Patients with left ventricular assist devices (LVADs) are becoming more common in our area and are uniquely challenging.
A patient with an LVAD will often not have a detectable pulse or blood pressure: the device provides non-pulsatile flow. Unless the patient exhibits other clinical signs of cardiovascular collapse, they do not need CPR.
However, a patient with an LVAD who has no pulse, no pressure and other signs of cardiovascular collapse (i.e., unresponsiveness, agonal respirations, poorly perfused extremities), should still have CPR and be treated per all ACLS protocols.
LVAD patients can be transported to all usual points of entry, including those with STEMIs or polytrauma. If the EMS provider feels it is warranted, the patient’s LVAD cardiologist can be called from the field for advice; this advice, including any suggestions for where to take the patient, should be confirmed with on-line medical control before making final decisions.
On-line medical control will be the final arbiter of any disputes about best disposition for the patient.