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Shouldn't You Be Laying Down If You Don't Have a Pulse?

14 comments

CHANGE THE PROTOCOLS.  THE LACK OF A PULSE doesn’t always call for CPR or de-fib anymore.  Not now that people are walking around with a new-design artificial heart that pumps continuously, i.e. no pulsing.

Our friend Sabotank sent along THIS ARTICLE from the Singapore Straits Times that says in part:

MADAM Salina Mohamed So’ot has no pulse. But she is very much alive.

The 30-year-old administrative assistant is the first recipient here to get a new artificial heart that pumps blood continuously, the reason why there are no beats on her wrist.  Older artificial hearts usually mimic the heart’s pulsations.

And the petite Madam Salina, who suffers from end-stage heart failure, would not have been able to use the older and bulkier models because they can only be implanted in patients 1.7m or taller.

These are becoming  so commonplace now that four of them have been implanted in the past four months in Singapore.  The device was developed in the U. S. by O.H. “Bud” Frazier, a prominent heart surgeon and pioneer in the development of cardiac devices at the Texas Heart Institute in Houston.  He introduced the device called the HeartMate2 three years ago and it has now reached approval for use.

As the Straits Times article mentions, the standard artificial heart is too large for small-statured people, but this new continuous-pump heart is only the size of an adult’s thumb.

An article in the MIT Technology Review from September, 2006, explains how the device works:

“Continuous flow pumps are like little turbo machines,” says Tim Baldwin, program director of the advanced technologies and surgery branch of the National Heart, Lung and Blood Institute in Bethesda MD. “They are more durable and allow you to make smaller devices.”

 With Frazier’s continuous flow design for an entirely artificial heart, a severely damaged heart is removed and replaced with two rotor-based pumps that continually cycle blood through the body, completely taking over the function of the heart.

The biggest advantage to the rotor-style or axial pumps is that they are small and relatively simple. The AbioCor heart, for example, is so large that it can only be implanted in people with large chest cavities, making it inappropriate for most women. “Axial pumps are about the size of an adult thumb and can pump more blood than a normal heart,” says Frazier.

 Continuous flow pumps are also more durable, due to the simplicity of their design–the only moving part is the rotor. “Other pumps work well, but there are lots of moving parts so they are subject to mechanical wear,” says Cohn. The longest the AbioCor heart functioned in clinical trials was 18 months, while continuous flow devices are being designed to operate for 10 or more years.

Another advantage of the continuous flow pump is its ability to increase flow on demand, much like a real heart.  If the patient gets up and starts walking, for example, the device senses the call for more flow and speeds up accordingly.

You can read the full article from the  MIT Technology Review HERE.

Have any Firegeezer readers come across any patients without a pulse yet?  Tell us your experience.

Posted by on September 30, 2009 • Filed under: current events
  • sabotank

    was reading this and wondering about the implications concerning:

    pulsox
    aed/defibrillator
    BP checks

    and that’s just the tip o’ my brain…

  • sabotank

    was reading this and wondering about the implications concerning:

    pulsox
    aed/defibrillator
    BP checks

    and that’s just the tip o’ my brain…

  • Scrappy

    We have a guy with one in our first due. The sound is really wild as well…a high-pitch hum like standing near a high power line. We had someone come in and talk about it, and the guy with it was very forthcoming with answers.

    sabotank, in answer to your question, a pulse ox will work to measure O2%, but won’t get a pulse. I’m not sure about an AED, but I suspect that it’ll detect no pulse and advise no shock. On the other hand, shocking won’t do any good most likely, since the pump has essentially failed. you will get a rhythm on the monitor, or so I’m told. As for BP, supposedly, unless the patient is hyper-hydrated, you won’t get one, unless you have a doppler. It’s just too faint. In many patients, the heart still beats a little bit, but not well enough to circulate blood (these are usually put in patients in end-stage left ventricular heart failure, who are waiting for a transplant).

    These patients have a wire coming out of their stomach that connects the pump to a small computer that they have to carry around with them. This computer runs the pump, so if something happens to the computer or the wire, the patient’s pump will stop. Something to remember in MVAs and such. Most times, the patient and their family are extremely well-educated about these things. They should have a card with phone numbers to call if there are problems, and there is someone on the other end ALWAYS to answer questions.

  • Scrappy

    We have a guy with one in our first due. The sound is really wild as well…a high-pitch hum like standing near a high power line. We had someone come in and talk about it, and the guy with it was very forthcoming with answers.

    sabotank, in answer to your question, a pulse ox will work to measure O2%, but won’t get a pulse. I’m not sure about an AED, but I suspect that it’ll detect no pulse and advise no shock. On the other hand, shocking won’t do any good most likely, since the pump has essentially failed. you will get a rhythm on the monitor, or so I’m told. As for BP, supposedly, unless the patient is hyper-hydrated, you won’t get one, unless you have a doppler. It’s just too faint. In many patients, the heart still beats a little bit, but not well enough to circulate blood (these are usually put in patients in end-stage left ventricular heart failure, who are waiting for a transplant).

    These patients have a wire coming out of their stomach that connects the pump to a small computer that they have to carry around with them. This computer runs the pump, so if something happens to the computer or the wire, the patient’s pump will stop. Something to remember in MVAs and such. Most times, the patient and their family are extremely well-educated about these things. They should have a card with phone numbers to call if there are problems, and there is someone on the other end ALWAYS to answer questions.

  • http://www.fdexcellence.com/ Paddy

    I never met a person without a pulse, but I’ve met my share of heartless bastards in my day!

  • http://www.fdexcellence.com Paddy

    I never met a person without a pulse, but I’ve met my share of heartless bastards in my day!

  • sabotank

    Paddy – i hear that

    Scrappy – Good info there, haven’t heard of any of those in my neck of the back woods. Would be an interesting Q&A session, i’m sure

  • sabotank

    Paddy – i hear that

    Scrappy – Good info there, haven’t heard of any of those in my neck of the back woods. Would be an interesting Q&A session, i’m sure

  • Mike

    These thingsare pooping up al over. 5he sponsering hospitals are preety good at letting you know when somebody comes home to your area with one. Every device is different and the patient and family are usually very knowledgeable.
    They will want to go to the facility which placed the device. Consider helo for long distance transport of the unstable patient.
    Most of these people cannot have CPR done because it may tear off the tubing at the heart.

  • Mike

    These thingsare pooping up al over. 5he sponsering hospitals are preety good at letting you know when somebody comes home to your area with one. Every device is different and the patient and family are usually very knowledgeable.
    They will want to go to the facility which placed the device. Consider helo for long distance transport of the unstable patient.
    Most of these people cannot have CPR done because it may tear off the tubing at the heart.

  • Mike

    Judging by my spelling I either need to go to sleep or have an artificial heart put it because I am hypoxic. You guys will figure it out.

  • Mike

    Judging by my spelling I either need to go to sleep or have an artificial heart put it because I am hypoxic. You guys will figure it out.

  • Mike McFadden

    I want to clear up any misconceptions in these devices. First off, I’m a 22-year Fire Service active captain / paramedic for a small southern California town (just over 105,000 people) with almost 29 years in EMS (mostly ALS). I know many folks who have these devices. They are called LVAD’s – Left Ventricular Assist Devices. These are used on folks to bridge the gap between dying from heart failure or getting a replacement heart. I was briefed on these devices quite extensively by hospital physiologists as I was trying to die. I have never got the opportunity to own a LVAD since I got a heart transplant about a week after my briefing. Today I regularly work out alongside these people and they live rather normal lives, so much so that some opt not to get transplants. There are dozens in San Diego county alone. Some models have slight pulses but most do not. O2 sat monitors may not work – the manuacturer of the Heart Mate LVAD devices recommends blood gases for accurate results. Finally, as for the AED thing – I wouldn’t go near them with these things. AED machines are designed to shock “shockable” pulseless rhythms. An area hospital in my county recently had a LVAD patient in V-Fib DRIVE HIMSELF to the hospital while completely conscious. He did get shocked in the ER, but not before some compassionate sedation. I guess my point is that these pumps will work unless you inturrupt blood flow or loose the battery, resulting in the pump quitting – kinda like a fire engine. TREAT THE PATIENT. True pulseless V-Tach and V-Fib cases look like crap, are guppy breathing at best, and are pulseless. If I had an AED telling me to shock a rhythm, but the patient was still pink and breathing (and wearing the fanny pack battery and a hose connected through his abdomen) I might tend to wait until I get him to the hospital. We treat patients, not monitors.
    Mike McFadden
    Fire Captain / Paramedic
    ACLS Instructor

  • Mike McFadden

    I want to clear up any misconceptions in these devices. First off, I’m a 22-year Fire Service active captain / paramedic for a small southern California town (just over 105,000 people) with almost 29 years in EMS (mostly ALS). I know many folks who have these devices. They are called LVAD’s – Left Ventricular Assist Devices. These are used on folks to bridge the gap between dying from heart failure or getting a replacement heart. I was briefed on these devices quite extensively by hospital physiologists as I was trying to die. I have never got the opportunity to own a LVAD since I got a heart transplant about a week after my briefing. Today I regularly work out alongside these people and they live rather normal lives, so much so that some opt not to get transplants. There are dozens in San Diego county alone. Some models have slight pulses but most do not. O2 sat monitors may not work – the manuacturer of the Heart Mate LVAD devices recommends blood gases for accurate results. Finally, as for the AED thing – I wouldn’t go near them with these things. AED machines are designed to shock “shockable” pulseless rhythms. An area hospital in my county recently had a LVAD patient in V-Fib DRIVE HIMSELF to the hospital while completely conscious. He did get shocked in the ER, but not before some compassionate sedation. I guess my point is that these pumps will work unless you inturrupt blood flow or loose the battery, resulting in the pump quitting – kinda like a fire engine. TREAT THE PATIENT. True pulseless V-Tach and V-Fib cases look like crap, are guppy breathing at best, and are pulseless. If I had an AED telling me to shock a rhythm, but the patient was still pink and breathing (and wearing the fanny pack battery and a hose connected through his abdomen) I might tend to wait until I get him to the hospital. We treat patients, not monitors.
    Mike McFadden
    Fire Captain / Paramedic
    ACLS Instructor