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Case Reports
. 2021 May 5:17:11156.
doi: 10.15766/mep_2374-8265.11156.

Left Ventricular Assist Device Multialarm Emergency: A High-Fidelity Simulation Case for Emergency Medicine Residents

Ryan Barnicle  1 , Sean Boaglio  2 , Jillian Fitzgerald  3 , Karalynn Otterness  4 , Scott Johnson  5 , Christine Ahn  4
Affiliations
Case Reports

Left Ventricular Assist Device Multialarm Emergency: A High-Fidelity Simulation Case for Emergency Medicine Residents

Ryan Barnicle et al. MedEdPORTAL. .

Abstract

Introduction: As left ventricular assist devices (LVADs) become more prevalent in the treatment of patients with end-stage heart failure, emergency physicians must become experts in the management and resuscitation of patients with LVADs. As with other high-acuity, low-occurrence scenarios, managing the unstable LVAD patient makes for an ideal topic for simulation-based resident education.

Methods: By incorporating a high-fidelity HeartMate 3 LVAD task trainer, our program developed and executed a novel LVAD simulation activity for our emergency medicine resident physicians. In the scenario, a 65-year-old male with recent LVAD placement arrived at a community hospital with undifferentiated hypotension. Various device alarms activated during the scenario and required intervention. Ultimately, the patient was found to be in septic/hypovolemic shock and only survived with appropriate resuscitation. We implemented a postscenario survey to assess the effectiveness of the simulation activity and administered it to 27 residents.

Results: Content and delivery of our simulation were found to be effective; all survey questions regarding content and delivery obtained a mean score of 4.5 or greater on a 5-point Likert scale. Residents reported an overall high level of confidence in achieving most of the skill-based learning objectives (most scores > 4.1). The two objectives with the lowest confidence ratings were troubleshooting an LVAD and its various alarms (3.8) and demonstrating the ability to assess an LVAD patient (3.9).

Discussion: Our LVAD simulation activity was successful and also revealed several potential areas for future research and simulation improvement.

Keywords: Cardiac Arrest; Emergency Medicine; LVAD; Left Ventricular Assist Device; Sepsis; Shock; Simulation.

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