Disclosures  I will be discussing off label use of devices

Objectives  Epidemiology of heart failure  Review Left Ventricular Assist Device  Definition  Basic Physiology / Implications of Continuous Flow  Identify different models of LVADs discharged from    

Hartford Hospital Emergency assessment of patients with LVADs Transportation of a patient with an LVAD Unique application of ACLS guidelines for LVAD patients Emergency Contact information for our CHAFT

Case  EMS are dispatched to the home of a 54 year old

man with light headedness  Upon arrival, patient meets the EMS crew at the door. He is alert, oriented and appropriate, complained of transient light headedness, now resolved. His wife is home and says, “he just doesn’t look right.”  He is awaiting a heart transplant and has a HeartMate II LVAD device  He is treated by physicians at a hospital about 25 miles away and is requesting transport to that hospital. The closest hospital is 5 miles away.

Advanced Heart Failure – The issue

Heart Transplant Patient The Problem: OHT Performed: 2000 OHT Needed: 10,000

Advanced Heart Failure – The issue

The Problem: OHT Performed: 2000

The Potential Solution:

OHT Needed: 10,000

Mechanical Circulatory Support: Left Ventricular Assist Device

Why do we need to know about LVAD Emergencies?

“The Scripps Mercy staff got an ambulance and – lucky for Merrill – it was staffed with one of the few paramedics at San Diego Medical Services who had just completed LVAD training and understood the situation.”

Left Ventricular Assist Device

HeartMate II HeartWare

HeartMate II

Implantable Pump Percutaneous Lead

Controller

 Surgically implanted  Left Ventricular Apex  Ascending Aorta 

Anastomosis of outflow cannula

Batteries

Concept = Archimedes Screw

Initially designed to pump water in 4th century Rome by Archimedes

Heart Mate II LVAD  2nd generation VAD  Archimedes Screw 

Continuous flow

 Left sided support  Wide range of flow capacity  Indicated for  

Bridge to transplant Destination therapy

HeartWare H-VAD

Concept = Centrifugal pump

Initially used as a mud lifting machine in 1475 during the Italian renaissance by Francesco di Giorgio Martini

HeartWare  3rd Generation Centrifugal Pump  Magnetically levitated  Left, Right or Biventricular Support Capability  Wide range of flow capacity and patient sizes  Indicated for Bridge-To-Transplant

System Controller Heart Mate II Both the Heartmate II EPC and Pocket Controller:  Deliver power to the pump  Controls pump speed and power  Performs diagnostic monitoring  Identifies alarm conditions and initiates Hazard and Advisory alarms The Pocket Controller  Display screen on controller  Back up battery housed within controller  (Up to 15 minutes if both power sources disconnected)  Records alarm data and device MUST ALWAYS HAVE performance 2 POWER SOURCES  (240 events)

CONNECTED

HeartWare® Controller The controller sends power and operating signals to the HVAD® Pump via a percutaneous driveline. It also collects data on system operation.

Data Connection Blue data connector is used by clinicians to adjust pump parameters and download pump information

Power Connection 2 identical power supply connectors – controller requires two power sources at all times

MUST ALWAYS HAVE 2 POWER SOURCES CONNECTED

Driveline Connection Pump driveline is attached to silver driveline connector and must not be disconnected

Power Connection

Two Types of Operation Heart Mate II Device

Battery Powered Operation

Tethered Operation

HeartWare® Controller DC Adapter (for car)

Battery must be connected as secondary power

3 Types of Operation HeartWare HeartWare Controller Bilateral Battery Power

HeartWare® Controller AC Adapter (for wall outlet)

A/C adapter will be primary power source. Battery must be connected as secondary power

NOTE: When using the AC or DC adapter, a HeartWare® Battery should always be connected to the controller’s second power connection.

HeartMate II Batteries and Battery Clip

 14 Volt Lithium Ion  6 – 10 hours of support (factory specification)  Patients experience up to 18 hours of battery power  4 hour recharge for fully discharged battery  Are drained simultaneously

HeartWare Batteries  Lithium ion  No clips  Last 6-8 hours  Takes 6-8 hours to charge  Are drained sequentially

Battery Charger Heart Mate II

HeartWare

Tethered Power Heart Mate II

HeartWare® Controller AC Adapter (for wall outlet) A/C adapter will be primary power source. Battery must be connected as second.



 

Delivers power to the pump  30 minutes back up battery power Performs diagnostic monitoring Indicates hazard and advisory alarms

NOTE: When using the AC or DC adapter, a HeartWare® Battery should always be connected to the controller’s second power connection.

Fixed Speed 9600 PI 5.5 Flow 4.5 Power 8.2

DISPLAY MODULE (EPC only) •Pump Mode ®Fixed ®Power Saver •Pump Speed (rpm) •Pulse Index Pocket Controller has display screen. Can scroll through PI, RPM’s, Flow, Power

•Estimated Flow (liters/min) ® Too low “---” ® Too high “+++” •Power (watts) •Alarm Conditions → Highest priority displayed

Quality of Life

LVAD patient assessment  Assess LVAD function  Auscultate for mechanical sounds over LVAD site  Assess peripheral perfusion  Review and record data displayed on digital screen  Highest priority alarm will be displayed on Power Module (if connected)  Check system controller for signs of alarms  Alarms with steady audio tone signify hazard alert  Review emergency contact sheet carried by patient

LVAD patient assessment  If pump appears to be running, no alarms and

patient appears well perfused   

Continue routine assessment Perform ECG monitoring Call VAD coordinator or designated VAD contact person

LVAD patient assessment  If perfusion inadequate, pump is alarming or

pump has stopped 

Check percutaneous lead connection from patient to system controller

If the percutaneous lead becomes disconnected from the system controller, the pump will stop and could result in serious injury or death

LVAD patient assessment  If perfusion inadequate, pump is alarming or

pump has stopped 

Ensure BOTH power cords are connected to power  



Batteries (cords and batteries securely in place) Power Module (cords securely in place)

Check battery fuel gage 

Change battery or connect to Power Module if less than two lights are illuminated Never remove both batteries at the same time or the pump will stop. This could result in serious injury or death.

Key Points…  If the percutaneous lead becomes

disconnected from the system controller 

The pump will stop and this could result in serious injury or death

 Never remove both power supplies at the

same time 

This will cause the pump to stop and could result in serious injury or death

Considerations for transport of a patient with an LVAD  Important to remember that these patients are

DEPENDANT on electrical power  Must have the following equipment with the patient:   

Power module and power cords Charged set of back-up batteries Backup controller and battery clips

 Aviation electronics will NOT interfere with LVAD and

vice versa  All modes of emergency transportation are acceptable  Notify VAD center as soon as possible

Case  EMS are dispatched to the home of a 54 year old

man with light headedness  Upon arrival, patient is alert, meets the EMS crew at the door. He is alert, oriented and appropriate, complained of transient light headedness, now resolved. His wife is home and says, “he just doesn’t look right.”  He is awaiting a heart transplant and has a HeartMate II LVAD device  He is treated by physicians at a hospital about 25 miles away and is requesting transport to that hospital. The closest hospital is 5 miles away.

Case continued  Moved into the ambulance  Took backup batteries and power module  ECG Performed

A Word about ACLS  All ACLS protocols are applicable EXCEPT: 

NO ROUTINE CHEST COMPRESSIONS  Chest compression

pose a risk due to the location of the LVAD grafts  

Outflow graft on Aorta Inflow graft on LV

 Can tear when

compressions are performed

A Word about ACLS  All ACLS protocols are applicable EXCEPT:  

NO ROUTINE CHEST COMPRESSIONS When cardioverting/defibrillating, keep pads approximately 1-2 inches from LVAD device 

Try to avoid current through device

 LVAD patients may tolerate arrhythmia fairly

well 

Use clinical presentation to guide urgency, NOT electrical rhythm

 Communicate with the LVAD / Heart Failure

team as soon as possible

HH VAD program current stats  40 patients on VAD support 

34 HM II 



25 DT

5 H-VAD 

1 placed via minimally invasive approach

 1 year survival – 92%  

6 patients > 3 years support 23 patients > 1 year support

Questions? Center for Advanced Heart Failure and Transplant Hartford Hospital 860-972-1212 VAD Dial – 860-816-4604

TEAM WORK IS MOST IMPORTANT THING!!!