EMS, Left Ventricular Assist Device Management

The incidence of heart failure has been increasing in the United States and worldwide, with estimates of 6 million and more than 30 million, respectively. This increasing prevalence of heart failure could be due to improved survival in patients with prior episodes of heart failure, and the overall aging of the population. The mortality rate for patients with advanced (stage D) heart failure is as high as 80% in 1 year of diagnosis. The only non-pharmacologic therapies approved in the United States for such heart failure patients are heart transplants and left ventricular assist devices (LVAD). In the past, LVADs were used as a bridge to transplant (BTT) for patients who were eligible for heart transplants. However, in January 2010, after the FDA approved a first-line intermediate-to-chronic left ventricular assist device for destination therapy, the number of patients who received LVAD implants increased significantly. As the population of patients with LVAD increases, it becomes important to have a standardized or universal LVAD management training system for prehospital emergency medical services. The goal of this article is to review a systematic approach to the management of LVAD patients in the pre-hospital setting. [1],[2],[3],[4],[5]