fTitle: ACLS for Left Ventricular Assist Devices (LVAD) patients
题目：左心室辅助装置（LVAD）病人的ACLS
Authors 作者: Haney Mallemat, MD and Michael Winters, MD

1. Basics for an LVAD 什么是LVAD
a. Indications for an LVAD: Extreme left-sided heart failure awaiting a transplant and Reversible heart disease such as myocarditis.
LVAD的指征：等待移植的极度左室心衰和可逆性心脏病，如心肌炎
b. LVAD is temporary until disease reverses then it will be removed.
LVAD是临时的，可在疾病过程纠正后测掉
c. LVAD is permanent as patient is not a candidate for transplant
如病人不适合做移植，LVAD将是永久的

2. ACLS for LVAD patients LVAD病人如何实施ACLS
a. First should assess if the LVAD is functioning
首先要判断LVAD是否工作正常
Check the battery to make sure it is charged
检查电池是否有电
Checking a pulse is not reliable as a pulse may not be palpable
检查脉搏是不可靠的，因为可能摸不到
Get a manual BP cuff and find MAP or listen for a hum
手工量一下血压，寻找“亨”音
a). If a MAP or hum is present, treat as such with fluids, vasopressors, etc
如果有血压和亨音，给液体，升压药等
b). If no MAP or hum is present, should perform CPR
如没有血压或亨音，要做CPR
b. CPR is controversial CPR是有争议的
a). Manufacturers manual recommends no CPR for fear of dislodging the device
and leaving a gaping hole in the heart
厂商说明书不建议做CPR，考虑到它有可能使仪器脱节，在心脏留下一个洞
b). However, the patient is dead if the device is not working and the heart is not pumping so CPR is at least attempting to resuscitate
但是，如LVAD不工作，心脏就不跳动，病人就死了。CPR至少可试用来复苏
c. Defibrillation/Cardioversion 除颤／转复
a). Acceptable to shock hearts with LVADs
可以电击LVAD的心脏
b). Be sure to disconnect from the power source prior to shocking
一定要在电击前切断电源

References 参考文献：
1. Rose EA, Gellins AC, Moskovitz AJ, et al. Long-Term Use of a Left Ventricular Assist Device for End-Stage Heart Failure. NEJM. 2001; 345(20):1435-43.
2. Wilson SR, et al. Ventricular assist devices. JACC. 2009; 54(18): 1647-59.
3. Klein T, Jacob MS. Management of implantable assisted circulation devices. Cardiol Clin. 2012; 30: 673-82.