1126 - Acute Inpatient Rehabilitation of a 10 year old with Left Ventricular Assist Device Following Cardiac Arrest: A Case Report

Case Diagnosis: Pediatric heart failure status-post left ventricular assist device (LVAD) placement and left middle cerebral artery (MCA) stroke.

Case Description: A 10-year-old with viral myocarditis presented to acute care in cardiogenic shock. Within 8 hours, she had cardiac arrest requiring extracorporeal membrane oxygenation support. Her course was complicated by a left MCA ischemic stroke. She underwent HeartMate 3 LVAD placement as a bridge to recovery versus heart transplantation. She was transferred to acute inpatient rehabilitation to address right hemiparesis, non-fluent aphasia, and self-care deficits in the context of a new LVAD.

Medically, her rehabilitation course was relatively uncomplicated with three device low flow alarms indicating low cardiac output, which were successfully co-managed with the rehabilitation and LVAD team. During her 12-day inpatient rehabilitation admission, she made significant functional progress, improving from mostly maximal assistance to independent for activities of daily living, and from supervision to independent for transfers and mobility domains.

Discussions: Pediatric patients requiring LVAD placement are rarely encountered in inpatient rehabilitation settings, and many facilities are unable to adequately meet the needs of this unique patient population. To prepare for the first patient with a LVAD admitted to the pediatric unit of a stand-alone inpatient rehabilitation facility, a robust multi-disciplinary staff educational initiative was undertaken. With assistance from staff familiar with adult LVAD management, industry personnel, and outpatient LVAD teams, more than 40 members of medical, nursing, and allied health staff completed over 100 hours of training in day-to-day management, troubleshooting, and emergency protocols in preparation for admitting this patient.

Conclusions: This case demonstrates feasibility for pediatric patients with LVADs to safely participate in acute inpatient rehabilitation. It also highlights gaps in access to high intensity rehabilitation services for these patients and the importance of adequate staff preparation and multi-disciplinary communication in delivering high-quality care in facilities unaccustomed to this patient population.