2022)
Original article
Published online: 2022-01-25

open access

Page views 5147
Article views/downloads 839
Get Citation

Connect on Social Media

Connect on Social Media

Examination of a patient with left ventricular assist device in an emergency condition — proposal for adaptation of the ABCDE examination algorithm

Tomasz Kłosiewicz1, Radosław Zalewski1, Roland Podlewski1, Sebastian Stefaniak2, Joanna Flaum3, Mateusz Puślecki12
Medical Research Journal 2022;7(1):3-9.

Abstract

Heart failure is becoming a medical issue that concerns more and more patients. The most effective treatment method is heart transplantation, however, more people are waiting for the procedure than there are available donors. The improvement of left ventricular assist device (LVAD) method was possible because of the joining forces of technological and medical advances. In recent years more patients have undergone the LVAD treatment. It has been a considerable challenge for medics in prehospital conditions. Device malfunction, bleeding, chest pain, or collapse pose a threat to life for those patients.

The aim of this paper was to adjust the ABCDE examination algorithm to be applied for patients with LVAD. Additionally, the author has described the method in detail. The article itself and the modification of the algorithm are based on the analyses of available source literature.

The biggest challenge for medics who examine patients with LVAD is a lack of pulse and inability to measure the pressure in a classical method. The most visible differences in the examination scheme have been observed in points C and E.

The authors have identified the need for simulation-based trainings dedicated to medical staff working in prehospital conditions. Additionally, a special system informing emergency services about LVAD patients living in their area should be implemented.

Article available in PDF format

View PDF Download PDF file

References

  1. Working Group on HeartFailure of the PolishCardiacSociety. Heartfailure in Poland – report on 2016. https://www.niewydolnosc-serca.pl/barometr.pdf (31.12.2021).
  2. McDonagh TA, Metra M, Adamo M, et al. ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42(36): 3599–3726.
  3. Korewicki J, Browarek A, Zembala M, et al. Ogólnopolski rejestr chorych z ciężką niewydolnością serca, zakwalifikowanych do przeszczepu serca: POLKARD-HF 2003–2007. Folia CardiolExcerpta. 2008; 3(8-9): 403–421.
  4. Poltransplant Biuletyn Informacyjny. Centrum Organizacyjno-Koordynacyjneds. Transplantacji Poltransplant. Red. Czerwiński. http://www.poltransplant.pl/Download/Biuletyn2020.pdf (31.12.2021).
  5. 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.
  6. Goebel M, Tainter C, Kahn C, et al. An Urban 9-1-1 System's Experience with Left Ventricular Assist Device Patients. Prehosp Emerg Care. 2019; 23(4): 560–565.
  7. 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.
  8. Mehra MR, Naka Y, Uriel N, et al. MOMENTUM 3 Investigators. A Fully Magnetically Levitated Circulatory Pump for Advanced Heart Failure. N Engl J Med. 2017; 376(5): 440–450.
  9. Tainter CR, Braun OÖ, Teran F, et al. Emergency department visits among patients with left ventricular assist devices. Intern Emerg Med. 2018; 13(6): 907–913.
  10. Kimura M, Nawata K, Kinoshita O, et al. Readmissions after continuous flow left ventricular assist device implantation. J Artif Organs. 2017; 20(4): 311–317.
  11. Iwashita Y, Ito A, Sasaki K, et al. Cardiopulmonary resuscitation of a cardiac arrest patient with left ventricular assist device in an out-of-hospital setting: A case report. Medicine (Baltimore). 2020; 99(2): e18658.
  12. Tigges-Limmer K, Schönbrodt M, Roefe D, et al. Suicide after ventricular assist device implantation. J Heart Lung Transplant. 2010; 29(6): 692–694.
  13. Schima H, Stoiber M, Schlöglhofer T, et al. Repair of left ventricular assist device driveline damage directly at the transcutaneous exit site. Artif Organs. 2014; 38(5): 422–425.
  14. Bischof D, Graves K, Genoni M, et al. Fatal disconnection of a ventricular assist device in an out-of-hospital setting. Emerg Med J. 2012; 29(3): 247–248.
  15. Teuteberg JJ, Slaughter MS, Rogers JG, et al. ADVANCE Trial Investigators. The HVAD Left Ventricular Assist Device: Risk Factors for Neurological Events and Risk Mitigation Strategies. JACC Heart Fail. 2015; 3(10): 818–828.
  16. Kirklin JK, Naftel DC, Pagani FD, et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant. 2015; 34(12): 1495–1504.
  17. Stehlik J, Estep JD, Selzman CH, et al. ROADMAP Study Investigators, ROADMAP Study Investigators, ROADMAP Study Investigators. Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients: Results From the ROADMAP Study. J Am Coll Cardiol. 2015; 66(16): 1747–1761.
  18. Thompson JS, Matlock DD, McIlvennan CK, et al. Development of a Decision Aid for Patients With Advanced Heart Failure Considering a Destination Therapy Left Ventricular Assist Device. JACC Heart Fail. 2015; 3(12): 965–976.
  19. Andersen M, Videbaek R, Boesgaard S, et al. Incidence of ventricular arrhythmias in patients on long-term support with a continuous-flow assist device (HeartMate II). J Heart Lung Transplant. 2009; 28(7): 733–735.
  20. Patel P, Williams JG, Brice JH. Sustained ventricular fibrillation in an alert patient: preserved hemodynamics with a left ventricular assist device. Prehosp Emerg Care. 2011; 15(4): 533–536.
  21. Butterfield M, Derr C, Keffeler J, et al. Organized cardiac activity in an awake LVAD patient during ventricular fibrillation. Am J Emerg Med. 2017; 35(7): 1041.e1–1041.e3.
  22. Tosto C, Adamo L, Craddock H, et al. Relationship between device acceptance and patient-reported outcomes in Left Ventricular Assist Device (LVAD) recipients. Sci Rep. 2019; 9(1): 10778.
  23. 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.
  24. Bramstedt KA, Simeon DJ. The challenges of responding to "high-tech" cardiac implant patients in crisis. Prehosp Emerg Care. 2002; 6(4): 425–432.
  25. Goebel M, Tainter C, Kahn C, et al. An Urban 9-1-1 System's Experience with Left Ventricular Assist Device Patients. Prehosp Emerg Care. 2019; 23(4): 560–565.
  26. Abelsson A. Learning through simulation. Disaster Emerg Med J. 2017; 2(3): 125–128.
  27. Puslecki M, Ligowski M, Dabrowski M, et al. High-fidelity simulation — the first DCD-ECMO procedure in Poland. Disaster and Emergency Medicine Journal. 2017; 2(1): 50–52.
  28. Sip M, Puslecki M, Dabrowski M, et al. Implementation of extended cardiopulmonary resuscitation procedure in in-hospital cardiac arrest: a preliminary simulated study. Disaster and Emergency Medicine Journal. 2021; 6(1): 10–20.