Critical considerations in management of patients with left ventricular assist device in an Emergency Department practice

In recent years, mechanical circulatory support has become an increasingly used treatment strategy for end-stage heart failure. Due to technological progress and higher availability of this therapy, the number of patients receiving left ventricular assist devices (LVAD) is increasing. A natural consequence of this is occurrence of complications related to this therapy. A patient presenting to an emergency department (ED) expects the highest level of care. Emergency department staff should have basic knowledge and skills to provide initial diagnostic and therapeutic interventions for patients with LVAD in life-threatening conditions. The most common reasons for patients with LVADs presenting to the ED are bleeding, heart rhythm disorders, stroke, or infections. This article aims to present the basic information that may be useful during the first medical contact in an emergency department. The authors have discussed the issue of diagnosis, and differences in laboratory findings and indicate where to best seek help. The article is dedicated to physicians, nurses, and paramedics working in emergency departments