Mechanical life support algorithm developed by simulation for inpatient emergency management of recipients of implantable left ventricular assist devices

Waqas Akhtar; Brigitte Gamble; Kristine Kiff; Agnieszka Wypych-Zych; Binu Raj; Junko Takata; Fernando Riesgo Gil; Ana Hurtado; Alex Rosenberg; Christopher T Bowles

doi:10.1016/j.resplu.2022.100254

Mechanical life support algorithm developed by simulation for inpatient emergency management of recipients of implantable left ventricular assist devices

Resusc Plus. 2022 May 31:10:100254. doi: 10.1016/j.resplu.2022.100254. eCollection 2022 Jun.

Affiliation

¹ Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom.

Abstract

Background: Published guidance concerning emergency management of left ventricular assist device (LVAD) recipients is both limited and lacking in consensus which increases the risk of delayed and/or inappropriate actions.

Methods: In our specialist tertiary referral centre we developed, by iteration, a novel in-hospital resuscitation algorithm for LVAD emergencies which we validated through simulation and assessment of our multi-disciplinary team. A Mechanical Life Support course was established to provide theoretical and practical education combined with simulation to consolidate knowledge and confidence in algorithm use. We assessed these measures using confidence scoring, a key performance indicator (the time taken to restart LVAD function) and a multiple-choice question (MCQ) examination.

Results: The mean baseline staff confidence score in management of LVAD emergencies was 2.4 ± 1.2 out of a maximum of 5 (n = 29). After training with simulation, mean confidence score increased to 3.5 ± 0.8 (n = 13).Clinical personnel who were provided with the novel resuscitation algorithm were able to reduce time taken to restart LVAD function from a mean value of 49 ± 8.2 seconds (pre-training) to 20.4 ± 5 seconds (post-training) (n = 42, p < 0.0001).The Mechanical Life Support course increased mean confidence from 2.5 ± 1.2 to 4 ± 0.6 (n = 44, p < 0.0001) and mean MCQ score from 18.7 ± 3.4 to 22.8 ± 2.6, out of a maximum of 28 (n = 44, p < 0.0001).

Conclusion: We present a simplified LVAD Advanced Life Support algorithm to aid the crucial first minutes of resuscitation where basic interventions are likely to be critical in assuring good patient outcomes.

Keywords: ALS, Advanced Life Support; Advanced life support; CALS, Cardiac Advanced Life Support; CPR, Cardio-Pulmonary Resuscitation; Cardiac arrest; DNAR, do not attempt resuscitation order; ECMO, Extracorporeal Membrane Oxygenation; ETCO2, End Tidal Carbon Dioxide, kPa Kilopascal; LVAD; LVAD, Left Ventricular Assist Device; Left ventricular assist device; MAP, Mean Arterial Pressure; MCQ, multiple-choice exam; MDT, multi-disciplinary team; MLS, Mechanical Life Support; Mechanical circulatory support; Resuscitation; VF, Ventricular Fibrillation; VT, Ventricular Tachycardia.