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Updated: Aug 12, 2025
06:10
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
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Stroke Diagnosis Protocol for Children With Ventricular Assist Devices
Michele G Mills1, Allison Reichhold2,3, Kim Maciorowski4
1From the Ruth D. and Ken M. Davee Pediatric Neurocritical Care Program, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|January 25, 2023
Summary
Implementing a new protocol for ventricular assist devices (VADs) significantly reduced stroke diagnosis time in pediatric patients. This approach also decreased unnecessary neuroimaging, improving care for children with heart failure.
Area of Science:
- Pediatric Cardiology
- Neurocritical Care
- Medical Device Technology
Background:
- Ventricular assist devices (VADs) are crucial for pediatric end-stage heart failure.
- VADs are associated with significant neurologic complications, including stroke, in over 20% of pediatric patients.
- Existing diagnostic and treatment pathways for VAD-associated stroke lacked standardization.
Purpose of the Study:
- To implement and evaluate a protocol aimed at improving the diagnosis and management of stroke in pediatric patients with VADs.
- To reduce the time to neuroimaging and improve the documentation of neurologic status in this vulnerable population.
- To assess the impact of a standardized protocol on diagnostic imaging utilization.
Main Methods:
- A multidisciplinary protocol was developed and implemented in 2019, including provider education, structured daily rounds, protocolized neurocritical team assessments, and a VAD-specific stroke algorithm.
- A pre- and postimplementation analysis (2015-2020) compared outcomes for 46 pediatric VAD patients (25 pre-protocol, 21 post-protocol).
- Key metrics included time to neuroimaging for suspected stroke, documentation of last known normal neurologic exam, and utilization of head CT scans.
Main Results:
- Post-protocol implementation, the median time to neuroimaging for suspected stroke decreased from 7 hours to 2.8 hours (p=0.038).
- Documentation of the last known normal neurologic exam became universal post-protocol (p=0.009), compared to inconsistent pre-protocol.
- The utilization of head CT scans for suspected stroke decreased significantly, from 11 cases pre-protocol to 3 cases post-protocol.
Conclusions:
- A standardized VAD protocol effectively reduces diagnostic delays for stroke in pediatric patients.
- The protocol improves the quality of neurologic assessments and reduces unnecessary neuroimaging.
- Further research is needed to validate these findings and optimize VAD care protocols.
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