Brit Long1, Jennifer Robertson2, Alex Koyfman3, William Brady4. 1. Brooke Army Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States. Electronic address: brit.long@yahoo.com. 2. Emory University, Department of Emergency Medicine, 80 Jesse Hill Jr Dr SE, Steiner Building, 3rd floor, Atlanta, GA 30303, United States. 3. The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States. 4. University of Virginia School of Medicine, Department of Emergency Medicine, Charlottesville, VA, United States. Electronic address: WB4Z@hscmail.mcc.virginia.edu.
Abstract
INTRODUCTION: End stage heart failure is associated with high mortality. However, recent developments such as the ventricular assist device (VAD) have improved patient outcomes, with left ventricular assist devices (LVAD) most commonly implanted. OBJECTIVE: This narrative review evaluates LVAD epidemiology, indications, normal function and components, and the assessment and management of complications in the emergency department (ED). DISCUSSION: The LVAD is a life-saving device in patients with severe heart failure. While first generation devices provided pulsatile flow, current LVAD devices produce continuous flow. Normal components include the pump, inflow and outflow cannulas, driveline, and external controller. Complications related to the LVAD can be divided into those that are LVAD-specific and LVAD-associated, and many of these complications can result in severe patient morbidity and mortality. LVAD-specific complications include device malfunction/failure, pump thrombosis, and suction event, while LVAD-associated complications include bleeding, cerebrovascular event, infection, right ventricular failure, dysrhythmia, and aortic regurgitation. Assessment of LVAD function, patient perfusion, and mean arterial pressure is needed upon presentation. Electrocardiogram and bedside ultrasound are key evaluations in the ED. LVAD evaluation and management require a team-based approach, and consultation with the LVAD specialist is recommended. CONCLUSION: Emergency clinician knowledge of LVAD function, components, and complications is integral in optimizing care of these patients. Published by Elsevier Inc.
INTRODUCTION: End stage heart failure is associated with high mortality. However, recent developments such as the ventricular assist device (VAD) have improved patient outcomes, with left ventricular assist devices (LVAD) most commonly implanted. OBJECTIVE: This narrative review evaluates LVAD epidemiology, indications, normal function and components, and the assessment and management of complications in the emergency department (ED). DISCUSSION: The LVAD is a life-saving device in patients with severe heart failure. While first generation devices provided pulsatile flow, current LVAD devices produce continuous flow. Normal components include the pump, inflow and outflow cannulas, driveline, and external controller. Complications related to the LVAD can be divided into those that are LVAD-specific and LVAD-associated, and many of these complications can result in severe patient morbidity and mortality. LVAD-specific complications include device malfunction/failure, pump thrombosis, and suction event, while LVAD-associated complications include bleeding, cerebrovascular event, infection, right ventricular failure, dysrhythmia, and aortic regurgitation. Assessment of LVAD function, patient perfusion, and mean arterial pressure is needed upon presentation. Electrocardiogram and bedside ultrasound are key evaluations in the ED. LVAD evaluation and management require a team-based approach, and consultation with the LVAD specialist is recommended. CONCLUSION: Emergency clinician knowledge of LVAD function, components, and complications is integral in optimizing care of these patients. Published by Elsevier Inc.
Authors: Rasmus Rivinius; Carolin Gralla; Matthias Helmschrott; Fabrice F Darche; Philipp Ehlermann; Tom Bruckner; Wiebke Sommer; Gregor Warnecke; Stefan Kopf; Julia Szendroedi; Norbert Frey; Lars P Kihm Journal: Front Cardiovasc Med Date: 2022-06-09
Authors: Mohammad Al-Ani; Sarah S Gul; Abhishek Khatri; Muhammad Abdul Baker Chowdhury; Matthew Drabin; Travis Murphy; Brandon Allen; Juan M Aranda; Juan Vilaro; Eric I Jeng; George J Arnaoutakis; Alex M Parker; Lauren E Meece; Mustafa M Ahmed Journal: Int J Cardiol Heart Vasc Date: 2020-08-14
Authors: Moritz Benjamin Immohr; Udo Boeken; Franziska Mueller; Emir Prashovikj; Michiel Morshuis; Charlotte Böttger; Hug Aubin; Jan Gummert; Payam Akhyari; Artur Lichtenberg; René Schramm Journal: ESC Heart Fail Date: 2021-01-21