open access

Vol 7, No 2 (2022)
Original article
Published online: 2022-04-19
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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.
Affiliations
  1. Department of Medical Rescue, Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland
  2. Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
  3. Medical Simulation Center, Poznan University of Medical Sciences, Poznan, Poland

open access

Vol 7, No 2 (2022)
ORIGINAL ARTICLES
Published online: 2022-04-19

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.

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.

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Keywords

heart-assist devices, resuscitation; physical examination; simulation study

About this article
Title

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

Journal

Medical Research Journal

Issue

Vol 7, No 2 (2022)

Article type

Original article

Pages

123-127

Published online

2022-04-19

Page views

4106

Article views/downloads

316

DOI

10.5603/MRJ.a2022.0017

Bibliographic record

Medical Research Journal 2022;7(2):123-127.

Keywords

heart-assist devices
resuscitation
physical examination
simulation study

Authors

Tomasz Kłosiewicz
Roland Podlewski
Małgorzata Ładzińska
Piotr Ziemak
Mateusz Puślecki

References (17)
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  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.
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  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.
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  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.

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