Improving Preparedness, Management, and Quality of Care for Unresponsive Lvad Patients

Introduction As left ventricular assist device (LVAD) use becomes more prevalent in clinical settings, it is critical that providers become more familiar with emergent resuscitative measures for these patients. Scarce literature exists on how hospital systems and providers should approach unresponsive LVAD patients. This quality improvement study developed an ACLS type algorithm to increase provider preparedness in these situations. Methods A detailed literature review on existing data and best practices was used to develop a new algorithm on how to approach unresponsive LVAD patients. A survey was distributed to internal medicine (IM), emergency medicine (EM), and family medicine (FM) residents before and after implementation of this algorithm to assess provider knowledge and comfort in caring for unresponsive LVAD patients. Results In the first survey, 37.3% EM, 46.3% IM, and 16.4% FM residents responded while in the second 33.3% were EM, 60% IM, and 6.7% FM. 35.8% reported they were not familiar at all with LVAD patient resuscitation and 80.6% stated their training did not involve instruction on running a code on an LVAD patient. Initially, 49.3% reported that, with their current level of experience, they would feel not at all comfortable running a code on an LVAD patient. This improved to 93.4% of residents feeling somewhat comfortable or better following algorithm distribution. Significant improvements were noted in important aspects to approaching an unresponsive LVAD patient such as correctly identifying the need to contact the VAD team immediately (34.3% to 93%), auscultating for a hum as the initial component of the physical exam (32.8% to 93%), performing chest compressions (43.3% to 93.3%), and using defibrillators if clinically indicated (50.7% to 96.7%). Overall comfort for creating differentials improved from 43.3% feeling not at all confident to 89.9% feeling at least somewhat confident. Although 63.3% feel that further education and training is needed, 93.3% felt educational tools similar to the provided algorithm/handout can be as effective as lecture based learning to bridge knowledge gaps. Conclusion Our study reveals that there is insufficient training for emergent resuscitation measures in LVAD patients. Similar levels of comfort and knowledge likely exist throughout the medical community despite rapid growth in LVAD use. Simple code-cart algorithms for unresponsive LVAD patients are as efficacious as lecture based learning in quickly increasing provider comfort and knowledge. Hospital systems nationally should consider implementing similar measures to enhance provider preparedness and improve LVAD patient care and survival.