EMS Care EMT Chapter 24-MCIT-F3-2113 | VAD   starts with an introduction to the topic. As  the number of patients relying on Mechanical Circulatory devices, rises in the community, there is a growing need for specific guidelines to assist emergency care providers in assisting or treating unresponsive or hypotensive patients with MCS. This lesson on MCS focuses on commonly used devices, their working, complications and the assessment and considerations while attending to these patients.

The lessons covered are

• Lesson 1: Mechanical Circulatory Support Devices (MCS).
• Lesson 2: Long-term MCS.
• Lesson 3: Ventricular Assist Devices (Vad).
• Lesson 4: Assessment: Patients with Vad.
• Lesson 5: Common Complications: Vad -Specific.
• Lesson 6: Vad -Related and Vad -Unrelated Complications.
• Lesson 7: Common Complications: Cardiac Arrest. And,
• Lesson 8: Total Artificial Heart.

Excerpt from EMS Care EMT Chapter 24-MCIT-F3-2113 | VAD

Highlights of Assessing and Treating a Vad Patient:

• Recognize that the patient has a Vad.
• Check the power source. Then, assess the level of consciousness, airway, and breathing.
• Auscultate heart sounds. If it is a continuous-flow device, a whirring sound will be heard.
• Vad can maintain perfusion even in the presence of ventricular fibrillation (the patient could be walking and talking)
• Monitor the ECG rhythm.
• Assess the device for alarms.
• Rapidly assess and determine if your patient has a Vad problem and cardiovascular compromise or an unrelated illness or injury
• The controller (usually around the patient’s waist) will have a colored tag to indicate the type of device and a resource number to call in an emergency. Some agencies carry a color-coded resource guide to assist with troubleshooting.
• Start a large-bore I-V
• Attempt to assess noninvasive MAP. A Doppler (if available) can also be used to measure MAP. The first sound the Doppler hears when deflating the blood pressure cuff is the MAP. Use MAP to assess the adequacy of perfusion. Acceptable MAP varies by device and ranges from 65 to 85 millimeters of mercury.
• A completely stable Vad patient may have no palpable pulse or measurable blood pressure.
• Mental status, skin color, and capillary refill must be used to determine the patient’s hemodynamic status and perfusion.
• Patients with a Vad should almost never be pronounced dead at the scene.
• The patient and their Vad -trained family or caregiver are experts on the device and should be utilized for information and assistance. And, lastly,
• The best medical resource available to EMS for Vad -related problems is the patient’s Vad The patient will always have a contact sheet for the Vad coordinator. Contact the coordinator and follow their instructions. It is not required to contact direct medical oversight for confirmation.