Left Ventricular Assist Devices in the Emergency Department

Author: Hadassah Ihlenfeldt, David Quinn, Riad Hosein / Editor: Lauren Fraser / Codes: / Published: 25/06/2021

Left ventricular assist devices (LVAD) are implanted into patients with severe left ventricular failure, to relieve symptoms and support the systemic circulation and end organ perfusion. These are put into patients either as destination therapy, or while awaiting a cardiac transplant. In some patients, they are used to allow comorbidities to improve which then allows the patient to be a cardiac transplant candidate.

At any one time, there are approximately 300 patients with LVADs in the UK. In 2018-2019, there were 102 long term VADS inserted into adult patients. This number has been relatively stable for the last few years.

These devices are implanted into the thorax most commonly between the left ventricle and the ascending aorta and provide continuous flow of blood from the left ventricle to the systemic circulation. This significantly alters a patients physiology along with adding an electronic and software component, meaning assessment and management of these patients within an emergency setting can be challenging. This learning module covers the basics of what an LVAD is, the common complications an emergency medical team may have to deal with, and the management of a collapsed LVAD patient.

Learning Objectives

What a left ventricular assist device is
Indications for LVAD insertion
Basic physiology of the LVAD
Measuring vital signs on a patient with an LVAD
Common complications
LVAD emergencies
Where to find further information
Assess and manage a collapsed patient who is dependent upon an LVAD
Manage common medical and trauma emergencies in a patient who is dependent upon an LVAD

START MODULE

References

NHS England, Annual report on mechanical circulatory support related to heart transplantation, Report for 2018/2019, Page 11.
Leebank F.W.G, Muslem R., Bleeding in critical care associated with left ventricular assist devices; pathophysiology, symptoms, and management. Hematology Am Soc Hematol Educ Program 2019; 2019 (1) 88-96.
Deepak, A, et al., INTERMACS analysis of stroke during support with continuous flow left ventricular assist devices: Risk factors and outcomes. JACC heart fail, 2017, Oct 5: 703-711.
Radoslav, Z, et al., In full flow: Left ventricular assist device infections in the modern era. Open Forum Infectious diseases, Volume 7, Issue 5, May 2020.
Bowles, C, et al., Algorithms to guide ambulance clinicians in the management of emergencies in patients with implanted rotary left ventricular assist devices. Emergency Medicine Journal. 2017. Volume 34, Issue 12: 842-850
Lim, Howell, Ranasinghe. The physiology of continuous-flow left ventricular assist devices, J Card Fail, 2017, Feb; 23(2) 169-180. [Online] URL: 10.1016/j.cardfail.2016.10.015