Heartmate II Patients and CPR - page 2

:redbeatheI would like to know, what do we do if our patient is a Heartmate Pt, and they are unconscious. We don't start CPR right, because it would do more damage. Has anyone had to deal with these patients or been in this... Read More

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    I've heard of a few similar stories with LV improvement. I had a patient a few weeks ago that was on a stem cell trial in which they injected stem cells into the myocardial tissue of an LVAD pt. The premise was similar to your story, in that in a few years if the LV had recovered, they would explant the HM-II. If not, the pt would be listed for tx. Pretty interesting stuff.

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    Quote from Donoharm
    Broad question but I am just curious - how good is the outcomes of LVAD patients? Quality of life - post-op, length of stays post-op. What if a pt can't take Coumadin can they still receive a LVAD? I don't know much about this area and I am a new nursing student. After reading many articles the above questions come to mind. Any veteran nurses in a cardio unit that deals with LVADs willing to give me some information?
    Outcomes with VADs depends mostly on how sick the patient was before they got it. Overall heart transplant is still the gold standard, but current 1yr and 2yr survival rates for VAD are close to those of transplant (~70-90%). Being unable to take coumadin is usually a contraindication to VAD therapy, although there are some devices that require less anticoagulation than others. It depends on the reason they can't take coumadin.

    Quality of life improvement again depends on how sick the patient was preop. Someone who had a sudden ischemic event like a huge MI and ended up on a transplant list with a VAD is not going to love it. Someone who's had end stage cardiomyopathy for years and been hospitalized multiple times, and who can't do anything much, will probably find they feel a ton better with good circulation and improved exercise tolerance. Most of the QOL surveys we do find that patients say they would do it again, even knowing what they know now.

    Average national length of stay post VAD is around 30 days. Sometimes this is due to physical reasons and sometimes due to needing to train the patient and family on how to work the VAD equipment and what to do in case of emergency. More often nowadays we transfer patients to rehab to get stronger (and decrease hospital length of stay) while we train them.
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    Here is some great info on VAD emergencies http://emcrit.org/wee/left-ventricul...devices-lvads/
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    Just curious, have any of you guys had the opportunity to work with the Heartware Vads yet? I personally thought they were uber-cool (yes I know that's not a real word lol). Goes to show how our modern lifestyles affect the ever-changing field of medicine when you can plug your LVAD into the cigarette lighter of your car!

    Sent from my SPH-D700 using allnurses.com
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    Yep, use them pretty regularly now. Outcomes seem slightly better than HM2 for now. It's cool that there is no pump pocket required, so no pump pocket infections/hematomas etc. They are a little less forgiving on anticoagulation than the HM2's. Can't really talk specifics because they are still in trial.
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    First question: We check to see if it is a controller problem by listening, if it is replace the controller. If not treat arrhythmia/volume etc. All while someone is calling the mechanical heart team (RNs or engineers) and the surgeons. And only when they say so we do compressions doesn't mean we aren't doing the other parts of ACLS in the mean time.

    Second question: When they do well they do great, I can think of one that came in once during the year and a half I have worked on my floor, another 2 that have come in twice and are out boating/riding mopeds. But then there are those that just do terrible and we get a little bit to much exposure to that in the in patient world. We have some awesome cases were it gets them to transplant and then some heart breaking stories that still have left me unsettled since April. Bottom line, its a new field and each new device is getting better and we are learning how to better treat the patients and the device.
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    I love that device, if I were to get one it would be the heartware. My patients mom brought in his power stuff for me and had the car charger and I was super entertained, I had heard about it but not see one. Really they can go to AC power with what looks like a laptop cable.
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    Which pump depends somewhat on patient size, comorbidities, whether they fit trial criteria, how literate they are (Heartware has alarm instructions written on the screen, while Heartmate II has illuminated symbols), how tolerant of anticoagulation they'll be (Heartware tends to need slightly higher INR/PTT), what their LV looks like (Heartware is small and not anchored by anything so can tend to move over time as the heart remodels, and you can get inflow obstruction - so someone with an acute event, or viral CM who is likely to recover more is not the best candidate in our experience. Also, hypertrophics have very thick myocardium and the pump inflow is a fixed length so sometimes cannot reach far enough into the LV cavity to unload it well).

    Both pumps have AC and DC (car) adapters, but the batteries last long enough now (6-14 hours) that the patients rarely use the car charger.


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