ECG Arrhythmias and Technical Alarms during Left Ventricular Assist Device (LVAD) Therapy and its Potential Impact on Alarm Fatigue

AbstractBackground: During alarm fatigue, true alarms can go unnoticed placing patients at risk for untoward outcomes. Patients with a left ventricular assist device (LVAD) may create challenges during electrocardiographic (ECG) monitoring due to technical alarms (i.e., artifact, ECG leads off), noise and vibrations associated with LVADs, and being able to tolerate some arrythmias. Clinical Nurse Specialists play a central role in and developing evidenced based strategies to improve alarm safety with the ultimate goal of improving patient outcomes. Purpose/Aim: In this case series, we analyze three patients being treated with an LVAD device in the cardiac intensive care unit (ICU) and determine: 1) the number and type of audible arrhythmia alarms; 2) the number of true versus false arrhythmias; 3) the number, type and duration of technical alarms; and 4) report alarm burden. Methods: Secondary analysis using data from the University of California, San Francisco (UCSF) Alarm Study. Results: There were a total of 547 arrhythmia alarms and 98% were false. There were 25,232 technical alarms. Of 514 total hours of ECG monitoring, technical alarms occurred for 65.9 (13%) hours. Alarm burden of 50.15 alarms per monitored hour in the ICU. Conclusion: Audible arrhythmia alarms are common in LVAD patients, and the vast majority are false. Importantly, none of the arrhythmia alarms led to an untoward event (i.e., code blue or death). Technical alarms are also very common and occur for hours during routine ECG monitoring. Continuous ECG monitoring creates unique challenges in LVAD patients. Future studies are needed to explore strategies, both clinical and algorithm bases, to improve the accuracy of arrhythmia detection and minimize technical alarms in LVAD patients