Emergency Medical Services Protocols for Assessment and Treatment of Patients with Ventricular Assist Devices.

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Prehospital and Disaster Medicine Pub Date : 2024-04-01 Epub Date: 2024-03-06 DOI:10.1017/S1049023X2400013X

Emily L Larson, JiWon Woo, Gyeongtae Moon, Kathy Liu, Matthew Vergel, Reed Jenkins, Kelly Jiang, Zachary Darby, Asa Margolis, Ahmet Kilic

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引用次数: 0

Abstract

Background: Patients with ventricular assist devices (VADs) represent a growing population presenting to Emergency Medical Services (EMS), but little is known about their prehospital care. This study aimed to characterize current EMS protocols in the United States for patients with VADs.

Methods: States with state-wide EMS protocols were included. Protocols were obtained from the state EMS website. If not available, the office of the state medical director was contacted. For each state, protocols were analyzed for patient and VAD assessment and treatment variables.

Results: Of 32 states with state-wide EMS protocols, 21 had VAD-specific protocols. With 17 (81%) states noting a pulse may not be palpable, protocols recommended assessing alternate measures of perfusion and mean arterial pressure (MAP; 15 [71%]). Assessment of VAD was advised through listening for pump hum (20 [95%]) and alarms (20 [95%]) and checking the power supply (15 [71%]). For treatment, EMS prehospital consultation was required to begin chest compression in three (14%) states, and mechanical (device) chest compressions were not permitted in two (10%) states. Contact information for VAD coordinator was listed in a minority of five (24%) states. Transport of VAD equipment/backup bag was advised in 18 (86%) states.

Discussion: This national analysis of EMS protocols found VAD-specific EMS protocols are not universally adopted in the United States and are variable when implemented, highlighting a need for VAD teams to partner with EMS agencies to inform standardized protocols that optimize these patients' care.

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评估和治疗心室辅助装置患者的紧急医疗服务规程。

背景：使用心室辅助装置（VAD）的患者越来越多地出现在紧急医疗服务（EMS）中，但人们对他们的院前护理却知之甚少。本研究旨在了解美国目前针对 VAD 患者的急救协议的特点：方法：研究对象包括制定了全州急救协议的州。从州急救中心网站上获取协议。如果无法获得，则联系州医疗总监办公室。对每个州的协议中有关患者和 VAD 评估及治疗变量进行分析：在 32 个制定了全州急救协议的州中，有 21 个制定了针对 VAD 的协议。有 17 个州（81%）指出可能无法摸到脉搏，因此协议建议评估灌注和平均动脉压 (MAP; 15 [71%])的替代指标。建议通过倾听泵的嗡嗡声（20 [95%]）和警报（20 [95%]）以及检查电源（15 [71%]）来评估 VAD。在治疗方面，有 3 个州（14%）在开始胸外心脏按压时需要进行 EMS 院前咨询，有 2 个州（10%）不允许进行机械（设备）胸外心脏按压。少数五个州（24%）列出了 VAD 协调员的联系信息。有 18 个州（86%）建议运送 VAD 设备/备用袋：这项全国性的急救协议分析发现，美国并未普遍采用针对 VAD 的急救协议，而且在实施时也存在差异，这突出表明 VAD 团队有必要与急救机构合作，为优化患者护理的标准化协议提供信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Prehospital and Disaster Medicine Medicine-Emergency Medicine

CiteScore

3.10

自引率

13.60%

发文量

279

期刊介绍： Prehospital and Disaster Medicine (PDM) is an official publication of the World Association for Disaster and Emergency Medicine. Currently in its 25th volume, Prehospital and Disaster Medicine is one of the leading scientific journals focusing on prehospital and disaster health. It is the only peer-reviewed international journal in its field, published bi-monthly, providing a readable, usable worldwide source of research and analysis. PDM is currently distributed in more than 55 countries. Its readership includes physicians, professors, EMTs and paramedics, nurses, emergency managers, disaster planners, hospital administrators, sociologists, and psychologists.