VENTRICULAR ASSIST DEVICE (VAD)

Purpose: The purpose of this policy is to assist UTSW/BioTel paramedics when evaluating a patient who has a Ventricular Assist Device (VAD) in place.

A ventricular assist device (VAD) is an implantable device used to artificially augment cardiac output and support circulation in patients with significant ventricular dysfunction. The mechanics of the VAD differ depending on manufacturer, however most devices support circulation via laminar flow, meaning that circulation may be present even though palpable pulses or a measureable blood pressure may be absent.

  1. RESPONSIVE PATIENT:
    1. Check the VAD for alarms:
    2. If alarms are activated, contact the VAD Coordinator or BioTel
    3. Check the VAD battery indicator:
      1. Change batteries, if indicated
    4. Obtain the patient’s Emergency Contact Card
    5. Obtain the patient’s travel batteries, charger and travel pack
    6. Management per symptom-specific protocol
    7. Contact BioTel for transport destination decision
  2. UNRESPONSIVE PATIENT:
    1. Do not begin chest compressions
    2. Evaluate airway -- If absent:
      1. Establish a patent airway
      2. Intubate if necessary
    3. Apply SpO2 monitoring:
      1. Administer supplemental oxygen to achieve a SpO2 at least 90%
    4. If intubated, apply continuous ETCO2 monitoring
    5. Apply continuous ECG monitoring using hands-free defibrillator pads in Paddles lead
    6. Check peripheral pulses -- If present:
      1. Treat according to symptom-specific Guidelines
      2. Contact BioTel for transport destination
    7. If peripheral pulses are absent, auscultate the sternal border. If humming:
      1. Connect cardiac monitor
      2. Defibrillate if necessary, according to the VENTRICULAR FIBRILLATION Guidelines
      3. Administer a 250cc Normal Saline bolus IV/IO
      4. Contact BioTel
    8. If peripheral pulses are absent and there is no indication of pump function:
      1. Do not begin chest compressions
      2. Evaluate the VAD for power loss:
        1. Change batteries, if necessary
        2. Connect to AC power
      3. Look for an external cardiac pump device:
        1. If present, begin external circulatory support
      4. Contact BioTel
  3. Obtain the patient’s travel batteries, charger and travel pack
  4. Contact BioTel for transport destination decision

    For additional patient care considerations not covered in this protocol, refer to the symptom-specific Guidelines or contact BioTel.