LVAD (Left Ventricular Assist Device) Malu a tshimpitshimpi: Alarme ya tshiamu tshia kulombola natshi, dishintulula dia ma batterie, ne CPR wa tshiendelele¶

Tshiamu tshia kuambuluisha natshi mu tshiadi tshia ku dia bakaji (LVAD, bu mudi HeartMate 3, HeartMate II, anyi HeartWare HVAD) ntshiamu tshia muoyo tshidibu bateka mu mubidi tshidi tshilamakaja buludiludi ku nsongo ya kuinshi (ku mutu) kua tshiadi tshia ku dia bakaji tshidi katshiyi tshienza mudimu bimpe tshidi tshikoka mashi adi ne oxygène mu mutshima ne atungunuka ne kubanda mu mutshima. Bualu bua LVADs ya tshipungu tshisatu ya lelu idi yenza mudimu ne tshiamu tshia lubilu lukole tshidi tshienda tshinyunguluka (impeller) tshidi tshituma mashi mu mushindu udi kauyi ujika pamutu pa kuikala mu dikuma dia muoyo didi dienda dienda bimpe (dienda dia muoyo didi kadiyi diendakana), mubedi wa LVAD udi mubike, udi ne makanda a mubidi mimpe, udi wakula katu ne tshianza tshidi mua kulenga (mu nshingu anyi mu nshingu) (carot) udi kayi ubala bimpe pa tshiamu tshia kupima natshi mashi tshia ku nzubu, ne KAKUENA dibala dijalame pa tshiamu tshia kupima natshi mashi tshia munu to. Malu a bukole ne a ordinatere adi afika ku pompe wa mutshima wa munda ku diambuluisha dia tshiamu tshia percutaneous (the drive) tshidi tshipatuka mu dikoba dia ku mutu kua difu ne tshidi tshilamakaja ne ordinatere wa pambelu System Controller uvuabu bavuala pa mukaba anyi pa tshilamba, udi wenza mudimu misangu yonso ne **batterie ibidi ya lithium-ion idibu mua kupingaja (anyi ** AC power). Shi mubedi wa LVAD mukuluke, kayi witaba, nansha muikale ne tshimanyishilu tshikunze tshidi tshiela mbila pa tshiamu tshienda, ubikile muaba unudi nomba ya tshimpitshimpi diakamue NE ubikile nomba ya telefone ya LVAD Coordinator wa mêba 24 mifunda buludiludi pa tshimanyishilu tshiabu tshia tshiamu tshia mudimu. Paudi muindile diambuluisha dia lukasa, tangila mikanda idi itangila malu a muoyo pa mudimu wa CPR ne AED wa bantu bakole, pacemaker anyi ICD defibrillator shock storm, ne mashi a mu tshifu ne melena.

Bu mudi kupatula nkamba yonso ibidi ya bateri ku tshiamu tshia LVAD musangu umue kudi kupangisha bukole bua pompe wa mutshima ne kuimanyika dienda dia mashi mu buongo mu tusunsa tukese, ne bualu dielakana dia kuenza mudimu wa dikuma dia tshiadi kudi mubedi wa LVAD udi kayi mumanye tshidi tshishipa mioyo, mikenji yebe ibidi mijalame idi ne: KUNANYI KUPATULA nzembu ya bateri yonso ibidi musangu umue (bateri udi mua kushintulula dîba dimue Dîba) ne bikala mubedi kayi mumanye tshidiye wenza, kayi upuyakana bimpe, ne kayi ne mutoyi wa tshiamu pa tshiadi tshia dia bakaji NANSHA kayi ne muoyo ne dikoba ditoke anyi dia bule nansha mudi pompe wenza mudimu, tuadija diakamue dienza dia tshiadi tshia pambelu (CPR).

Enza nunku mpindieu¶

1. Anji kukonkonona diandamuna ne dipuyakana (KUjimiji dîba bua kumvua tshiona tshia radial pa mubedi wa LVAD udi mubike anyi mukuluke to). Bualu bua ma pompe adi endakana adi atungunuka ne kuendakana mashi bimpe kakuyi mutoyi wa mashi, dipanga dia tshiona tshidi tshiumvuika kadiena diumvuija dijika dia mutshima kudi mubedi wa LVAD to. Shi muntu udi mubike, wakula, anyi udila, buongo buende budi bupeta mashi: KUENJI CPR nansha kakese kudi mubedi wa LVAD udi mubike anyi udi wandamuna, nansha mudi tshianza tshienda katshiyi tshienza mudimu bimpe ne tshiamu tshia ECG tshileja ne: ventricular fibrillation.
2. Bikila nimero ya lukasa lukasa ya muaba unudi NE bikila nimero ya 24/7 Hospital LVAD Coordinator idi milamakaja ku tshibombi tshia bintu bia mubedi. Ela 911 mu États-Unis ne Canada, 112 mu Union européenne mujima, 999 mu Royaume-Uni, 000 mu Australie, anyi tangila liste wetu wa nomba ya tshimpitshimpi. Amba patoke ne: "Lungenyi lua lukasa lua luondapu lua mubedi udi ne tshiamu tshia diambuluisha natshi mu tshiadi tshia ku dia bakaji (LVAD / HeartMate 3): [amba ni mubedi mmubike ne alarme anyi kayi mumanye tshidiye wenza]."
3. Teleja buludiludi pa mutu pa tshiadi tshia ku dia bakaji tshia kuinshi ne tshia kuulu tshia ku dia bakaji ne tshiamu tshia kuteleja nabi (anyi teka ditshi diebe pa tshiadi tshiabu tshidi katshiyi ne tshintu) bua mutoyi wa tshiamu udi utungunuka. LVAD udi wenza mudimu udi umvuika bu mutoyi wa brosse wa menu anyi wa mashinyi a kusonga nawu bilamba munda mua tshiadi (ne cadence mukese wa tshianana ku sekonde yonso wa 33 wa Mate).
4. Wewe mumvue kakuena mutoyi (Pompe mmuimane): Tangila diakamue tshiamu tshia mashinyi tshidi tshilamakaja ku tshiamu tshia kulombola natshi ne nsinga ibidi ya bateri bua kumona ni tshintu tshidi tshipatuka, ne tangila tshiamu tshia kulombola natshi mudimu bua kumanya ni Mutshima Mukunze / Kakuyi Power / Pump Off alarme.
5. Wewe ushintulula ma batterie adi mafue, SHINTULULA MISANGU YONSO nkamba ya batterie UMWE musangu umua (KUPATUDI nansha nkamba ya batterie yonso ibidi musangu umue). Umbusha umue wa batterie udi mujike, ela umue wa batterie mujima, windile bua miendu ya vert idi ileja batterie ijadika, pashishe umbusha batterie musangu muibidi. Kupatula nkamba yonso ibidi ya nzembu musangu umua kudi kushipa nzembu ya pompe wa munda diakamue.
6. Bikala mubedi kayi ne lungenyi, kayi wandamuna, wela mupuya anyi kayi upuyakana, ne umueneka mutoke anyi mutoke (cyanotic), utuadije diakamue dipanda dia tshiadi dia pambelu (CPR) dia mushinga mukole. Munkatshi mua bidimu bia bungi, bantu bavua bamona bavua batshina ne: dipanda dia tshiadi divua mua kupatula LVAD mu mutshima. Mikenji ya lelu ya American Heart Association (AHA) ne European Resuscitation Council (ERC) idi ijadika ne: dikuma dia tshiadi dia pambelu didi dimpe ne didi ne bua kuenzeka kudi mubedi wa LVAD udi kayi wandamuna, kayi upuyakana, udi kayi ne mashi mimpe (udita bikole ne lukasa munkatshi mua tshiadi ku minite 10 too ne ku 10, paudi ufina muambuluishi muibidi udi ujikija lutatu lua tshiamu tshia kulombola natshi/mabateri ne udi uteka biamu bia AED).
7. Lama muaba wa kupatukila mu tshifu bua kukoka anyi kukoka, ne ulue ne tshibombi tshijima tshifiike tshia LVAD Emergency Travel Bag ku ambulanse. Kukoki nansha kakese tshiamu tshitoke tshidi tshipatuka mu difu, kutshinyi nansha kakese tshiamu nansha tshimue, ne kupatuka kumbelu nansha kakese kuyi ne tshiamu tshia tshiamu tshia mudimu tshia mubedi, mabateri anayi, ma batterie, ne tshiamu tshia nzembu tshia AC mashinyi a lupitadi ne nzubu ya diambuluisha dia lukasa ya mu tshimenga kayena ne ma bateri anyi nkamba ya LVAD to).

Mutshi wa mapangadika: dikonkonona dia malu a tshimpitshimpi a LVAD, dijikija dia bilumbu bia alarme, ne algorithme wa CPR¶

flowchart TD
    Start["LVAD Patient Emergency: Dikuluka dia tshimpitshimpi, dipanga dia mupuya, disama dia tshiadi, anyi alarme wa tshiamu tshia mudimu tshidi ne dîyi dikole"] --> CheckAwake{"Tshitupa 1: Mubedi udiku mubike, mudimuke, anyi udi witaba dîyi anyi dilenga anyi? (Vuluka: Babedi ba LVAD badi batabale kabatu ne tshipupu tshia radial to)"}

    CheckAwake -->|"EYOWA: Mubedi udi mubike anyi udi wandamuna"| AwakeAction["KUENJI CPR (Nansha shi Pulseless anyi mu VF pa Monitor); Somba anyi ulala mubedi panshi bimpe, bikila 911 + mulombodi wa LVAD, ne uteleje tshifu tshia ku dia bakaji bua kuenza mudimu wa tshiamu tshia nzembu"]

    AwakeAction --> CheckAlarm{"Tshitupa 2: Bala tshibuelelu tshia LVAD System Controller Screen & Lights: I alarme ya njiwu mikunze anyi alarme ya jaune?"}

    CheckAlarm -->|"ALARME WA NJIKI MUTUKU (Dîyi dikole didi dienda dikola + Mutshima anyi Bateri Mukunze udi ukenka): Mutshima mukese (muinshi mua 2,5 L/min), Pompe udi ujika, Driveline mmupatuke, anyi Bateri udi ujika mujima"| FixRed["MUSHINDU WA KUSUMIJA MUOYO: 1. Lamakaja tshiamu tshia mashinyi/tshiamu tshia nzembu tshidi tshinyanguke diakamue, 2. Shintulula ma batterie adi mafue UMUE MUMUE, 3. Bikala luya lukese (muinshi mua 2,5 L/min) ne mutoyi, Lala panshi ne ubandishe maulu (Check bua kujimija hydratation, Bponade, Rponade anyi Rponade Disama dia mutshima)"]

    CheckAlarm -->|"ALARME WA MUSHINDU WA KUDIMUENA (Mutoyi wa tshitupa tshîpi + Butoke bua jaune): Muinshi mua minite 15 Bateri udi mushale, Tshiamu tshia nzembu tshikosolola, anyi Watts ya bungi / Power Spike"| FixYellow["Shintulula Bateri Mujimine MUMUE MUMUE; Note: Watts ya bungi + Mashi a tshitoke tshifiike/Cola + LDH ya bungi = Ditekemena dia LVAD PUMP THROMBOSIS (Tshintu tshia lukasa tshia kuya ku LVAD Center)"]

    CheckAwake -->|"NO: Mubedi kena mumanye, kena wandamuna, ne kena upuyakana bimpe to (anyi udi anu upuyakana)"| ListenHum{"Tshitupa 3: Pitshisha tusunsa 10: Teleja ku tshiadi tshia ku dia bakaji bua LVAD Mechanical Hum ne Tangila Driveline/Battery Connections"}

    ListenHum -->|"KAKUENA MUTOYI (Pompe muimane): Driveline udi munyanguke anyi ma batterie mafue"| ReconnectFirst["Diakamue, pingaja tshiamu tshia mashinyi anyi shintulula bateri 1 udi ne makanda (anyi ushintulule tshiamu tshia kulama nabi mashinyi pikala tshiamu tshia mashinyi tshifue)"]

    ReconnectFirst --> CheckRestart{"Pump Hum udi utuadija kabidi mu tusunsa 10 ne mubedi udi ujuka diakamue anyi?"}
    CheckRestart -->|"EYOWA"| PostRestart["Tangila njila wa luya ne mashinyi diakamue ku lupitadi lua LVAD"]
    CheckRestart -->|"TSHIENA: Pompe kena ubanga kabidi anyi mubedi udi ushala kayi mumanye lungenyi/apnée/cyanotic"| StartCPR["TUADILA KUTUA MU MUTU (100 too ne ku 120/min) + KUTUA MU MUTU + KUTEKA AED/DEFIBRILLATOR PADS (Kuteka kumpala-kunyima kudi kuimpe; Kukosolola LVAD ku Shock to)"]

    ListenHum -->|"HUM UDIKU (Pompe udi wenza mudimu), kadi mubedi udi kayi ne lungenyi, udi ne disama dia luya, udi mutoke/mutoke, anyi EtCO2 udi muinshi mua 20 mmHg / Doppler MAP udi muinshi mua 50 mmHg"| StartCPR

Mudimu wa LVADs udi wenda utungunuka: bua tshinyi kakuena dipuekesha dia mashi ne mushindu kayi wa kupima tension (Doppler MAP)¶

Bua kutabalela mubedi wa LVAD mu njiwu, bantu badi pabuipi, baminganga, ne bena mudimu ba mu nzubu wa njiwu badi ne tshia kumvua mudi tshiamu tshia diambuluisha tshia rotary ventricular tshishintulula mubidi wa muntu:

1. Inflow Cannula, Centrifugal Rotor, Outflow Graft, ne Driveline¶

Mu tshikondo tshia dipanda dia mutshima mubulula: - Inflow Cannula wa pompe wa titanium udi musonga buludiludi mu apex (nsongo ya kuinshi) ya ventricule wa ku dia bakaji. - Munda mua nzubu wa pompe, tshintu tshidi tshienza mudimu ne tshiamu tshia nzembu (HeartMate 3 tshidi tshienza mudimu ne tshiamu tshia Full MagLev tshidi ne miaba minene ya mashi idi ikepesha bikole dienza dia mashi ne tshidi tshishintulula lubilu kunyima kua sekonde 2 yonso bua kuenza mini-pulse wa tshianana; HeartMate II wa kale udi wenza mudimu ne tshiamu tshia nzembu; tshiamu tshia hydro-magnetic centrifugal impeller) tshidi tshinyunguluka ku 3,000 too ne ku 9,000 revolutions per minute (RPM). - Mashi adi apatuka katupa katupa ku diambuluisha dia tshiamu tshia Dacron Outflow Graft tshisonga pa aorta udi ubanda, tshidi tshifila 4.0 too ne ku 6.0 litre ku minite ya mashi ku buongo, ku mifuba ne ku mubidi. - Tshilamba tshia silicone/tshilamba tshia Percutaneous Driveline tshidi tshipita mu tshimanu tshia difu ne tshipatuka mu dikoba ku dia balume anyi dia bakaji dia kuulu, tshilamakaja pompe wa munda ne System Controller wa pambelu.

2. Bua tshinyi babedi ba Awake LVAD kabena ne tshiadi tshia mashika (anyi anu tshianza tshia mashika tshia tshitupa tshîpi)¶

Mu mutshima wa muntu udi kayi ne bualu, tshipiminu tshia mashi tshidi tshishintuluka pankatshi pa 120 mmHg mu tshikondo tshia dikokangana dia mutshima (systole) ne 80 mmHg mu tshikondo tshia dikisha (diastole), wenza 40 mmHg pulse pressure wave udi umvua ku tshianza. Mu mubedi wa LVAD, tshiamu tshia mashi tshidi tshipatuka mu tshitupa tshia ku dia bakaji mu tshitupa tshionso tshia systole ne tshia diastole ne tshidi tshituma mashi mu aorta anu bu mayi adi afumina mu tshina tshia mu budimi. Bu mudi tshitupa tshia ku dia bakaji tshia mubidi tshitekete ne katshiyi ne bujitu, tshiamu tshia aorte tshidi tshishala tshikanga misangu ya bungi anyi tshionso, tshikepesha bukole bua mashi too ne ku muinshi mua 5 too ne ku 15 mmHg. - Tshipeta 1 (Kakuyi dikuma dia mashi): Kuena mua kumvua dikuma dia radial anyi dia carotid ne minu yebe to, nansha padi mubedi mutabale, udia biakudia bia mu midi, ne upeta litre 5 ya mashi ku minite yonso. - Tshipeta 2 (Biamu bia tension bia mashi bidi bienza mudimu nkayabi bidi bipangila): Biamu bia tension wa mashi bia ku nzubu anyi bia mu lupitadi bidi bimanyine pa kumona oscillations mikole ya pulsatile; pa mubedi wa LVAD, tshiamu tshia ku bianza tshidi tshienza bilema misangu ne misangu anyi tshileja nomba wa dishima wa njiwu. - Tshipeta 3 (Biamu bia oxymètre bia munu bidi bipangila): Oximètres ya mpukapuka ya munu (SpO2) bidi bikengela tshienzedi tshia nzembu tshia mu mishipa bua kumbusha butoke bua mu mishipa; mu mubedi wa LVAD, tshipiminu tshia oximètre tshia munu tshidi mua kubala muinshi mua dishima (70%) anyi kuleja mulongo mupepele nansha padi oxygène wa mu mashi muikale 100 pa lukama.

3. Mushindu kayi udi baminganga ne baminganga bapima tension wa mashi mu mubedi wa LVAD: Mushindu wa Doppler Mean Arterial Pressure (MAP)¶

Pamutu pa tension systolique ne diastolique, dienda dia mashi mu LVAD didi dipimibua ku Mean Arterial Pressure (MAP) ku diambuluisha dia tshiamu tshia tension tshia ku bianza ne tshiamu tshia ultrason Doppler tshia ku bianza (tshitu misangu ya bungi tshilama mu tshibombi tshia mubedi tshia ku nzubu): 1. Weja tshiamu tshia sphygmomanometre ku tshianza tshia kuulu. 2. Ela gel wa ultrason pa mushipa wa ku tshianza ku tshitupa tshia munda tshia tshianza (anyi mushipa wa ku tshianza ku tshianza) ne ukuate tshiamu tshia 8-MHz Doppler probe tshidi tshienza bu crayon ku angle wa 45-degree too ne paudi umvua mutoyi wa lupepele lua "whooshing" lua mashi adi atungunuka. 3. Ela tshiamu tshia ku bianza too ne padi mutoyi wa tshiona tshijika, pashishe upuekesha 20 mmHg. 4. Kangula bitekete bitekete tshiamu tshia kukanga natshi bua kupatula kapepe ka 2 mmHg ku sekonde: nomba mulelela udi pa tshiamu tshia nzembu mudi mutoyi wa Doppler udi utungunuka upingana kumpala udi Mean Arterial Pressure (MAP). 5. Target LVAD MAP Range: 70 to 80 mmHg (ne kakuyi kupita 85 to 90 mmHg). Bualu bua pompe ya LVAD ya centrifuge idi itamba kuenza mudimu kunyima kua bujitu, pikala MAP wa mubedi mubandile pa mutu pa 90 to 100 mmHg, tshipepele tshikole tshia aorte tshidi tshipingaja tshianyima ku rotor wa pompe, tshienza bua dienda dia pompe kumpala dipueke bikole, dienza bua alarme wa "Low Flow", ne divudija bikole njiwu ya stroke hemorrhagique.

Difunda dia nomba 4 idi pa tshiamu tshia LVAD System Controller Screen¶

Paudi ufina buto bua kuleja pa HeartMate II, HeartMate 3, anyi HVAD System Controller, bintu binayi bia mudimu bidi biendakana pa tshiamu:

Dijikija dia bilumbu bia alarme ya njiwu mikunze ne alarme ya jaune¶

Tshiamu tshionso tshia LVAD tshidi tshienza mudimu ne bimuenekelu bia mekala ne bipese bia mbila bidi biumvuika:

1. Bimanyinu bia njiwu bikunze (mutoyi wa mbila udi utungunuka + ne munya mukunze udi ukenka: Bidi bikengela kuenza bualu kampanda diakamue)¶

• Mutshima mukunze udi ukenka + "Pompe Off / Low Flow (<2.5 L/min)":
• Bualu A (Dikosolola dia nzembu anyi dia njila wa mashinyi): Tangila diakamue ni tshiamu tshia mashinyi tshitoke tshipatuka mu tshibuelelu tshia tshiamu tshia mashinyi (enza bua tshiibi tshia bukubi tshikale tshikanga) anyi bikala nkamba yonso ibidi ya bateri mipatuke ku mpukapuka.
• Bualu B ("Suction Event" / Empty Left Ventricle): Shi pompe utshidi anu wela mbila pa mutu pa tshiadi, ventricle wa ku dia bakaji kena ne mashi makumbane adi abuelamu to, bienza bua cannule wa dibuela dikuate tshimanu tshia mutshima munda (tshidi mua kujula tachycardie ventriculaire). Diambuluisha dia kumpala dia lukasa: Teka mubedi panshi pa mukolo ne bandisha maulu ende pa matadi (bandisha maulu kayi wenza mudimu) bua kupingaja mashi a mu mishipa mu mutshima paudi muindile bua kuya ne ambulanse. Malu adi mua kufikisha ku disama adi bu mudi: dipanga dia mâyi mu mubidi, dipatuka dia mashi mu tshifu, dipanga dia tshiadi tshia balume, disama dia mutshima anyi disama dia tshiadi didi dienda dikola.
• Batterie mukunze udi ukenka ("Mu minite mikese ya 5 ya bukole idi mishale"):
• Tshia kuenza diakamue: Pingaja ma batterie adi manyanguke UMUE MUMUE ne ma batterie makumbane a mu tshibombi tshia luendu, anyi udi mua kulamakaja ku tshiamu tshia AC Mobile Power Unit.
• Dipanga dia tshiamu tshia kulombola natshi mudimu (tshiamu tshia tshianana tshidi ne alarme mukunze anyi kakuyi mutoyi nansha mudiku ma batterie mapiamapia):
• Mubedi yense wa LVAD udi uvuala anyi udi ne Backup System Controller wa muomumue munda mua tshibombi tshiende tshia luendu. Anu balami anyi baminganga balongesha kudi mulombodi wa LVAD ke badi ne tshia kuenza Emergency Controller Exchange: kusomba anyi kulala panshi mubedi, teka Backup Controller mupiamupia ku luseke lua wa kale, kuanji kulamakaja ma batterie abidi mapiamapia ku controleur mupiamupia, kulekela tshikunji tshia bukubi tshidi pa percutaneous driveline, kupatula driveline ku controller, ne kuela mu controller mupiamupia mu tusunsa 5 too ne ku 10**.

2. Ma alarme a jaune (Mutoyi wa tshitupa tshîpi kunyima kua sekonde 1 anyi 4: Bidi bikengela kuenza bualu kampanda ne lukasa)¶

• Muendu wa jaune wa batterie: Muinshi mua minite 15 ya muoyo wa batterie udi mushale; kushintakaja ma batterie umue ku umue.
• Mushindu wa nzembu mmukosolola: Umue wa ku milonda ibidi ya bateri mmupatuke; upingaje muaba wende diakamue bua mubedi kayi wenza mudimu ne bateri umue to.
• High Watts / Power Spike Advisory: Rotor udi ukoka bukole bua nzembu bupite bungi; udi wela meji ne LVAD Pump Thrombosis.

"Awake in Ventricular Fibrillation" Phenomenon ne Safe Defibrillation / CPR Rules¶

Tshimue tshia ku bintu bidi bikemesha bikole mu malu a luondapu a matuku etu aa tshidi tshienzeka padi baminganga bateka tshiamu tshia ECG kudi mubedi wa LVAD uvua muye ku tshiibi tshia kumpala wela mbila anu bua disama dia mutu, ditshioka anyi dia "Low Flow", ne tshiamu tshia ECG tshileja coarse Ventricular Fibrillation (VF) anyi pulseless Ventricular Tachydia (V).

1. Mmunyi mudi muntu mua kuikala mutabale ne wakula padiye mu disama dia tshiadi?¶

Mu muntu udi kayi ne LVAD, disama dia tshiadi didi diimanyika mashi onso adi enda diakamue, ne didi difikisha muntu ku dijimija lungenyi mu masekonde 6 anyi 10. Mu mubedi wa LVAD, nansha mudi tshiamu tshia nzembu tshia mutshima tshikale mu tshipupu tshia mu tshiadi, pompe wa LVAD udi utungunuka ne kukoka mashi mu mikolo (ku diambuluisha dia tshienzedi tshia mu mishipa tshia Fontan tshidi katshiyi tshienza mudimu mu mutshima wa dia balume) ne upompa 2,5 too ne ku 3,5 litre ku minite mu aorte, wenza bua buongo buikale bubike ne budimu. - Mukenji wa mushinga mukole: **KENJI KUENZA MU MUTU MU MUTU MU MUDIMU MU MUDIMU MU MUDIMU MU MUDIMU MU MUDIMU MU MUSHINDU WA KUENZA MU MUDIMU MU MUDIMU MU MUSHINDU WA KUENZA MU MUDIMU MU MUSHINDU WA KUENZA MUDIMU MU MUSHINDU WA KUENZA Mukenji wa mushinga mukole: KUENZI MUDIMU MU MUSHINDU WA KUENZA MUDIMU MU MUDIMU MU MUSHINDU WA KUENZA MU MUDIMU. Pamutu pa nanku, ikala mulale panshi, umupeshe oxygène wa pa mutu, utuadije kumuela oxygène, ne umufikishe diakamue ku tshibambalu tshia malu a mpukapuka muaba udi baminganga mua kumupesha didia dia mu mishipa (anyi dia mu mishipa) midazolam) kumpala kua kuenza synchronized cardioversion/defibrillation, pamue ne intraarrhythmics (amiodarone anyi lidocaine).

2. Dîba kayi dia kutuadija dikuma dia tshiadi (CPR) ne mushindu wa kuela AED Pads pa mubedi wa LVAD udi kayi mumanye tshidiye wenza¶

Shi mubedi wa LVAD KAYI MUYE LUMU, kena wandamuna, ne kena upuyakana biyampe (anyi anu upuyakana): 1. Tangila tshiamu tshia kulombola natshi ne teleja tshiadi tshia ku dia bakaji too ne ku masekonde 10: Shi batterie anyi nkamba ya mashinyi mipatuke, uyipingaje diakamue. 2. Bikala tshiamu tshia nzembu katshiyi tshituadija kabidi mudimu mu tusunsa 10, NANSHA bikala tshiamu tshia nzembu tshienza mutoyi kadi mubedi mushale kayi mumanye lungenyi, mupuya, mutoke anyi mutoke (anyi mu ambulanse udi ne tshipupu tshia ku ndekelu CO2 [EtCO2] < 20 mmHg anyi Doppler MAP < 50 mmHg), TUADILA BIDIMU BIDI BIUMVUIKA BIDI BIUMVUIKA BIDI BIMUENEKA. - Diteka dia tshianza ne bunene: Munkatshi mua tshifuba tshia tshiadi (sternum), 5 to 6 centimeters (2 to 2.4 inches) muinshi mua buloba, ku 100 to 120 compressions per minute. Milongo ya malu a luondapu idi ileja ne: dikuma dia tshiadi dia pambelu kadiena dipatula biamu bia LVAD bia matuku etu aa to, ne ke mushindu umuepele wa kusungila mubedi udi ne disama dia mutshima dia balume, tamponade anyi diimanyika dia pompe. - Kuena ne bua kuenza mudimu ne biamu bia CPR bia piston (LUCAS anyi AutoPulse): Nansha mudi dikuma dia ku bianza dimpe, biamu bia kuenza nabi mudimu anyi piston bidi mua kutshibula tshintu tshidi tshipatuka anyi kutshibula tshitupa tshia mu difu ne bitu bitamba kuepukibua anu padi tshibambalu tshia LVAD tshilomba. - Mikenji ya AED ne ya defibrillation: KUPATUDI tshiamu tshia LVAD anyi ma batterie bua kutshinyisha mubedi (pompe wa titanium ne biamu bia ordinatere bidi bikuba ku bukole bua defibrillation). Teka biamu bia defibrillateur mu Anterior-Posterior (kumpala-to-panyima) position (tshiamu tshimue ku tshiadi tshia kuulu tshia ku dia balume anyi tshia pankatshi kule ne tshiadi tshia difu, ne tshiakabidi kunyima pankatshi pa maboko) bua nzembu kayiyi ipitshila buludiludi mu nzubu wa pompe wa tshiamu.

Malu 4 a tshimpitshimpi adi kaayi a tshiamu adi atangila babedi ba LVAD¶

Nansha padi tshiamu tshia LVAD katshiyi tshileja alarme nansha umue ne pompe wenza mutoyi bimpe, mubedi yonso wa LVAD udi mu diondapangana dia matuku onso a muoyo (warfarin [target INR 2.0 to 3.0] PLUS daily aspirin) ne udi ne ntatu inayi ya tshimpitshimpi ya luondapu:

Nomba ya tshimpitshimpi ya mu tshijengu ne mikenji ya bibambalu¶

Bualu buonso bua tshimpitshimpi bua LVAD budi bulomba diumvuangana dia lukasa ne tshibambalu tshia mubedi tshidibu bateka Advanced Heart Failure / Ventricular Assist Device (VAD) Center:

• États-Unis ne Canada: Ela 911 NE ubikile 24/7 VAD Coordinator Emergency Number mufunda pa tshiamu tshia ku tshianza tshia System Controller ne pa mukaba wa difu. Ba munganga badi balonda American Heart Association (AHA) Scientific Statement on Cardiopulmonary Resuscitation in Infants and Adults With Mechanical Circulatory Support ne EMS Guide to Mechanical Circulatory Support (ICCAC).
• Royaume-Uni: Ela 999 ne umanyishe NHS Cardiothoracic Transplant & Mechanical Circulatory Support Centre (Harefield, Papworth, Freeman, Queen Elizabeth Birmingham, Wythenshawe, anyi Golden Jubilee Glasgow) udibu basungule. Bilombola kudi Resuscitation Council UK ne British Society for Heart Failure (BSH) LVAD emergency algorithms.
• Buobumue bua matunga a ku Mputu: Ela 112. Bilombola bilondeshela European Resuscitation Council (ERC) Guidelines (Cardiac Arrest in Special Circonstances: LVAD) ne European Society of Cardiology (ESC) / EACTS Guidelines.
• Australie ne Nouvelle-Zélande: Ela 000 mu Australie anyi 111 mu Nouvelle-Zélande ne yukila ne Heart Transplant / VAD Coordinator (St Vincent's Sydney, The Alfred Melbourne, Fiona Stanley Perth, Prince Charles Brisbane, anyi Auckland City Hospital).
• India ne Asia-Pacific: Ela 112 (anyi 108 mu Inde), 995 mu Singapour, 119 mu Japon ne mu Corée du Sud, anyi 999 mu Malaysie ne mu Hong Kong.

Nkonko itubu bela misangu ya bungi¶

Bua tshinyi muntu udi mutabale, udi ne makanda a mubidi mimpe udi ne LVAD kena ne tshiona tshidi tshimueneka ku tshianza anyi ku nshingu?¶

Biamu bia lelu bia diambuluisha dia tshiadi tshia ku dia bakaji (bu mudi HeartMate 3, HeartMate II, ne HVAD) mbiamu bidi biendakana bidi bienza mudimu ne tshiamu tshidi tshienda tshinyunguluka bua kupatula mashi bipepele ne katuyi tujika kuinshi kua tshiadi tshia ku dia bakaji mu aorta, pamutu pa kufina mashi mu mushindu udi mutshima wenda unyunguluka. Bu mudi mashi enda anu bu mayi a mu tshina tshia mâyi, kudi dishilangana dikese pankatshi pa tension wa systolique ne wa diastolique, nunku tshiamu tshia aorte tshidi tshishala tshikanga misangu ya bungi ne kakuena mutoyi wa pulse udi ufika ku tshianza anyi ku nshingu to. Shi mubedi wa LVAD mubike, mudimuke, ne wakula, dipanga dia tshiadi didi 100 pa lukama, ne kuena ne tshia kuenza CPR nansha kakese kudi mubedi wa LVAD mubike to.

Mmunyi muudi mua kumanya ni pompe wa LVAD udi wenza mudimu biwikala kuyi mua kumvua tshiona tshia mashi?¶

Teka tshiamu tshia kuteleja natshi (anyi fina ditshi diebe buludiludi) ku luseke lua kuinshi lua dia bakaji lua tshiadi anu kuinshi kua dibele ne pa mutu pa difu dia kuulu dia dia bakaji. LVAD udi wenza mudimu udi upatula mutoyi wa pa buawu udi wenda ukola anyi wa tshiona (muomumue ne brosse wa meno wa ku nzembu anyi motere mukese; pa HeartMate 3, neuteleje kabidi mutoyi mukese wa dishintuluka dia dîyi kunyima kua sekonde 2 yonso padi tshiamu tshia rotor tshienda lubilu luende). Mu tshikondo tshimue tshimue, tangila kazubu ka pambelu ka System Controller kadi pa mukaba wa mubedi: pikala tshimanyishilu tshia bukole tshia vert tshitema ne kakuyi alarme ya njiwu mikunzubile idi ikenka anyi iela mbila, pompe udi wenza mudimu.

Bua tshinyi kuena ne bua kupatula nkamba yonso ibidi ya bateri ku tshiamu tshia LVAD musangu umue to?¶

Tshiamu tshia LVAD tshidi tshikengela bintu bibidi bidi bienza mudimu bidi bilamakaja misangu yonso. Wewe mupatule nkamba yonso ibidi ya bateri musangu umue bua kushintulula ma bateri adi mafue, nzembu ya nzembu idi ifumina ku pompe wa muoyo idi ijika diakamue (anyi idi yeyemena anu ku bateri mukese wa tshimpitshimpi udi munda mua tshiamu tshia kulombola natshi mudimu tshidi anu bua kuela dîyi dia alarme). Padi tshiamu tshia LVAD tshilekela kunyunguluka, ki nganu mashi adi enda kumpala adi ajika to, mashi adi afumina mu aorta udi ne bukole bua bungi adi apingana diakamue panyima kupitshila ku pompe udi muimane mu mutshima, ne adi afikisha muntu ku dijimija lungenyi diakamue ne ku dinyanguka dia mashi. Misangu yonso, umbusha tshiamu tshia batterie UMUE, ela batterie UMUE mupiamupia, tangila minda ya vert, ne anu pashishe ushintulule batterie muibidi.

Bidiku bimpa bua kuenza mudimu wa dikuma dia tshiadi (CPR) kudi mubedi wa LVAD udi kayi mumanye tshidiye wenza anyi, anyi nebinyange pompe?¶

Eyowa, dikuma dia tshiadi dia pambelu didi dimpe ne didi disungila muoyo padi mubedi wa LVAD bushuwa mu disama dia mutshima. Ku ntuadijilu kua muyuki wa LVADs, bimanyinu bia biamu bivua bidimuija ne: dikuma dia tshiadi didi mua kupatula pompe mu mutshima, ne kufikisha ku dielakana dia njiwu padibu bakuata muntu. Tshisumbu tshia American Heart Association (AHA) ne European Resuscitation Council (ERC) mbashintulule mikenji yabu ya mbulamatadi bilondeshile makebulula a mu lupitadi adi aleja ne: dikuma dia tshiadi ku bianza kadiena diumusha LVADs ya lelu to. Shi mubedi wa LVAD kayi mumanye tshidiye wenza, kayi upuyakana bimpa, umueneka mutoke anyi bule, ne kayi ne mutoyi wa tshiamu pa tshiadi (udi kayi utuadija diakamue mu masekonde 10 kunyima kua disangisha dia tshiamu tshidi tshipatuka) NANSHA kayi ne muoyo nansha mudiye ne pompe wa mupuya, tuadija dikuma dia tshiadi pa minite 10 too ne ku 100 diakamue.

Bua tshinyi mashi a mubidi mukunze anyi a cola mu mubedi wa LVAD adi umvuija lutatu lua lukasa?¶

Shi tshitupa tshia mashi tshienza munda mua nzubu wa pompe wa LVAD wa titanium ne tshikuate tshiamu tshia lubilu lua bungi (pompe wa LVAD thrombose), tshiamu etshi tshidi tshienza mudimu bu tshiamu tshia kusanganya natshi bintu, tshikosolola miliyo ya globules rouges ku sekonde yonso (hemolyse intravasculaire mikole). Hemoglobine udi mupatuke udi upitshila mu mifuba ne wenza bua mashi ikale makunze, mafike, anyi a cola, eku dikokangana dia tshitupa tshia mashi tshidi pa tshiamu tshidi tshinyunguluka tshienza bua se: "High Watts / Power Spike" ikale ne alarme ku tshiamu tshia kulombola natshi ne dibandila dia bungi bua LDH mu mashi. Bikila 911 ne mulombodi wa LVAD diakamue bua lupitadi lufike ku difila manga adi atekesha mashi mu mijilu anyi kushintulula pompe kumpala kua yeye kukanga bimpe.

Mubedi udi ne LVAD udi mua kuenza MRI mu nzubu wa lupitadi anyi?¶

Tòo, NANSHA TO. Tshiamu tshionso tshia diambuluisha tshia mu tshiadi tshia ku dia bakaji tshidibu bateka tshidi ne biamu bia bukole bia kashidi ne biamu bia ferromagnetique bidi munda mua tshiadi. Kuteka mubedi wa LVAD munda mua nzubu wa tshiamu tshia magnetic Resonance Imaging (MRI) nekuimanyike tshiamu tshia pompe diakamue, kukoka ne kuosha pompe wa titanium munda mua mutshima, ne kushipa mubedi. Shi mubedi wa LVAD upeta biyukeno bya AVC (dipuekesha dia mpala, diteketa dia tshianza, dipanga dia kuakula) anyi disama dia mukolo, baminganga ba lupitadi batu misangu yonso benza mudimu ne tshiamu tshia Non-Contrast Brain CT ne CT Angiography (CTA) pamutu pa MRI.

Miaba ne buludiki bua mbulamatadi¶

• Tshisumbu tshia muoyo tshia mu Amerike (AHA, États-Unis): Dikolesha dia muoyo ne mikolo mu bana batekete ne bantu bakole badi ne diambuluisha dia tshiamu tshia mashi: Dimanyisha dia malu a sianse dia kudi tshisumbu tshia muoyo tshia mu Amerike (Peberdy et al., Circulation, algorithme clinique pour les patients non répondants de LVAD, safety of external external expression, MAP 70 to 80 mmHg, ne EtCO2 < 20 mmHg tshipiminu tshia dikuma).
• European Resuscitation Council (ERC, Europe): ERC Guidelines 2021: Cardiac Arrest in Special Circonstances: Patients with Ventricular Assist Devices (LVADs) (Lott et al., Resuscitation, 10-second driveline/power reconnect rule and immediate compressions and unconscious kakuyi kupuyakana).
• International Consortium for Circulatory Assist Clinicians (ICCAC) & Heart Failure Society of America (HFSA): EMS Field Guide to Mechanical Circulatory Support (HeartMate 3, HeartMate II, and HeartWare HVAD Color-Coded Controller Guides).
• Société internationale pour la transplantation du cœur et des pulmons (ISHLT): ISHLT Consensus Guidelines for Mechanical Circulatory Support: Emergency Management of Pump Thrombosis, Acquired von Willebrand GI Bleeding, Driveline Infection, and Right Ventricular Failure.
• Resuscitation Council UK & British Society for Heart Failure (BSH, United Kingdom): Emergency Algorithm for Assessment and Resuscitation of Patients with a Left Ventricular Assist Device (LVAD).

Malu adi apetangana¶

• CPR wa bantu bakole, dikuma dia tshiadi, ne dienza mudimu ne AED
• Pacemaker anyi ICD defibrillator shock storm ne infection mu tshibombi tshia tshiamu
• Dipatuka dia mashi mu tshifu, dipatuka dia mashi (hematemesis), ne melena
• Dijingulula dia tshipupu (FAST) ne diambuluisha dia kumpala dia lukasa
• Supraventricular tachycardia (SVT), vagal maneuvers, ne ventricular arrhythmies