Analysis of Patients With Ventricular Assist Devices Presenting to an Urban Emergency Department

Ryan P. McKillip, MD; Anand Gopalsami, MD; Magdeline Montoya, MD; Gene Kim, MD; James J. Walter, MD; Colleen Juricek, MS; Eric Shappell, MD MHPE

Disclosures

Western J Emerg Med. 2018;19(6):907-911. 

In This Article

Introduction

With over 10,000 implantations to date, left ventricular assist device (LVAD) insertion as a bridge-to-transplant, bridge-to-recovery, or destination therapy, is an increasingly common intervention for patients with advanced heart failure,[1,2] yet most emergency physicians have limited training or experience in the care of such patients. Numerous clinical studies have illustrated the effectiveness and complications of LVADs,[3,4] but literature on the emergency department (ED) presentation of this population is limited, particularly with regard to device-specific complications.[5–7] In addition to the complications associated with heart failure, patients with LVADs are at risk for critical adverse events such as intracranial and gastrointestinal bleeding, driveline infection, and pump thrombosis. Early diagnosis of pump thrombosis is critical, as it can result in urgent transplantation, device replacement, or death. Incidence has been reported as 0.02 to 0.08 events per patient per year with continuous-flow devices.[8]

While investigators have proposed pathways for evaluating patients with LVADs and assessing device function in the ED,[9–11] the incidence and nature of ED encounters in this patient population remains unclear. Increased awareness regarding the common ED presentations of patients with LVADs could lead to more targeted education interventions, improved provider preparedness, and enhanced care for this complicated population. The purpose of this study was to characterize the presentation and clinical course of patients with LVADs presenting to an urban, academic medical center ED with a focus on device-specific complications.

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