Prehospital assessment and management of patients with ventricular-assist devices.

Advances in the management of heart failure have led to an increasing number of patients living outside the hospital with a variety of ventricular-assist devices (VADs). These implantable pumps may be placed temporarily as a bridge to cardiac transplantation or resolution of a reversible condition, or as destination therapy for the rest of the patient's life. Emergency medical services (EMS) providers may be called to care for such patients experiencing an emergency related to the device itself, the underlying cardiac condition, or a totally unrelated medical or traumatic issue. Providers should have a basic knowledge of how these devices work and what sort of complications VAD patients may experience. In addition, they should know how to troubleshoot the devices if they alarm or malfunction, what emergency interventions can and cannot be performed, and where to turn for guidance if needed. Challenges related to management of patients with VADs include their poor baseline medical status, limitations of traditional prehospital assessment techniques, the relative infrequency with which these patients are encountered, and the rapidity with which device technology is evolving. This article presents a brief history of VADs, with an emphasis on left ventricular-assist devices (LVADs), reviews the relevant anatomy and pathophysiology, and describes the types of devices currently in clinical use. It discusses patient-specific and device-specific complications that may be encountered and concludes with an approach to prehospital patient assessment and care.