2. Topics Zoll LifeVest  What it is  Who it treats  How does EMS handle these patients?

3. Topics Ventricular Assist Devices  What they are  What they do  How to treat these patients

4. Video

5. Zoll LifeVest Wearable AED  Harness  Control Module  Battery  Three Pads  Electrodes

6. Who Uses Them?  ICD Removal  Potential for SCA  Current or old MI  Cardiomyopathy Patients

7. Statistics Over 25,000 Patients 358 Saves Dupage County 1 Save 200+% increase

8. How Do We Treat These Patients? Normal AED Patient Alarm will sound 45 seconds Disable Vest

9. How Do We Treat These Patients? Remove Battery

10. How Do We Treat These Patients? Remove the vest Itself

11. Ventricular Assist Devices

12. Video

13. Pulsatile Vs. Non-Pulsatile Pulsatile  Older first generation models Non-Pulsatile  Second / Third Generation Models

14. VAD’s Ventricular Assist Devices  LVAD  RVAD  Bi-Vad

15. VAD

16. Who uses VAD’s? 7318 people were waiting for a heart 2210 received one 623 died waiting ~1200-1500 VAD implanted in 2008

17. Who uses VAD’s? Bridge to Transplant Bridge to Recovery Destination Therapy

18. Field Considerations  Treat patient as an adult with special health care needs.  Find family member or aide who is familiar with equipment  Always treat the patient!

19. Field Considerations If patient has an LVAD and it is working properly, it is providing patient's cardiac output and is not in time with patient's real heart. Patient’s EKG rate will not equal pulse rate. Instead pulse should be at rate of the LVAD pump

20. Field Considerations All VADs are dependant on adequate preload in order to maintain proper functioning Pump can “cavitate” if there is a decreased preload Volume resuscitation in an unstable VAD patient is the first line of therapy before vasopressors but be cautious with fluid as to not over load the right ventricle in LVADs only

21. Field Considerations Nitrates can be detrimental to a VAD patient because of the reduction in preload  Results in decreased pump efficiency  Consult with medical control before administering nitrates per protocol Initiate IV therapy with all VAD patients if possible

22. Field Considerations A patient can be in a lethal arrhythmia and be asymptomatic. Treat the patient not the monitor. Do not cardiovert/defib unless the patient is unstable with the arrhythmia. Electrical shock from cardiovert/defib will not damage any of the VAD equipment

23. Field Considerations Chest Compressions are NOT recommended. Chest compressions can disrupt the implanted equipment causing massive hemorrhaging.

24. Transport Consideration If able, transport the patient with any other pertinent equipment needed for the VAD pump.  Batteries  Charging unit  Hand pump (if available)

25. Questions???

26. Sources http://www.mayoclinic.org/heart- transplant/vad.html http://www.mayoclinic.org/heart- transplant/vad.html http://www.medicinenet.com/left_ventricula r_assist_device_lvad/page2.htm http://www.medicinenet.com/left_ventricula r_assist_device_lvad/page2.htm www.mfri.org/dom/Drill_pdf/DM_0911.ppt http://www.uchospitals.edu/specialties/hea rt/services/heart-failure/assist-devices.html http://www.uchospitals.edu/specialties/hea rt/services/heart-failure/assist-devices.html