Left ventricular assist device complications - Revision history

Danbot: Strip excess bold text

2026-03-22T09:24:12Z

Strip excess bold text

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	===Components===		===Components===
	*~~'''~~Pump~~'''~~ = Internal pump (usually placed in preperitoneal space), takes blood from a cannula in the apex of the left ventricle and pumps it into the aorta		*Pump = Internal pump (usually placed in preperitoneal space), takes blood from a cannula in the apex of the left ventricle and pumps it into the aorta
	*~~'''~~Driveline~~'''~~ = Percutaneous cable that exits the abdominal wall, connects pump to external components (controller, battery)		*Driveline = Percutaneous cable that exits the abdominal wall, connects pump to external components (controller, battery)
	*~~'''~~Controller~~'''~~ = External "box" containing computer for the device that monitors pump performance, has a display screen and controls for settings/alarms/diagnostics, and will display will show pump speed in RPM and pump output in L/min		*Controller = External "box" containing computer for the device that monitors pump performance, has a display screen and controls for settings/alarms/diagnostics, and will display will show pump speed in RPM and pump output in L/min
	*'''Power Supply''' = Controller can be connected to batteries for patient mobility, or to a "power base station" that plugs into the wall for home use		*'''Power Supply''' = Controller can be connected to batteries for patient mobility, or to a "power base station" that plugs into the wall for home use

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	====HeartMate I or XVE====		====HeartMate I or XVE====
	#~~'''~~Use:~~'''~~ Destination Therapy		#Use: Destination Therapy
	#~~'''~~Flow Type:~~'''~~ Pulsatile		#Flow Type: Pulsatile
	#~~'''~~Backup Method:~~'''~~ Hand Pump		#Backup Method: Hand Pump
	#~~'''~~Battery:~~'''~~ 12volt MiMH - 10hrs		#Battery: 12volt MiMH - 10hrs
	#~~'''~~Defib/Cardioversion:~~'''~~ Use hand pump during defib/cardioversion		#Defib/Cardioversion: Use hand pump during defib/cardioversion

	====HeartMate II====		====HeartMate II====
	(~~'''~~Most common type in use today~~'''~~)		(Most common type in use today)
	#~~'''~~Use:~~'''~~ Bridge to transplant or destination therapy		#Use: Bridge to transplant or destination therapy
	#~~'''~~Flow type:~~'''~~ Continuous		#Flow type: Continuous
	#~~'''~~Backup Method:~~'''~~ No external method		#Backup Method: No external method
	#~~'''~~Battery:~~'''~~ 14V Li-Ion - 10 hrs		#Battery: 14V Li-Ion - 10 hrs
	#~~'''~~Defib/Cardioversion:~~'''~~ No precautions		#Defib/Cardioversion: No precautions
	#~~'''~~Target INR:~~'''~~ 1.8 to 2.5		#Target INR: 1.8 to 2.5

	====Thoratec VAD (HeartMate III)====		====Thoratec VAD (HeartMate III)====
	#~~'''~~Use:~~'''~~ Bridge to Transplant		#Use: Bridge to Transplant
	#~~'''~~Flow Type:~~'''~~ Pulsatile		#Flow Type: Pulsatile
	#~~'''~~Backup Method:~~'''~~ No external method		#Backup Method: No external method
	#~~'''~~Battery:~~'''~~ 12V lead acid gel battery - 7.2 Ah - up to 3 hrs		#Battery: 12V lead acid gel battery - 7.2 Ah - up to 3 hrs
	#~~'''~~Defib/Cardioversion:~~'''~~ No precautions		#Defib/Cardioversion: No precautions
	====HeartWare HVAD====		====HeartWare HVAD====
	#~~'''~~Use:~~'''~~ Bridge to Transplant		#Use: Bridge to Transplant
	#~~'''~~Anatomy:~~'''~~ Designed to be implanted completely in pericardial space, no need for pump pocket formation		#Anatomy: Designed to be implanted completely in pericardial space, no need for pump pocket formation
	#~~'''~~Flow Type:~~'''~~ Centrifugal pump		#Flow Type: Centrifugal pump
	#~~'''~~Target INR:~~'''~~ 2.0-3.0		#Target INR: 2.0-3.0

	==Complications/Differential Diagnosis<ref name="LVAD" />==		==Complications/Differential Diagnosis<ref name="LVAD" />==
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	**Auscultate for pump noise		**Auscultate for pump noise
	**Device parameters (found on controller)		**Device parameters (found on controller)
	***~~'''~~Pump speed~~'''~~ - varies by device - 2,000-10,000 RPM		***Pump speed - varies by device - 2,000-10,000 RPM
	***~~'''~~Power~~'''~~ - normal 4-6 Watts		***Power - normal 4-6 Watts
	***~~'''~~Flow~~'''~~ - normal 4-6 L/min		***Flow - normal 4-6 L/min
	***~~'''~~Pulsatility Index (PI)~~'''~~ - normal 1-10		***Pulsatility Index (PI) - normal 1-10
	****Measures magnitude of pulsatile flow provided by native cardiac contractions		****Measures magnitude of pulsatile flow provided by native cardiac contractions
	****Higher PI = less LVAD support		****Higher PI = less LVAD support

Cmb23: /* EvaluationPartyka C, Taylor B. Review article: ventricular assist devices in the emergency department. Emerg Med Australas. 2014 Apr;26(2):104-12. */

2023-10-22T01:45:09Z

EvaluationPartyka C, Taylor B. Review article: ventricular assist devices in the emergency department. Emerg Med Australas. 2014 Apr;26(2):104-12.

← Older revision		Revision as of 01:45, 22 October 2023
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	*Assess perfusion and general state (mental status, skin temp/color, capillary refill, etc)		*Assess perfusion and general state (mental status, skin temp/color, capillary refill, etc)
	**LVADs are preload dependant - if symptoms of hypoperfusion, give fluid blous		**LVADs are preload dependant - if symptoms of hypoperfusion, give fluid blous
	*HR measured via ECG or auscultation (may be difficult secondary to pump noise)		*HR measured via ECG or auscultation (may be difficult secondary to pump noise). A hum or whir should be present to indicate the pump is functioning.
	*Get 12-lead [[ECG]] on all LVAD patients		*Get 12-lead [[ECG]] on all LVAD patients
	**Demonstrates primary cardiac disease<ref name="LVAD 2">Pistono M, Corrà U, Gnemmi M, Imparato A, Temporelli PL, Tarro Genta F, Giannuzzi P. How to face emergencies in heart failure patients with ventricular assist device. Int J Cardiol. 2013 Oct 15;168(6):5143-8</ref>		**Demonstrates primary cardiac disease<ref name="LVAD 2">Pistono M, Corrà U, Gnemmi M, Imparato A, Temporelli PL, Tarro Genta F, Giannuzzi P. How to face emergencies in heart failure patients with ventricular assist device. Int J Cardiol. 2013 Oct 15;168(6):5143-8</ref>

Elcatracho: /* Background */

2023-03-15T16:17:58Z

Background

← Older revision		Revision as of 16:17, 15 March 2023
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	*Developed in 1960s as bridge to cardiac transplant		*Developed in 1960s as bridge to cardiac transplant
	**LVAD (left ventricle), RVAD (right ventricle), BiVAD (both venticles via separate pumps)<ref name="LVAD Prehospital">Mechem CC. Prehospital assessment and management of patients with ventricular-assist devices. Prehosp Emerg Care. 2013 Apr-Jun;17(2):223-9.</ref>		**LVAD (left ventricle), RVAD (right ventricle), BiVAD (both venticles via separate pumps)<ref name="LVAD Prehospital">Mechem CC. Prehospital assessment and management of patients with ventricular-assist devices. Prehosp Emerg Care. 2013 Apr-Jun;17(2):223-9.</ref>
			*Also used as destination therapy
	*VADs have 3 major variables:		*VADs have 3 major variables:
	#Speed		#Speed
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	#Battery level - typically powered by two batteries, with power base unit that can be plugged into wall		#Battery level - typically powered by two batteries, with power base unit that can be plugged into wall
	#Pulsatility index:		#Pulsatility index:
	#*Decreased index, may indicate low preload		#*Decreased index, may indicate low preload or decreased native LV contractility
	#*Increased index, may indicate volume overload		#*Increased index, may indicate volume overload or increased native LV contractility
	#*Pump speed and pulsatility index are inversely related		#*Pump speed and pulsatility index are inversely related

Jonrako: /* Cardiac Arrest */

2021-07-21T08:23:25Z

Cardiac Arrest

← Older revision		Revision as of 08:23, 21 July 2021
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	*Immediately evaluate LVAD components and attach to reliable power source		*Immediately evaluate LVAD components and attach to reliable power source
	**Some first-generation LVADs have external hand pumps that can be used to provide circulation		**Some first-generation LVADs have external hand pumps that can be used to provide circulation
	*~~Otherwise follow [[ACLS]] as in a normal~~ patient		*Begin CPR if patient is unresponsive with MAP less than 50mmHg, end tidal carbon dioxide level less than 20mmHg, or LVAD cannot be restarted.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>
	**Unstable patients with shockable dysrhythmias should be cardioverted.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>		**Unstable patients with shockable dysrhythmias should be cardioverted.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>
	***Optimal placement of pads is in the anterior-posterior fashion & not over the drive line.		***Optimal placement of pads is in the anterior-posterior fashion & not over the drive line.
	**Patient can be intubated, given IV fluids and drugs, etc		**Patient can be intubated, given IV fluids and ACLS drugs, etc
	*New Paradigm shift with since AHA officially endorsed the use of chest compressions in 6/2017.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>		*New Paradigm shift with since AHA officially endorsed the use of chest compressions in 6/2017.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>
	**Some studies available<ref>Shinar Z, Bellezzo J, Stahovich M, Cheskes S, Chillcott S, Dembitsky W. Chest compressions may be safe in arresting patients with left ventricular assist devices (LVADs). Resuscitation. 2014 May;85(5):702-4.</ref><ref>Mabvuure NT, Rodrigues JN. External cardiac compression during cardiopulmonary resuscitation of patients with left ventricular assist devices. Interact Cardiovasc Thorac Surg. 2014 Aug;19(2):286-9.</ref> indicate that CPR may not be as harmful as previously thought, or that abdominal compressions are an alternative<ref>Eric M Rottenberg, Jarrett Heard, Robert Hamlin, Benjamin C Sun, and Hamdy Awad. Abdominal only CPR during cardiac arrest for a patient with an LVAD during resternotomy: A case report. J Cardiothorac Surg. 2011; 6: 91.</ref> but further investigation needed		**Some studies available<ref>Shinar Z, Bellezzo J, Stahovich M, Cheskes S, Chillcott S, Dembitsky W. Chest compressions may be safe in arresting patients with left ventricular assist devices (LVADs). Resuscitation. 2014 May;85(5):702-4.</ref><ref>Mabvuure NT, Rodrigues JN. External cardiac compression during cardiopulmonary resuscitation of patients with left ventricular assist devices. Interact Cardiovasc Thorac Surg. 2014 Aug;19(2):286-9.</ref> indicate that CPR may not be as harmful as previously thought, or that abdominal compressions are an alternative<ref>Eric M Rottenberg, Jarrett Heard, Robert Hamlin, Benjamin C Sun, and Hamdy Awad. Abdominal only CPR during cardiac arrest for a patient with an LVAD during resternotomy: A case report. J Cardiothorac Surg. 2011; 6: 91.</ref> but further investigation needed
	*Begin CPR if patient is unresponsive with MAP less than 50mmHg, end tidal carbon dioxide level less than 20mmHg, or LVAD cannot be restarted.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>

	==Disposition==		==Disposition==

Jonrako: /* Cardiac Arrest */

2021-07-21T08:19:57Z

Cardiac Arrest

← Older revision		Revision as of 08:19, 21 July 2021
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	*New Paradigm shift with since AHA officially endorsed the use of chest compressions in 6/2017.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>		*New Paradigm shift with since AHA officially endorsed the use of chest compressions in 6/2017.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>
	**Some studies available<ref>Shinar Z, Bellezzo J, Stahovich M, Cheskes S, Chillcott S, Dembitsky W. Chest compressions may be safe in arresting patients with left ventricular assist devices (LVADs). Resuscitation. 2014 May;85(5):702-4.</ref><ref>Mabvuure NT, Rodrigues JN. External cardiac compression during cardiopulmonary resuscitation of patients with left ventricular assist devices. Interact Cardiovasc Thorac Surg. 2014 Aug;19(2):286-9.</ref> indicate that CPR may not be as harmful as previously thought, or that abdominal compressions are an alternative<ref>Eric M Rottenberg, Jarrett Heard, Robert Hamlin, Benjamin C Sun, and Hamdy Awad. Abdominal only CPR during cardiac arrest for a patient with an LVAD during resternotomy: A case report. J Cardiothorac Surg. 2011; 6: 91.</ref> but further investigation needed		**Some studies available<ref>Shinar Z, Bellezzo J, Stahovich M, Cheskes S, Chillcott S, Dembitsky W. Chest compressions may be safe in arresting patients with left ventricular assist devices (LVADs). Resuscitation. 2014 May;85(5):702-4.</ref><ref>Mabvuure NT, Rodrigues JN. External cardiac compression during cardiopulmonary resuscitation of patients with left ventricular assist devices. Interact Cardiovasc Thorac Surg. 2014 Aug;19(2):286-9.</ref> indicate that CPR may not be as harmful as previously thought, or that abdominal compressions are an alternative<ref>Eric M Rottenberg, Jarrett Heard, Robert Hamlin, Benjamin C Sun, and Hamdy Awad. Abdominal only CPR during cardiac arrest for a patient with an LVAD during resternotomy: A case report. J Cardiothorac Surg. 2011; 6: 91.</ref> but further investigation needed
			*Begin CPR if patient is unresponsive with MAP less than 50mmHg, end tidal carbon dioxide level less than 20mmHg, or LVAD cannot be restarted.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>

	==Disposition==		==Disposition==

Jonrako: /* Cardiac Arrest */

2021-07-21T08:13:57Z

Cardiac Arrest

← Older revision		Revision as of 08:13, 21 July 2021
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	**Unstable patients with shockable dysrhythmias should be cardioverted.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>		**Unstable patients with shockable dysrhythmias should be cardioverted.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>
	***Optimal placement of pads is in the anterior-posterior fashion & not over the drive line.		***Optimal placement of pads is in the anterior-posterior fashion & not over the drive line.
	**Patient ~~should~~ be intubated, given IV fluids and drugs, etc		**Patient can be intubated, given IV fluids and drugs, etc
	*New Paradigm shift with since AHA officially endorsed the use of chest compressions in 6/2017.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>		*New Paradigm shift with since AHA officially endorsed the use of chest compressions in 6/2017.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>
	**Some studies available<ref>Shinar Z, Bellezzo J, Stahovich M, Cheskes S, Chillcott S, Dembitsky W. Chest compressions may be safe in arresting patients with left ventricular assist devices (LVADs). Resuscitation. 2014 May;85(5):702-4.</ref><ref>Mabvuure NT, Rodrigues JN. External cardiac compression during cardiopulmonary resuscitation of patients with left ventricular assist devices. Interact Cardiovasc Thorac Surg. 2014 Aug;19(2):286-9.</ref> indicate that CPR may not be as harmful as previously thought, or that abdominal compressions are an alternative<ref>Eric M Rottenberg, Jarrett Heard, Robert Hamlin, Benjamin C Sun, and Hamdy Awad. Abdominal only CPR during cardiac arrest for a patient with an LVAD during resternotomy: A case report. J Cardiothorac Surg. 2011; 6: 91.</ref> but further investigation needed		**Some studies available<ref>Shinar Z, Bellezzo J, Stahovich M, Cheskes S, Chillcott S, Dembitsky W. Chest compressions may be safe in arresting patients with left ventricular assist devices (LVADs). Resuscitation. 2014 May;85(5):702-4.</ref><ref>Mabvuure NT, Rodrigues JN. External cardiac compression during cardiopulmonary resuscitation of patients with left ventricular assist devices. Interact Cardiovasc Thorac Surg. 2014 Aug;19(2):286-9.</ref> indicate that CPR may not be as harmful as previously thought, or that abdominal compressions are an alternative<ref>Eric M Rottenberg, Jarrett Heard, Robert Hamlin, Benjamin C Sun, and Hamdy Awad. Abdominal only CPR during cardiac arrest for a patient with an LVAD during resternotomy: A case report. J Cardiothorac Surg. 2011; 6: 91.</ref> but further investigation needed

Jonrako: /* Cardiac Arrest */

2021-07-21T08:13:16Z

Cardiac Arrest

← Older revision		Revision as of 08:13, 21 July 2021
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	**Some first-generation LVADs have external hand pumps that can be used to provide circulation		**Some first-generation LVADs have external hand pumps that can be used to provide circulation
	*Otherwise follow [[ACLS]] as in a normal patient		*Otherwise follow [[ACLS]] as in a normal patient
	**Unstable patients with shockable dysrhythmias should be cardioverted.		**Unstable patients with shockable dysrhythmias should be cardioverted.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>
	***optimal placement of pads is in the anterior-posterior fashion & not over the drive line.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>		***Optimal placement of pads is in the anterior-posterior fashion & not over the drive line.
	**Patient should be intubated, given IV fluids and drugs, etc		**Patient should be intubated, given IV fluids and drugs, etc
	*New Paradigm shift with since AHA officially endorsed the use of chest compressions in 6/2017.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>		*New Paradigm shift with since AHA officially endorsed the use of chest compressions in 6/2017.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>

Jonrako: /* Cardiac Arrest */

2021-07-21T08:12:03Z

Cardiac Arrest

← Older revision		Revision as of 08:12, 21 July 2021
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	**Some first-generation LVADs have external hand pumps that can be used to provide circulation		**Some first-generation LVADs have external hand pumps that can be used to provide circulation
	*Otherwise follow [[ACLS]] as in a normal patient		*Otherwise follow [[ACLS]] as in a normal patient
			**Unstable patients with shockable dysrhythmias should be cardioverted.
			***optimal placement of pads is in the anterior-posterior fashion & not over the drive line.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>
	**Patient should be intubated, given IV fluids and drugs, etc		**Patient should be intubated, given IV fluids and drugs, etc
	*New Paradigm shift with since AHA officially endorsed the use of chest compressions in 6/2017.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>		*New Paradigm shift with since AHA officially endorsed the use of chest compressions in 6/2017.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>

Jonrako: /* EvaluationPartyka C, Taylor B. Review article: ventricular assist devices in the emergency department. Emerg Med Australas. 2014 Apr;26(2):104-12. */

2021-07-21T06:57:23Z

EvaluationPartyka C, Taylor B. Review article: ventricular assist devices in the emergency department. Emerg Med Australas. 2014 Apr;26(2):104-12.

← Older revision		Revision as of 06:57, 21 July 2021
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	**CT with contrast to look for thrombus, discuss with radiologist to protocol		**CT with contrast to look for thrombus, discuss with radiologist to protocol
	*Blood pressure measured with manual BP cuff and Doppler ultrasound - MAP is identified when constant flow is heard		*Blood pressure measured with manual BP cuff and Doppler ultrasound - MAP is identified when constant flow is heard
	**MAP should be 70-90 mmHg		**MAP should be 65-80 mmHg<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>
	**Can also monitor with [[arterial line]]		**Can also monitor with [[arterial line]]
	*Basic lab should be obtained on all LVAD patients		*Basic lab should be obtained on all LVAD patients

Jonrako: /* Complications/Differential Diagnosis */

2021-07-21T06:51:04Z

Complications/Differential Diagnosis

← Older revision		Revision as of 06:51, 21 July 2021
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	==Complications/Differential Diagnosis<ref name="LVAD" />==		==Complications/Differential Diagnosis<ref name="LVAD" />==
	*Bleeding - most common reason for ED visit, most common in first month after implant (frequency 42%<ref name="REMATCH">Rose EA, Gelijns AC, Moskowitz AJ et al. Long-term use of a left ventricular assist device for end-stage heart failure. N. Engl. J. Med. 2001; 345: 1435–1443.</ref>)		*Bleeding - most common reason for ED visit, most common in first month after implant (frequency 42%<ref name="REMATCH">Rose EA, Gelijns AC, Moskowitz AJ et al. Long-term use of a left ventricular assist device for end-stage heart failure. N. Engl. J. Med. 2001; 345: 1435–1443.</ref>)
	**GI bleeding is the most common source (15%-30%) followed by epistaxis.<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>		**[[GI bleeding]] is the most common source (15%-30%) followed by [[epistaxis]].<ref>Stenberg, R., & Shenvi, C. (2020). Targeted Evaluation of Patients With Left Ventricular Assist Devices and Shock or Hypotension. Annals of Emergency Medicine, 76(1), 34–41. https://doi.org/10.1016/j.annemergmed.2020.01.003 </ref>
	**Mechanisms:		**Mechanisms:
	***Acquired [[Von Willebrand Disease (vWD)]] from pump shear forces<ref>Suarez J., Patel C.B., Felker G.M., Becker R., Hernandez A.F., Rogers J.G. Mechanisms of bleeding and approach to patients with axial-flow left ventricular assist devices. Circ Heart Fail. 2011;4:770–784.</ref>		***Acquired [[Von Willebrand Disease (vWD)]] from pump shear forces<ref>Suarez J., Patel C.B., Felker G.M., Becker R., Hernandez A.F., Rogers J.G. Mechanisms of bleeding and approach to patients with axial-flow left ventricular assist devices. Circ Heart Fail. 2011;4:770–784.</ref>