Mechanical Circulatory Support Complications

Mechanical circulatory support changes both the patient's physiology and the nurse's assessment. An intra-aortic balloon pump supports native cardiac output through timed counterpulsation, whereas a durable continuous-flow LVAD draws blood from the left ventricle and propels it into the aorta. The LVAD may therefore unload the left ventricle while increasing the workload placed on the right ventricle, and it may produce little or no palpable arterial pulsation. The device and the patient must be assessed together. A low-flow alarm can reflect hypovolemia, right-ventricular failure, excessive afterload, pump thrombosis, or outflow-graft obstruction. A power increase with biochemical hemolysis points in a different direction from persistent low flow without hemolysis. The safest response is to assess perfusion first, confirm the alarm and power source, trend device parameters, and involve the specialized VAD team before changing anticoagulation, pump speed, or controller settings.