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Larson EL, Woo J, Moon G, Liu K, Vergel M, Jenkins R, Jiang K, Darby Z, Margolis A, Kilic A. Emergency Medical Services Protocols for Assessment and Treatment of Patients with Ventricular Assist Devices. Prehosp Disaster Med 2024; 39:136-141. [PMID: 38445327 DOI: 10.1017/s1049023x2400013x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Patients with ventricular assist devices (VADs) represent a growing population presenting to Emergency Medical Services (EMS), but little is known about their prehospital care. This study aimed to characterize current EMS protocols in the United States for patients with VADs. METHODS States with state-wide EMS protocols were included. Protocols were obtained from the state EMS website. If not available, the office of the state medical director was contacted. For each state, protocols were analyzed for patient and VAD assessment and treatment variables. RESULTS Of 32 states with state-wide EMS protocols, 21 had VAD-specific protocols. With 17 (81%) states noting a pulse may not be palpable, protocols recommended assessing alternate measures of perfusion and mean arterial pressure (MAP; 15 [71%]). Assessment of VAD was advised through listening for pump hum (20 [95%]) and alarms (20 [95%]) and checking the power supply (15 [71%]). For treatment, EMS prehospital consultation was required to begin chest compression in three (14%) states, and mechanical (device) chest compressions were not permitted in two (10%) states. Contact information for VAD coordinator was listed in a minority of five (24%) states. Transport of VAD equipment/backup bag was advised in 18 (86%) states. DISCUSSION This national analysis of EMS protocols found VAD-specific EMS protocols are not universally adopted in the United States and are variable when implemented, highlighting a need for VAD teams to partner with EMS agencies to inform standardized protocols that optimize these patients' care.
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Affiliation(s)
- Emily L Larson
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MarylandUSA
| | - JiWon Woo
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MarylandUSA
| | - Gyeongtae Moon
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MarylandUSA
| | - Kathy Liu
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MarylandUSA
| | - Matthew Vergel
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MarylandUSA
| | - Reed Jenkins
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MarylandUSA
| | - Kelly Jiang
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandUSA
| | - Zachary Darby
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MarylandUSA
| | - Asa Margolis
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandUSA
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MarylandUSA
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Schullerer D, Schurter D, Meinhold A, Paal S, Staubli S, Bichsel I, Dave H, Cesnjevar R, Schweiger M. Safety issues with an inter-hospital transport of a patient with a Berlin Heart Excor biventircular assist device. Artif Organs 2023; 47:582-588. [PMID: 36356800 DOI: 10.1111/aor.14455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/26/2022] [Accepted: 11/02/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Interhospital transfers of pediatric patients on the Berlin Heart Excor have been published on an occasional basis. METHODS Nowadays medicine evolves away from just feasibility towards quality and safety issues. Management tools like risk analysis have found their way into clinical practice. RESULTS Exemplary, we present a case of a 20 months old boy on a Berlin Heart BiVAD Excor who underwent a 224 km ground transport. After a systematic review of the published literature, we describe our safety management with the aim was to provide highest quality of care for the transport. CONCLUSION Besides a risk analysis, we also describe our training and simulation protocol.
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Affiliation(s)
| | - David Schurter
- Schutz & Rettung Zurich, Ambulance Service, Zurich, Switzerland
| | - Anke Meinhold
- Paediatric Cardiac Intensive Care, University Children's Hospital, Zurich, Switzerland
| | - Sebastian Paal
- Children's Heart Centre, University Children's Hospital, Zurich, Switzerland
| | - Susanne Staubli
- Visualisation, University Children's Hospital, Zurich, Switzerland
| | - Isabelle Bichsel
- Children's Heart Centre, University Children's Hospital, Zurich, Switzerland
| | - Hitendu Dave
- Children's Heart Centre, University Children's Hospital, Zurich, Switzerland
| | - Robert Cesnjevar
- Children's Heart Centre, University Children's Hospital, Zurich, Switzerland
| | - Martin Schweiger
- Children's Heart Centre, University Children's Hospital, Zurich, Switzerland
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3
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Akhtar W, Gamble B, Kiff K, Wypych-Zych A, Raj B, Takata J, Gil FR, Hurtado A, Rosenberg A, Bowles CT. Mechanical life support algorithm developed by simulation for inpatient emergency management of recipients of implantable left ventricular assist devices. Resusc Plus 2022; 10:100254. [PMID: 35669526 PMCID: PMC9162943 DOI: 10.1016/j.resplu.2022.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/23/2022] [Accepted: 05/16/2022] [Indexed: 12/01/2022] Open
Abstract
Background Published guidance concerning emergency management of left ventricular assist device (LVAD) recipients is both limited and lacking in consensus which increases the risk of delayed and/or inappropriate actions. Methods In our specialist tertiary referral centre we developed, by iteration, a novel in-hospital resuscitation algorithm for LVAD emergencies which we validated through simulation and assessment of our multi-disciplinary team. A Mechanical Life Support course was established to provide theoretical and practical education combined with simulation to consolidate knowledge and confidence in algorithm use. We assessed these measures using confidence scoring, a key performance indicator (the time taken to restart LVAD function) and a multiple-choice question (MCQ) examination. Results The mean baseline staff confidence score in management of LVAD emergencies was 2.4 ± 1.2 out of a maximum of 5 (n = 29). After training with simulation, mean confidence score increased to 3.5 ± 0.8 (n = 13). Clinical personnel who were provided with the novel resuscitation algorithm were able to reduce time taken to restart LVAD function from a mean value of 49 ± 8.2 seconds (pre-training) to 20.4 ± 5 seconds (post-training) (n = 42, p < 0.0001). The Mechanical Life Support course increased mean confidence from 2.5 ± 1.2 to 4 ± 0.6 (n = 44, p < 0.0001) and mean MCQ score from 18.7 ± 3.4 to 22.8 ± 2.6, out of a maximum of 28 (n = 44, p < 0.0001). Conclusion We present a simplified LVAD Advanced Life Support algorithm to aid the crucial first minutes of resuscitation where basic interventions are likely to be critical in assuring good patient outcomes.
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Key Words
- ALS, Advanced Life Support
- Advanced life support
- CALS, Cardiac Advanced Life Support
- CPR, Cardio-Pulmonary Resuscitation
- Cardiac arrest
- DNAR, do not attempt resuscitation order
- ECMO, Extracorporeal Membrane Oxygenation
- ETCO2, End Tidal Carbon Dioxide, kPa Kilopascal
- LVAD
- LVAD, Left Ventricular Assist Device
- Left ventricular assist device
- MAP, Mean Arterial Pressure
- MCQ, multiple-choice exam
- MDT, multi-disciplinary team
- MLS, Mechanical Life Support
- Mechanical circulatory support
- Resuscitation
- VF, Ventricular Fibrillation
- VT, Ventricular Tachycardia
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Affiliation(s)
- Waqas Akhtar
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Brigitte Gamble
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Kristine Kiff
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | | | - Binu Raj
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Junko Takata
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Fernando Riesgo Gil
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Ana Hurtado
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
| | - Alex Rosenberg
- Harefield Hospital, Hill End Road, Harefield, Uxbridge UB96JH, United Kingdom
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Zaidi MA, Christenson CR. Critical Care Management of Surgical Patients with Heart Failure or Left Ventricular Assist Devices: A Brief Overview. Surg Clin North Am 2021; 102:85-104. [PMID: 34800391 DOI: 10.1016/j.suc.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patients with heart failure, including those with implanted left ventricular assist devices, continue to increase in number. When they require noncardiac surgery, cardiac critical care expertise may not be immediately available to assist. This review serves to provide surgeons and surgical intensivists with a brief overview of the management of this patient population and common clinical scenarios and complications.
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Affiliation(s)
- Mohsin A Zaidi
- Anesthesiology and Critical Care Medicine, Department of Anesthesiology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, USA.
| | - Carl R Christenson
- Department of Anesthesiology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, M.L. 0531, Cincinnati, OH 45267, USA
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Strobel AM, Alblaihed L. Cardiac Emergencies in Kids. Emerg Med Clin North Am 2021; 39:605-625. [PMID: 34215405 DOI: 10.1016/j.emc.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Encountering a child with congenital heart disease after surgical palliation in the emergency department, specifically the single-ventricle or ventricular assist device, without a basic familiarity of these surgeries can be extremely anxiety provoking. Knowing what common conditions or complications may cause these children to visit the emergency department and how to stabilize will improve the chance for survival and is the premise for this article, regardless of practice setting.
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Affiliation(s)
- Ashley M Strobel
- Department of Emergency Medicine, University of Minnesota Medical School, Hennepin County Medical Center, University of Minnesota Masonic Children's Hospital, 701 South Park Avenue R2.123, Minneapolis, MN 55414, USA.
| | - Leen Alblaihed
- Department of Emergency Medicine, University of Maryland School of Medicine, University of Maryland Upper Chesapeake Medical System, 500 Upper Chesapeake Drive, Bel Air, MD 21014, USA
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Potapov EV, Antonides C, Crespo-Leiro MG, Combes A, Färber G, Hannan MM, Kukucka M, de Jonge N, Loforte A, Lund LH, Mohacsi P, Morshuis M, Netuka I, Özbaran M, Pappalardo F, Scandroglio AM, Schweiger M, Tsui S, Zimpfer D, Gustafsson F. 2019 EACTS Expert Consensus on long-term mechanical circulatory support. Eur J Cardiothorac Surg 2019; 56:230-270. [PMID: 31100109 PMCID: PMC6640909 DOI: 10.1093/ejcts/ezz098] [Citation(s) in RCA: 231] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Long-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many-sometimes contradictory-observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device.
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Affiliation(s)
- Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Christiaan Antonides
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Maria G Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC, La Coruña, Spain
| | - Alain Combes
- Sorbonne Université, INSERM, Institute of Cardiometabolism and Nutrition, Paris, France
- Service de médecine intensive-réanimation, Institut de Cardiologie, APHP, Hôpital Pitié–Salpêtrière, Paris, France
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Margaret M Hannan
- Department of Medical Microbiology, University College of Dublin, Dublin, Ireland
| | - Marian Kukucka
- Department of Anaesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Nicolaas de Jonge
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Antonio Loforte
- Department of Cardiothoracic, S. Orsola Hospital, Transplantation and Vascular Surgery, University of Bologna, Bologna, Italy
| | - Lars H Lund
- Department of Medicine Karolinska Institute, Heart and Vascular Theme, Karolinska University Hospital, Solna, Sweden
| | - Paul Mohacsi
- Department of Cardiovascular Surgery Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Mustafa Özbaran
- Department of Cardiovascular Surgery, Ege University, Izmir, Turkey
| | - Federico Pappalardo
- Advanced Heart Failure and Mechanical Circulatory Support Program, Cardiac Intensive Care, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Martin Schweiger
- Department of Congenital Pediatric Surgery, Zurich Children's Hospital, Zurich, Switzerland
| | - Steven Tsui
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - Daniel Zimpfer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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7
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Approach to Complications of Ventricular Assist Devices: A Clinical Review for the Emergency Provider. J Emerg Med 2019; 56:611-623. [PMID: 31003823 DOI: 10.1016/j.jemermed.2019.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/25/2019] [Accepted: 03/06/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Heart failure is a major public health problem in the United States. Increasingly, patients with advanced heart failure that fail medical therapy are being treated with implanted ventricular assist devices (VADs). OBJECTIVE This review provides an evidence-based summary of the current data for the evaluation and management of implanted VAD complications in an emergency department context. DISCUSSION With a prevalence of >5.8 million individuals and >550,000 new cases diagnosed each year, heart failure is a major public health problem in the United States. Increasingly, patients with advanced heart failure that fail medical therapy are being treated with implanted VADs. As the prevalence of patients with VADs continues to grow, they will sporadically present to the emergency department, regardless of whether the facility is a designated VAD center. As a result, all emergency physicians must be familiar with the basic principles of VAD function, as well as the diagnosis and initial management of VAD-related complications. In this review, we address these topics, with a focus on contemporary third-generation continuous flow VADs. This review will help supplement the critical care skills of emergency physicians in managing this complex patient population. CONCLUSIONS The cornerstone of managing the unstable VAD patient is rapid initiation of high-quality supportive care and recognition of device-related complications, as well as the identification and use of specialist VAD teams and other resources for support. Emergency physicians must understand VADs so that they may optimally manage these complex patients.
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8
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Goebel M, Tainter C, Kahn C, Dunford JV, Serra J, Pierce J, Donofrio JJ. An Urban 9-1-1 System's Experience with Left Ventricular Assist Device Patients. PREHOSP EMERG CARE 2018; 23:560-565. [PMID: 30285520 DOI: 10.1080/10903127.2018.1532475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Left ventricular assist devices (LVADs) are used with increasing frequency and left in place for longer periods of time. Prior publications have focused on the mechanics of troubleshooting the device itself. We aim to describe the epidemiology of LVAD patient presentations to emergency medical services (EMS), prehospital assessments and interventions, and hospital outcomes. Methods: This is a retrospective chart review of known LVAD patients that belong to a single academic center's heart failure program who activated the 9-1-1 system and were transported by an urban EMS system to one of the center's 2 emergency departments between January 2012 and December 2015. Identifying demographics were used to query the electronic medical record of the responding city fire agency and contracted transporting ambulance service. Two reviewers abstracted prehospital chief complaint, vital signs, assessments, and interventions. Emergency department and hospital outcomes were retrieved separately. Results: From January 2012 to December 2015, 15 LVAD patients were transported 16 times. The most common prehospital chief complaint was weakness (7/16), followed by chest pain (3/16). Of the 7 patients presenting with weakness, one was diagnosed with a stroke in the emergency department. Another patient was diagnosed with subarachnoid hemorrhage and expired during hospital admission. This was the only death in the cohort. The most common hospital diagnosis was GI bleed (3/16). The overall admission rate was 87.5% (14/16). Conclusions: EMS interactions with LVAD patients are infrequent but have high rates of admission and incidence of life-threatening diagnoses. The most common prehospital presenting symptoms were weakness and chest pain, and most prehospital interactions did not require LVAD-specific interventions. In addition to acquiring technical knowledge regarding LVADs, EMS providers should be aware of non-device-related complications including intracranial and GI bleeding and take this into account during their assessment.
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9
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Foëx BA. He was brought in blue… with an LVAD. Arch Emerg Med 2017; 34:850-851. [DOI: 10.1136/emermed-2017-207298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/06/2017] [Indexed: 11/04/2022]
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10
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Bowles CT, Hards R, Wrightson N, Lincoln P, Kore S, Marley L, Dalzell JR, Raj B, Baker TA, Goodwin D, Carroll P, Pateman J, Black JJM, Kattenhorn P, Faulkner M, Parameshwar J, Butcher C, Mason M, Rosenberg A, McGovern I, Weymann A, Gwinnutt C, Banner NR, Schueler S, Simon AR, Pitcher DW. Algorithms to guide ambulance clinicians in the management of emergencies in patients with implanted rotary left ventricular assist devices. Emerg Med J 2017; 34:842-850. [PMID: 29127102 PMCID: PMC5750371 DOI: 10.1136/emermed-2016-206172] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 07/27/2017] [Accepted: 09/02/2017] [Indexed: 11/04/2022]
Abstract
Advances in left ventricular assist device (LVAD) therapy have resulted in increasing numbers of adult LVAD recipients in the community. However, device failure, stroke, bleeding, LVAD thrombosis and systemic infection can be life-threatening emergencies. Currently, four LVAD systems are implanted in six UK transplant centres, each of which provides device-specific information to local emergency services. This has resulted in inconsistent availability and content of information with the risks of delayed or inappropriate decision-making. In order to improve patient safety, a consortium of UK healthcare professionals with expertise in LVADs developed universally applicable prehospital emergency algorithms. Guidance was framed as closely as possible on the standard ABCDE approach to the assessment of critically ill patients.
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Affiliation(s)
- Christopher T Bowles
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Rachel Hards
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Neil Wrightson
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Paul Lincoln
- Department of Cardiothoracic Transplantation, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Shishir Kore
- Department of Cardiothoracic Transplantation, Wythenshawe Hospital, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Laura Marley
- Department of Cardiothoracic Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Jonathan R Dalzell
- Scottish Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK
| | - Binu Raj
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Tracey A Baker
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Diane Goodwin
- Department of Cardiothoracic Transplantation, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Petra Carroll
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jane Pateman
- Anaesthetic Department, Royal Sussex County Hospital, Brighton, UK
| | - John J M Black
- Clinical Directorate, South Central Ambulance Service Foundation Trust, Oxfordshire, UK
| | - Paul Kattenhorn
- East of England Ambulance Service Headquarters, Whiting Way, Melbourn, Cambs., SG8 6EN., East of England Ambulance Service Headquarters, Melbourn, Cambs, UK
| | - Mark Faulkner
- London Ambulance Service, Medical Directorate Office, London, UK
| | - Jayan Parameshwar
- Department of Cardiothoracic Transplantation, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Charles Butcher
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Mark Mason
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Alexander Rosenberg
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ian McGovern
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Alexander Weymann
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Nicholas R Banner
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Stephan Schueler
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Andre R Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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