Pearls for the Crashing LVAD Patient

• Left ventricular assist devices (LVAD) are placed as a bridge to transplant, bridge to recovery, or as destination therapy.
• As thousands of LVADs have been implanted, it is likely that a sick LVAD patient will show up in your ED or ICU.
• In addition to pump thrombosis (UMEM pearl 12/31/13), two complications to also consider in the crashing LVAD patient include infection and arrhythmias.
• Infection:
  • The driveline and pump pocket are the most common locations for device infection.
  • Most are caused by Staphylococcus and Enterococcus organisms.
  • For pump pocket and deeper wound infections be sure to also add coverage against Pseudomonas species. 
• Arryhthmias:
  • The highest incidence is within the first month after implantation.
  • Consider a "suction event," where the inflow cannula contacts the ventricular septum.
  • Suction events can be caused by hypovolemia, small ventricular size, or RV failure and are treated with fluid resuscitation and decreasing the LVAD speed.

References

Pratt AK, et al. Left ventricular assist device management in the ICU. Crit Care Med 2013; 42:158-168.

 

Follow me on Twitter (@critcareguys)