Left Ventricular Assist Device Management in the Emergency Department

Paul Trinquero, MD; Andrew Pirotte, MD; Lauren P. Gallagher, MD, MA; Kimberly M. Iwaki, MD; Christopher Beach, MD; Jane E. Wilcox, MD

Disclosures

Western J Emerg Med. 2018;19(5):834-841. 

In This Article

Overview of Current Left Ventricular Assist Devices (LVAD) and VAD Components

LVADs are surgically implanted into the apex of the left ventricle of the heart (inflow cannula) and are connected to the aorta via an outflow cannula providing circulatory support to the patient. A driveline passes from the device through the skin, connecting to a system controller that in turn is connected to external power. While the first generation VADs were pulsatile, all current devices are continuous flow, which have improved survival and lowered rates of device failure.[4] This paper will focus on the second-and third-generation continuous-flow VADs currently approved by the FDA, as very few patients still have first-generation VADs.

The HeartMate II™ (HMII), the HeartMate III™ (HMIII), and the HeartWare® (also called HVAD) are the three FDA-approved assist devices. The characteristics of the various pumps are highlighted in the table. In the case of an obtunded or altered patient, this table provides a reference to distinguish devices and information to relay over the phone to the VAD team or implanting hospital.

Notable VAD components include the driveline, controller, and battery pack.[5] The driveline is tunneled from the device to the skin and exits through the abdominal wall. It forms the connection between the surgically implanted VAD, which is located in the thoracic cavity (HVAD, HMIII) or intra-abdominal cavity (HMII), and the external controller. The controller serves to convey pump function parameters and alarms as well as provide a medium to adjust the device settings. Finally, an external, replaceable, and rechargeable battery pack powers the device.

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