Quote from Christy1019
I would have to disagree, pt's on LVAD, especially heartmate II or newer generations heartware, once the mechanical stops, unfortunately you're done. Mind you, the old generation LVAS XVE (a.k.a Heartmate I) had a manual pump in case it stops, but they are obsolete now. A real scenario is when a patient is "unconscious" and has (red heart alarm) you should first listen to the "humming" of the pump...then if it's present there are 5 main differentials...Hypovolemia, Arrhythmia, Right Ventricular Ischemia, Tamponade and Thrombosis. Thrombosis is a tricky one because you can feel the system controller heat up if you touch it due to the thrombos sitting in the propeller, and the only way you can save them is take them to the cath lab and use tpa...because in the meantime they will revert back to their old EF ie. 10%, that they had prior to LVAD placement.
Christy, this makes no sense to me, and I work solely with VADs. If you had a pump thombus in the "propeller", how on earth would that make the system controller heat up? The pump is implanted in the abdomen and the controller is external.. I see no reason why or how this would possibly happen. In fact if there's a pump thrombus, it totally depends where exactly it is as to whether pump power would go up or down - in an axial flow pump if flow is restricted by a clot, less blood goes through the pump, so less pump work, so power goes down. If there's a small clot on the impeller, it may cause drag and increase pump work so that would make pump power go up. None of these scenarios would make the controller heat up.
As to the OP's question, if a VAD patient (particularly continuous flow VAD like HM-II) becomes unconscious, your first responsibility is to ABCs. Protect the airway, get O2 on, call a code, get a backboard, get the crash cart and/or sternotomy cart. The actions will depend a lot on how fresh postop they are - a fresh postop is more likely to be tamponading than someone 2 years down the track, who may be septic/hypotensive/having a stroke.
Remember people can become unconscious for neuro reasons and you may not be able to get a pulse, but try and get a doppler BP at the brachial artery to check for circulation. Check if the VAD is running - what does the monitor say, if they are on monitor? Do they have a flow? Are they having suction/PI events? Is the VAD alarming? What is alarming? Did the controller just fail and they are passed out, in which case you can just switch to the backup and get things running quickly? Do they have a bad cable (there is a current advisory on HMII patient-power module cable pins which are breaking). Is the pump running on auscultation of the pump pocket? If not, they may need to reopen the chest, clamp the outflow graft, and do internal compressions (again, depends how fresh postop they are).
Bottom line, dead is dead, so if they are unconscious, pump is off, you have no pulse or doppler pressure, by all means try chest compressions, because you can't be deader than dead. The inflow cannulae are not sharp edged like they used to be, so you may be lucky and not lacerate the heart. Just remember if the pump is ON and you have no doppler blood pressure, there's no point doing CPR/ECC unless you drop the pump speed - you're just trying to compress a heart that is empty from the VAD sucking all the blood out at high speed. You can drop to a minimum speed of 6000rpm but remember you won't have a flow displayed on the monitor once you go below 8000rpm.
This should get you started thinking.. let me know if you have further questions.