VAD and Zoll Life Vest

1
VAD and Zoll Life Vest

• North Naples Fire Control
• And Rescue District
• Lt. Jodi Van Sickle

2
VAD

• Ventricular Assist Device
• Implanted in the chest to augment cardiac output
• Bridge to transplant
• Destination therapy
• For pts w/ advanced heart failure and symptomatic
  despite meds and who do not meet transplant
  criteria
• GOAL improve quality of life
• PERMANENT

3
VAD cont

• Types
• LVAD- augment blood flow to the body (most
  common)
• RVAD- augment blood flow to the lungs
• BiVAD- augments both

4
VAD cont

• How it works
• Blood flows the normal path through the heart
  until it reaches the left ventricle
• A cannula is placed in the apex of the heart that
  drains the blood into the systems pump
• Blood then pumped into the aorta
• A cable driveline exits the abdominal wall
  connecting the internal pump to the external
  controller The brains

5
VAD cont

• Pts are typically on anticoagulants
• Complications include
• Pump thrombus
• Nasal, GI, or intracranial bleeds
• Thromboembolic events (CVAs)
• Pump failure due to a pump thrombus

6
VADs cont

• VAD Coordinator is your best friend!!!
• They assist with pt treatment and transport
• They know everything about the pt
• Often called by the pt or family member prior to
  your arrival
• Talk to them!!!
• Be EXTREMELY careful not to cut, twist, bend or
  kink the driveline!!!

7
VAD Pt assessment

• Start with ABCs as normal
• When you get to C there are some differences!!
• Most VADs do not create a pulsatile-flow
• No palpable pulses!!
• Therefore BPs manually will not be produced

8
VADs cont

• Automatic BP may produce a reading
• Preferred route would be by doppler!
• A pressure of 60-90mmHg is considered acceptable
• Pulse oximetry may produce a poor reading

9
VADs cont

• Assessing the pts mental status, skin and lips
  are your best bet!!
• You may not even hear heart tones
• You can listen for the hum of the device over the
  pump pocket at the lower left rib margin on the
  anterior chest.

10
VAD Alarming!!

• Call the VAD coordinator!!
• Double check the driveline and two sources of
  power are connected to the system controller
• If the VAD stops the pt will go back into heart
  failuresome quicker than others
• Restarting a pump is usually against protocol due
  to clot formation

11
VAD assessment cont

• IF EKG is a concerning arrhythmia, make sure you
  discuss with the coordinator PRIOR TO
  interventions!!
• Its possible for the pt to be in V-Tach or V-Fib
  awake and talking if the pump is working properly
• ASSESS YOUR PATIENT!!!!

12
VAD assessment cont

• If pt requires defibrillation
• Do not stop the pump
• Place pads anterior/posterior and not over the
  pump

13
VAD assessment cont

• If you think your pt is in cardiac arrest
• CALL THE COORDINATOR!!!!!
• DO NOT START CPR UNTIL CONFIRMED WITH
  COORDINATOR!!!!!

14
VAD cont

• Usually VAD pts call for something unrelated to
  their VAD
• Assess and treat the pt according to our
  protocolsbut always have the coordinator
  involved in your treatment!!!
• When transporting, remember the pts emergency
  travel pack and a family member!!

15
ZOLL Life Vest

• Its an AED that is worn all the time by the
  patient.
• Automatically detects SCA
• Its for the patients that are not eligible for
  an internal cardiac defibrillator

16
ZLV cont

• The device will alert the pt if it detects an
  arrhythmia
• Automatically delivers a treatment shock if the
  pt does not respond to the alarms
• The pt is able to prevent the shocks while
  conscious
• Automatically delivers up to 5 shocks in a
  treatment sequence

17
ZLV cont

• If you hear the device alarming
• DO NOT touch the patient!!

18
ZLV cont

• If trained and equipped to deal with ventricular
  arrhythmias then you may remove the vest
• If not leave it in place throughout transport
  for continued monitoring a treatment

19

• Thank you!!