title: Emergency procedures for patients with a continuous flow left ventricular assist device.
abstract: The number of ventricular assist devices (VADs) being implanted for terminal heart failure is rising at an exponential rate. These implanted patients have a decreased mortality, but still have significant morbidities, as the prevalence of these patients increases in the community. When VAD patients are discharged to home, they will very likely require emergency medical services (EMSs) and emergency medical doctors (EDs) with their future care. The interface of these patients with the community would suggest an increasing prevalence of encounters requiring the need for acute medical care. This will place the initial responsibility of these patients in the hands of EMS first responders and emergency room providers. To date, there is very little literature published on out-of-hospital or ED care for VAD patients. Most EMS personnel and ED feel uncomfortable treating a patient with a VAD because they have not had sufficient exposure. The cardiovascular treatment of VAD patients in the field can pose different challenges typically encountered including difficulties measuring a pulse and sometimes undetectable BP. Despite these unique challenges, official guidelines or even standard operating procedures regarding the emergency treatment of VAD patients are still lacking. We present a basic overview of the most commonly used left VAD systems and propose guidelines that should be followed in the event of an emergency with a VAD patient out of hospital.
authors.affiliation: Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany.|Division of Cardiology, University of Bern, Bern, Switzerland.
authors.forename: Juliane
authors.initials: J
authors.lastname: Vierecke
authors.affiliation: Department of Congenital Pediatric Surgery, Zurich Children's Hospital, Zürich, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Schweiger
authors.affiliation: Division of Cardiology, University of Cincinnati Medical Center, Cincinnati, USA.|Division of Cardiology, University of Bern, Bern, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Feldman
authors.affiliation: Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Evgenij
authors.initials: E
authors.lastname: Potapov
authors.affiliation: Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Kaufmann
authors.affiliation: Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Germinario
authors.affiliation: Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.affiliation: Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.affiliation: Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Krabatsch
mesh_terms: D004632:Emergency Medical Services; D004638:Emergency Treatment; D004867:Equipment Design; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D017410:Practice Guidelines as Topic
keywords: cardiac care, heart failure; prehospital care; prehospital care, first responders; resuscitation, training