Ventricular Assist Devices Zoll LifeVest External Defibrillator

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Ventricular Assist Devices Zoll LifeVest External
Defibrillator
Edward Hospital EMSS
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Topics

• Zoll LifeVest
• What it is
• Who it treats
• How does EMS handle these patients?

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Topics

• Ventricular Assist Devices
• What they are
• What they do
• How to treat these patients

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• Video

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Zoll LifeVest

• Wearable AED
• Harness
• Control Module
• Battery
• Three Pads
• Electrodes

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Who Uses Them?

• ICD Removal
• Potential for SCA
• Current or old MI
• Cardiomyopathy Patients

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Statistics

• Over 25,000 Patients
• 358 Saves
• Dupage County
• 1 Save
• 200 increase

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How Do We Treat These Patients?

• Normal AED Patient
• Alarm will sound
• 45 seconds
• Disable Vest

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How Do We Treat These Patients?

• Remove Battery

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How Do We Treat These Patients?

• Remove the vest
• Itself

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• Ventricular Assist Devices

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• Video

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Pulsatile Vs. Non-Pulsatile

• Pulsatile
• Older first generation models
• Non-Pulsatile
• Second / Third Generation Models

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VADs

• Ventricular Assist Devices
• LVAD
• RVAD
• Bi-Vad

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VAD
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Who uses VADs?

• 7318 people were waiting for a heart
• 2210 received one
• 623 died waiting
• 1200-1500 VAD implanted in 2008

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Who uses VADs?

• Bridge to Transplant
• Bridge to Recovery
• Destination Therapy

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Field Considerations

• Treat patient as an adult with special health
  care needs.
• Find family member or aide who is familiar with
  equipment
• Always treat the patient!

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Field Considerations

• If patient has an LVAD and it is working
  properly, it is providing patient's cardiac
  output and is not in time with patient's real
  heart.
• Patients EKG rate will not equal pulse rate.
  Instead pulse should be at rate of the LVAD pump

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Field Considerations

• All VADs are dependant on adequate preload in
  order to maintain proper functioning
• Pump can cavitate if there is a decreased
  preload
• Volume resuscitation in an unstable VAD patient
  is the first line of therapy before vasopressors
  but be cautious with fluid as to not over load
  the right ventricle in LVADs only

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Field Considerations

• Nitrates can be detrimental to a VAD patient
  because of the reduction in preload
• Results in decreased pump efficiency
• Consult with medical control before administering
  nitrates per protocol
• Initiate IV therapy with all VAD patients if
  possible

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Field Considerations

• A patient can be in a lethal arrhythmia and be
  asymptomatic. Treat the patient not the monitor.
• Do not cardiovert/defib unless the patient is
  unstable with the arrhythmia.
• Electrical shock from cardiovert/defib will not
  damage any of the VAD equipment

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Field Considerations

• Chest Compressions are NOT recommended. Chest
  compressions can disrupt the implanted equipment
  causing massive hemorrhaging.

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Transport Consideration

• If able, transport the patient with any other
  pertinent equipment needed for the VAD pump.
• Batteries
• Charging unit
• Hand pump (if available)

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Questions???
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Sources

• http//www.mayoclinic.org/heart-transplant/vad.htm
  l
• http//www.medicinenet.com/left_ventricular_assist
  _device_lvad/page2.htm
• www.mfri.org/dom/Drill_pdf/DM_0911.ppt
• http//www.uchospitals.edu/specialties/heart/servi
  ces/heart-failure/assist-devices.html