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Lesson

LVAD Emergencies

12 min Cardiac & ECG Skip to quiz

Objective: Treat an LVAD (heart pump) patient by perfusion, not by the missing pulse. Start CPR if they are unresponsive with no signs of flow. Check the controller at the same time.

Why this matters

A missing pulse can push a crew to start CPR on a talking patient with a humming pump. It can also delay CPR on a lifeless patient while they hunt batteries. An LVAD is a left-ventricular assist device, a heart pump. Continuous-flow pumps often have no palpable pulse even when the device is working.

If the patient is unresponsive with no signs of perfusion, start CPR now. A second person checks or restarts the controller at the same time. Do not delay blood flow to the brain for a device-first pause.

Key points
  • Listen over the pump, on the left chest or upper abdomen, for a continuous hum. Ask the family for the backup controller and charged batteries.
  • The pulse ox and the automatic cuff may fail. Use the capnography waveform, mental status, and skin. Use a MAP from an arterial line if they have one. MAP means mean arterial pressure. Use Doppler, or a MAP estimate, if your protocol includes it.
  • Call the VAD coordinator early. VAD means ventricular assist device. The number is often on the device bag. Go to the implanting center if time allows.

Clinical sequence

  1. From the door, ask four things. Are they talking? Are they breathing? Is there a hum? Are there alarms?
  2. If they are awake, the missing pulse is expected. Treat the complaint: volume, arrhythmia, infection, or stroke. Bring the spare controller.
  3. If they are unresponsive with no signs of perfusion, start CPR now. A second person checks the hum, batteries, and controller at the same time. Do not take a long device-first pause.
  4. Defibrillate VF or pVT if it is present. VF means ventricular fibrillation. pVT means pulseless ventricular tachycardia. Place the pads as usual. Avoid the driveline. Do not stop resuscitation only because there was never a pulse.
  5. Call the VAD coordinator and notify the VAD center. Do not spend the scene hunting a pulse that will not be there.

Teaching points

  • No pulse is not PEA until you have checked the pump. PEA means pulseless electrical activity. Continuous-flow LVADs often have no palpable pulse.
  • A hum plus a normal mental status means circulation until you prove otherwise. A silent pump plus collapse is the emergency.
  • CPR: if they are unresponsive with no signs of perfusion, start compressions now and check the device at the same time. Do not start CPR on a talking LVAD patient.
  • Defibrillation and arrest drugs still apply for a shockable arrest. Stay clear of the driveline. The family is your device expert on scene.
Verbalize
  • This is an LVAD. I am listening for the hum.
  • No pulse is expected if the pump is running.
  • Get the coordinator number and the spare controller.
  • Unresponsive with no perfusion: start CPR now and check the pump at the same time.

Common errors

  • Starting CPR on a talking patient because the pulse ox is blank.
  • Leaving the spare batteries behind.
  • Stopping resuscitation only because there was never a pulse.

Practice

One-minute check

Unresponsive LVAD patient, family upset, no pulse, a faint hum, and MAP unknown. Say the first four actions, including who starts CPR and who checks the controller. Then the same patient is talking and the pump is humming. What do you not start?

Related: PEA: Without a Pulse, High-Quality CPR.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. A continuous-flow LVAD patient with no palpable pulse who is talking:
2. The first device check on an LVAD emergency is:
3. Chest compressions in an LVAD emergency are for:
4. VF in an LVAD patient:
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