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Review
. 2018 Sep;19(5):834-841.
doi: 10.5811/westjem.2018.5.37023. Epub 2018 Jul 26.

Left Ventricular Assist Device Management in the Emergency Department

Paul Trinquero  1 , Andrew Pirotte  2 , Lauren P Gallagher  3 , Kimberly M Iwaki  1 , Christopher Beach  1 , Jane E Wilcox  4
Affiliations
Review

Left Ventricular Assist Device Management in the Emergency Department

Paul Trinquero et al. West J Emerg Med. 2018 Sep.

Abstract

The prevalence of patients living with a left ventricular assist device (LVAD) is rapidly increasing due to improvements in pump technology, limiting the adverse event profile, and to expanding device indications. To date, over 22,000 patients have been implanted with LVADs either as destination therapy or as a bridge to transplant. It is critical for emergency physicians to be knowledgeable of current ventricular assist devices (VAD), and to be able to troubleshoot associated complications and optimally treat patients with emergent pathology. Special consideration must be taken when managing patients with VADs including device inspection, alarm interpretation, and blood pressure measurement. The emergency physician should be prepared to evaluate these patients for cerebral vascular accidents, gastrointestinal bleeds, pump failure or thrombosis, right ventricular failure, and VAD driveline infections. Early communication with the VAD team and appropriate consultants is essential for emergent care for patients with VADs.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Emergency department approach to VAD patient. VAD, ventricular assist device; HPI, history of present illness; CT, computed tomography; ICH, intracranial hemorrhage; EKG, electrocardiography; AMS, altered mental status; MAP, mean arterial pressure; RPM, revolutions per minute; PI, pulsatility index; PT, patient; ACLS, advanced cardiovascular life support; CXR, chest x-ray; CBC, complete blood count; Hb, hemoglobin; WBC, white blood cell count; LDH, lactic acid dehydrogenase.
Figure 2
Figure 2
Obtaining a blood pressure (BP) for patient with Ventricular Assist Device. MAP, mean arterial pressure.
Figure 3
Figure 3
Approach to low flow alarms for patient with Ventricular Assist Device. EKG, electrocardiography; MAP, mean arterial pressure; IV, intravenous; JVD, jugular vein distention; LE, leg; RV, right ventricle.
See this image and copyright information in PMC

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