Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Dec;34(12):842-850.
doi: 10.1136/emermed-2016-206172. Epub 2017 Nov 10.

Algorithms to guide ambulance clinicians in the management of emergencies in patients with implanted rotary left ventricular assist devices

Christopher T Bowles  1 , Rachel Hards  1 , Neil Wrightson  2 , Paul Lincoln  3 , Shishir Kore  4 , Laura Marley  5 , Jonathan R Dalzell  6 , Binu Raj  1 , Tracey A Baker  1 , Diane Goodwin  3 , Petra Carroll  1 , Jane Pateman  7 , John J M Black  8 , Paul Kattenhorn  9 , Mark Faulkner  10 , Jayan Parameshwar  3 , Charles Butcher  1 , Mark Mason  1 , Alexander Rosenberg  1 , Ian McGovern  1 , Alexander Weymann  1 , Carl Gwinnutt  11 , Nicholas R Banner  1 , Stephan Schueler  2 , Andre R Simon  1 , David W Pitcher  11
Affiliations
Review

Algorithms to guide ambulance clinicians in the management of emergencies in patients with implanted rotary left ventricular assist devices

Christopher T Bowles et al. Emerg Med J. 2017 Dec.

Abstract

Advances in left ventricular assist device (LVAD) therapy have resulted in increasing numbers of adult LVAD recipients in the community. However, device failure, stroke, bleeding, LVAD thrombosis and systemic infection can be life-threatening emergencies. Currently, four LVAD systems are implanted in six UK transplant centres, each of which provides device-specific information to local emergency services. This has resulted in inconsistent availability and content of information with the risks of delayed or inappropriate decision-making. In order to improve patient safety, a consortium of UK healthcare professionals with expertise in LVADs developed universally applicable prehospital emergency algorithms. Guidance was framed as closely as possible on the standard ABCDE approach to the assessment of critically ill patients.

Keywords: clinical assessment; clinical management; first responders; guidelines; left ventricular assist device; prehospital care; resuscitation.

PubMed Disclaimer

Conflict of interest statement

Competing interests: RH and AS have had remunerated consultancy agreements with Medtronic which provided funding for this initiative.

Figures

Figure 1
Figure 1
Guiding principles identified for the development of emergency algorithms. LVAD, left ventricular assist device; DC, direct current.
Figure 2
Figure 2
Initial assessment of the left ventricular assist device (LVAD) patient (Algorithm 1).
Figure 3
Figure 3
Left ventricular assist device (LVAD) troubleshooting (Algorithm 2).
Figure 4
Figure 4
Ensuring adequate circulation to sustain life (Algorithm 3). CPR, cardiopulmonary resuscitation; LVAD, left ventricular assist device; VF, ventricular fibrillation; VT, ventricular tachycardia.
See this image and copyright information in PMC

Comment in

  • He was brought in blue… with an LVAD.
    Foëx BA. Foëx BA. Emerg Med J. 2017 Dec;34(12):850-851. doi: 10.1136/emermed-2017-207298. Epub 2017 Nov 16. Emerg Med J. 2017. PMID: 29146832 No abstract available.

References

    1. Slaughter MS, Rogers JG, Milano CA, et al. . Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med 2009;361:2241–51. 10.1056/NEJMoa0909938 - DOI - PubMed
    1. Aaronson KD, Slaughter MS, Miller LW, et al. . Use of an intrapericardial, continuous-flow, centrifugal pump in patients awaiting heart transplantation. Circulation 2012;125:3191–200. 10.1161/CIRCULATIONAHA.111.058412 - DOI - PubMed
    1. Miller LW, Pagani FD, Russell SD, et al. . Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med 2007;357:885–96. 10.1056/NEJMoa067758 - DOI - PubMed
    1. Birks EJ, Tansley PD, Hardy J, et al. . Left ventricular assist device and drug therapy for the reversal of heart failure. N Engl J Med 2006;355:1873–84. 10.1056/NEJMoa053063 - DOI - PubMed
    1. Emin A, Rogers CA, Parameshwar J, et al. . Trends in long-term mechanical circulatory support for advanced heart failure in the UK. Eur J Heart Fail 2013;15:1185–93. 10.1093/eurjhf/hft127 - DOI - PubMed