Vol 7, No 2 (2022)
Original article
Published online: 2022-04-19

open access

Page views 4130
Article views/downloads 330
Get Citation

Connect on Social Media

Connect on Social Media

Are we well prepared to examine patients with left ventricular assist device in emergency conditions? — a simulation-based pilot study

Tomasz Kłosiewicz1, Roland Podlewski1, Małgorzata Ładzińska2, Piotr Ziemak3, Mateusz Puślecki12
Medical Research Journal 2022;7(2):123-127.

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.

Article available in PDF format

View PDF Download PDF file

References

  1. 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.
  2. 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.
  3. 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.
  4. Guglin M. Approach to unresponsive patient with LVAD. The VAD Journal. 2018; 4.
  5. Olasveengen TM, Semeraro F, Ristagno G, et al. European resuscitation council guidelines 2021: basic life support. Resuscitation. 2021; 161: 98–114.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. Guglin M. Approach to Unresponsive Patient with LVAD. The VAD Journal. 2018.
  12. 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.
  13. 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.
  14. Hryniewicz K, Satterle P, Cabuay B, et al. 177 more formal training needed for emergency medical services technicians on left ventricular assist device. The Journal of Heart and Lung Transplantation. 2011; 30(4): S65–S66.
  15. 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.
  16. 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.
  17. Barnicle R, Boaglio S, Fitzgerald J, et al. Left ventricular assist device multialarm emergency: a high-fidelity simulation case for emergency medicine residents. MedEdPORTAL. 2021; 17: 11156.