Echocardiography in the Management of Patients with Left Ventricular Assist Devices: Recommendations from the American Society of Echocardiography

Stainback, Raymond F.; Estep, Jerry D.; Agler, Deborah A.; Birks, Emma J.; Bremer, Merri L.; Hung, Judy; Kirkpatrick, James N.; Rogers, Joseph G.; Shah, Nishant R.

doi:10.1016/j.echo.2015.05.008

Cited by 258 publications

(175 citation statements)

References 93 publications

Supporting

Mentioning

139

Contrasting

Unclassified

Order By: Relevance

“…If there is anastomotic site stenosis, the color Doppler signal may show flow turbulence, and pulsed-and continuous-wave Doppler may show abnormally high systolic velocity (>2 m/s). 22 Is There Intrinsic LVAD Dysfunction? Intrinsic LVAD dysfunction can occur as a result of thrombosis or pannus within the LVAD system, failure of LVAD bearings or rotor, or electric failure because of driveline malfunction.…”

Section: Is There Obstruction To Lvad Inflow or Outflow?mentioning

confidence: 99%

“…clinical measure of the degree of LV unloading achieved by the LVAD. 22 If endocardial definition is suboptimal, a microbubble contrast agent should be used for accurate LVIDd measurement. Impaired LVAD performance can be detected echocardiographically by noting an enlarged LVIDd compared with previous values obtained when the patient was stable.…”

Section: Is There Significant Valve Dysfunction?mentioning

confidence: 99%

See 1 more Smart Citation

Cardiopulmonary Resuscitation in Adults and Children With Mechanical Circulatory Support: A Scientific Statement From the American Heart Association

Peberdy¹,

Gluck²,

Ornato³

et al. 2017

Circulation

View full text Add to dashboard Cite

ABSTRACT:Cardiac arrest in patients on mechanical support is a new phenomenon brought about by the increased use of this therapy in patients with end-stage heart failure. This American Heart Association scientific statement highlights the recognition and treatment of cardiovascular collapse or cardiopulmonary arrest in an adult or pediatric patient who has a ventricular assist device or total artificial heart. Specific, expert consensus recommendations are provided for the role of external chest compressions in such patients. Mechanical circulatory support (MCS) has evolved from a rarely used therapy reserved for the most critically ill hospitalized patients to an accepted longterm outpatient therapy for treating patients with advanced heart failure. This growth is attributable to improved technology, improved survival, reduced adverse event profiles, greater reliability and mechanical durability, and limited numbers of organs available for donation. With the number of patients supported by durable MCS systems increasing in the community, so too is the need for emergency care providers to receive specific guidance on how to assess and treat a patient with MCS who is unresponsive or hypotensive.No evidence-based or consensus recommendations currently exist for the evaluation and treatment of cardiovascular emergencies in patients with MCS. Because of the unique characteristics of mechanical support, these patients have physical findings that cannot be interpreted the same as for patients without MCS. For example, stable patients supported by a durable, continuous-flow ventricular assist device (VAD) often do not have a palpable pulse. Unfortunately, different and sometimes conflicting instructions are given by hospital providers and emergency medical services (EMS) directors to EMS and other healthcare personnel on core resuscitative practices such as the role of external chest compressions in such a patient who suddenly becomes or is found unresponsive. PURPOSEThe purpose of this scientific statement is to describe the common types of MCS devices that emergency healthcare providers may encounter and to present expert, consensus-based recommendations for the evaluation and resuscitation of adult and pediatric patients with MCS with suspected cardiovascular collapse or cardiac arrest. These recommendations focus initially on emergency first-response providers, whether outside or inside the hospital, with additional sections on advanced care that may be provided in the emergency department or in-hospital settings. CONSENSUS PROCESSThe need for standardized recommendations for the emergency treatment of acutely unstable patients with MCS was identified during the 2014 meeting of the American Heart Association (AHA) Science Subcommittee. A writing group was commissioned to review the current literature and to develop consensus-derived recommendations for the initial treatment of these patients. Members of the writing group were chosen for their combined expertise in MCS, cardiopulmonary resuscitation (CPR), emergenc...

show abstract

Section: Is There Obstruction To Lvad Inflow or Outflow?mentioning

confidence: 99%

Section: Is There Significant Valve Dysfunction?mentioning

confidence: 99%

Cardiopulmonary Resuscitation in Adults and Children With Mechanical Circulatory Support: A Scientific Statement From the American Heart Association

Peberdy¹,

Gluck²,

Ornato³

et al. 2017

Circulation

View full text Add to dashboard Cite

show abstract

“…Echocardiography is fundamental for optimal management of LVAD patients but should be interpreted with the knowledge of each patient's clinical status [29].…”

Section: Arrhythmiamentioning

confidence: 99%

Understanding Left Ventricular Assist Devices

et al. 2018

View full text Add to dashboard Cite

Background/Aims: Long-term mechanical assist devices are now commonly used in the treatment of severe heart failure to unload the failing ventricle, maintain sufficient end-organ perfusion and improve functional capacity. Depending on the assisted ventricles, 3 categories of long-term assist devices are available: left ventricular assist device (LVAD), biventricular assist device and total artificial heart. Improvements in technology, especially the advent of smaller, durable continuous flow pumps, have led to the use of LVADs in a much broader population of patients in the last 10 years. Both the number of patients living with LVADs and the life expectancy of these patients are increasing. Regarding this growing number of patients with LVAD, intensivists need to understand the physiology of the devices, their functioning, potential complications and their management. Methods: We performed a narrative review of relevant medical literature regarding the physiology of patients with LVAD and management of common complications relevant to the critical care physicians. Results: The most frequent complications occurring in the LVAD patients after the post-operative period are bleeding, driveline infections, thrombosis, device malfunction, right ventricular failure and arrhythmias. Bleeding is the most frequent adverse event in LVAD due to a combination of anticoagulation and acquired von Willebrand disease secondary to shear stress produced within the pump. Their management includes antiplatelet therapy arrest, reduction of the anticoagulation regimen and specific therapy if feasible. Infection is the second most common cause of death after cardiac failure in LVAD patients. All infections must be aggressively treated to avoid seeding the device. Device thrombosis can develop even when patients are adequately anticoagulated and taking antiplatelet therapy because the LVAD is responsible for a chronic hypercoagulable state. Conclusion: Management of these unique patients in the ICU is best accomplished with a multidisciplinary team that includes specialists in advanced heart failure, LVAD nurse coordinators and intensivists.

show abstract

“…It is one of the few research validated imaging methods available for diagnosing LVAD pump thrombosis. While current guidelines warn against performing ramp tests in patients with subtherapeutic anticoagulation given the risk of internal thrombus liberation [3], this test is not traditionally considered a risk factor for thromboembolization in the setting of therapeutic anticoagulation. We present, to our knowledge, the first case of multiembolic cerebrovascular event following a ramp test echocardiogram in a patient with appropriate therapeutic anticoagulation.…”

Section: Introductionmentioning

confidence: 99%

Case Report of Multiembolic Cerebrovascular Event Associated with Ramp Study Echocardiogram

Butera

Grazette

Lawrence

et al. 2016

Journal of Cardiac Failure

View full text Add to dashboard Cite

The incidence of ramp test echocardiogram-associated embolic events in the setting of therapeutic anticoagulation is likely rare and has not been reported. We present such a case in a patient with a HeartMate II left ventricular assist device (LVAD) whose serial head computed tomography images, deteriorating clinical course, and the multiembolic nature of the event suggest causality. If the pretest probability of pump thrombosis in an individual LVAD patient is sufficiently high, the potential risks of performing a ramp study echocardiogram may not be warranted, even in the setting of adequate anticoagulation.

show abstract

Echocardiography in the Management of Patients with Left Ventricular Assist Devices: Recommendations from the American Society of Echocardiography

Cited by 258 publications

References 93 publications

Cardiopulmonary Resuscitation in Adults and Children With Mechanical Circulatory Support: A Scientific Statement From the American Heart Association

Cardiopulmonary Resuscitation in Adults and Children With Mechanical Circulatory Support: A Scientific Statement From the American Heart Association

Understanding Left Ventricular Assist Devices

Case Report of Multiembolic Cerebrovascular Event Associated with Ramp Study Echocardiogram

Contact Info

Product

Resources

About