Are we well prepared to examine patients with left ventricular assist device in emergency conditions? — a simulation-based pilot study
, 1, 2, 3, 12
Abstract
Introduction: Left ventricular assist device (LVAD) therapy is becoming more and more important. There is now increasing number of patients on LVAD therapy. This means that they will also be more frequent patients in emergency departments. There are several differences in cardiovascular function in these patients. An examination performed according to the well-known ABCDE algorithm, can be difficult to interpret and result in incorrect decisions. The aim of this pilot study was to preliminarily assess the ability of medical university students to examine a patient with LVAD.
Material and methods: The authors designed a simulation study. The aim of the scenario was to assess the unconscious, spontaneously breathing patient with LVAD and provide assistance appropriate to the patient’s condition. Ten groups of students from different polish medical universities participated in the study.
Results: All teams implemented the ABCDE examination protocol. Seven teams started chest compressions due to absence of pulse despite spontaneous breathing. Out of seven teams that started compressions, two terminated after discussion within the team. Half of the teams completed the driveline and LVAD device check. Four teams contacted the LVAD coordinator. Three teams in the study did not perform perfusion assessment.
Conclusions: An examination according to the ABCDE algorithm can be performed in a patient with LVAD. However, there is a need to modify the standard algorithm to adjust for the characteristics of an LVAD patient. Consideration should be given to inadequate skills in interpreting the results ABCDE examination. Simulation-based learning should be an important part of pre- and postgraduate education.
Keywords: heart-assist devicesresuscitationphysical examinationsimulation study
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