Left Ventricular Assist Device Management in the Emergency Department

Paul Trinquero, MD; Andrew Pirotte, MD; Lauren P. Gallagher, MD, MA; Kimberly M. Iwaki, MD; Christopher Beach, MD; Jane E. Wilcox, MD

Disclosures

Western J Emerg Med. 2018;19(5):834-841. 

In This Article

Physical Exam Including VAD Components

Evaluation of a stable VAD patient should include a focused physical exam and inspection of the major device components. Cardiac auscultation facilitates rapid evaluation of the device; in a properly functioning VAD, a "whirring" sound should be heard. By definition, patients with VADs should be relatively free of signs and symptoms of HF due to the presence of the mechanical support device. Thus, any signs of volume overload (e.g., elevated jugular venous pressure, presence of ascites or peripheral edema) may be indicative of subacute or chronic right ventricular failure, while shortness of breath, pulmonary edema, or hypotension are often present with acute device malfunction (e.g., pump thrombosis, cannula obstruction).

Distal perfusion should be assessed via capillary refill or simply by palpating the extremities. Because of an increased propensity for bleeding, the VAD patient should be evaluated for focal neurologic deficits, change in mental status, or presence of headache with a stat non-contrast computed tomography (CT) of the brain to rule out intracranial hemorrhage.[7]

The VAD driveline exit site will be covered with a sterile dressing and should be inspected carefully in a sterile fashion (mask, gloves) for any evidence of infection. The controller should be inspected and current settings and pump parameters recorded, including any alarms. Finally, ensure that the patient has brought along his or her back-up batteries and controller.

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