Management of the controller and its alarm functions will be predominately undertaken by the patient or their carer who has been trained in use of the VAD and its maintenance. Paramedics should not attempt to troubleshoot the VAD device without the assistance of the patient/carer or the advice of the FSH staff unless the patient is clearly critical. It is important to recognise that not all VAD patients will have a carer with them at all times.
The patient should be treated symptomatically as per Clinical Practice Guidelines.
Perform resuscitation as per normal guidelines taking note of the following:
Note: Ambulance staff are encouraged to contact the Advanced Heart Failure and Cardiac Transplant Service at Fiona Stanley Hospital at any time for advice regarding the patient’s usual health state and advice regarding complication/issue management. Please call (08) 6152 2222 and ask for the Cardiac Transplant Consultant on-call.
A Left Ventricular Assist Device, commonly known as an LVAD or VAD, is a mechanical circulatory assistance device that is used to partially or completely replace the function of a failing left ventricle. These LVADs are generally intended for longer term use (months to years and in some cases for life) and are mostly for patients suffering from congestive heart failure.
VADs are used to help patients have an improved quality of life with decreased heart failure symptoms. VADs are used as a:
VADs are usually designed to assist the left ventricle (LVAD), but occasionally can be inserted on the right side (RVAD), or both ventricles at the same time (BiVAD). The configuration used can depend on factors including the underlying heart disease, right and left ventricular function and the pulmonary arterial resistance.
With medical and device advances, VADs have improved significantly in terms of providing improved survival and quality of life among recipients. Ventricular Assist Device therapy patients are only managed in Western Australia by the Advanced Heart Failure and Cardiac Transplant Service at Fiona Stanley Hospital. There are currently 15-20 patients in the community on VAD support.
There are three main types of longer term VADs used in Western Australia – the Heartmate 3®, the HeartWare HVAD® and the Thoratec HeartMate II® VAD. The components, function, routine monitoring and complication profile are similar between devices.
Mobile Power Unit
All VADs consist of the following components:
VADs continuously unload the ventricle throughout the cardiac cycle. They are referred to as ‘continuous flow’ devices. Often the aortic valve does not open (or not open fully) as most of the blood flow is exiting the heart via the VAD. Due to this, the patient often will not have a palpable pulse. If a pulse is not palpable a standard blood pressure measurement will not be possible. In the hospital setting blood pressure is obtained using a Doppler device.
Other techniques can be used to assess a patient’s cardiac output state. These include assessing for warmth, colour, capillary refill, mentation and checking for LVAD parameters or alarms. If the LVAD is running, a mechanical whirring sound should be heard over the heart.
The patient &/or carer/relative may be able to give an account of the patient’s usual condition.
There often remains a degree of pulsatility so it is therefore beneficial to still attempt pulse oximetry monitoring but this may be inaccurate (falsely low or unrecordable).
LVAD patients still have their own active heart rhythm so can be monitored and have ECGs. They are still susceptible to arrhythmia as the unsupported right ventricle still needs to send blood efficiently to the left ventricle.
VAD patients may often have an Automated Implantable Cardioverter Defibrillation device. VT may be well tolerated especially in patients with combined LVAD and RVAD support. If the patient is in VT but looks and feels well, there is often time to contact the AHFCTS team for advice. Don’t forget the patient and their carer are experienced in managing their LVAD and are a great source of information/advice in VAD assessment.
Possible complications for a patient on a VAD include:
CAUTION: Never disconnect power from both controller leads at the same time.
CAUTION: Never disconnect power sources from the controller at the same time.
Liaise with the Advanced Heart Failure & Cardiac Transplant Service at Fiona Stanley Hospital Regarding Treatment
Specialists at Fiona Stanley Hospital are available 24 hours per day and should be consulted with regarding your assessment findings and recommended treatment. The phone numbers are carried by the patient at all times and can be found on their back up equipment carry bag. The patient is to be transported to FSH wherever possible as staff there have training in this device and monitoring equipment is available
If a VAD patient is to be taken to Fiona Stanley Hospital all of their VAD equipment is to be brought with them (including spare controller, spare batteries, mains/AC power unit, battery charger)
Adapted from “Left Ventricular Assist Devices- Ambulance Management” Version 4-July 2015. Courtesy of the Alfred Hospital.- This information has been collated using resources from the Alfred Hospital. Pictures obtained from HeartWare and Thoratec websites, presentations and documentation. Information has been reviewed and adapted for use at Fiona Stanley Hospital by Dr Jay Baumwol (Heart Failure Consultant), Helen Hayes (VAD Nurse Practitioner) and Julie Barber (Clinical Nurse Consultant) Oct 2020.
St John WA