[Left ventricular assist devices in emergency medicine : Case-based analysis for emergency medical services and emergency departments].

Abstract

Background: Left ventricular assist devices (LVAD) are an established treatment for advanced heart failure. Due to the continuous flow, pulse palpation, noninvasive blood pressure measurement and pulse oximetry are often unreliable in acute care.

Objective: Case-based analysis of the acute care of patients with left ventricular assist devices in emergency medical services and emergency departments, exemplified by a patient supported with HeartMate 3® and derivation of practical recommendations for action.

Material and methods: Anonymized prehospital and clinical documentation of a 67-year-old female patient was evaluated. Monitoring, clinical assessment, device and power supply checks, pump parameters, diagnostics and triage were analyzed using consensus documents, reviews, registry data and manufacturer's data.

Results: In this study three key problem areas emerged: unreliable standard monitoring, initial misclassification as technical device failure and necessary contextual interpretation of pump parameters. Prehospital findings included dyspnea, cyanosis, impaired consciousness and inability to obtain blood pressure or oxygen saturation values. The later device readout showed stable parameters without acute pump malfunction. The underlying cause was severe Staphylococcus aureus bacteremia with renal replacement therapy-dependent renal failure.

Conclusion: Severe clinical deterioration in LVAD patients is not necessarily pump-related. Key elements are perfusion assessment, device and power supply checks, interpretation of pump parameters, extended diagnostics and early consultation with an LVAD center.