How to face emergencies in heart failure patients with ventricular assist device

Ventricular assist device (VAD) technology has rapidly evolved, and VADs are now seen as a reliable lifesaving option to support the failing heart in the short- and long-term: in some cases, VAD therapy represents a well-accepted treatment option for advanced heart failure that can obviate the need for heart transplantation. In the near future, more and more cardiologists will encounter VAD patients in their clinical practice and need to know how to handle the inherent risks associated with VAD use. The emergency care of a VAD patient differs from that of conventional practice and specific expertise is required to avoid inappropriate management that could lead to inefficient treatment and/or dangerous consequences. Here, we describe two emergency scenarios in VAD patients, two paradigmatic clinical in-hospital situations, in different settings. Following a brief overview of the role of cardiopulmonary resuscitation maneuvers in VAD patients, we propose a working algorithm that might help to ensure a timely and efficient response to acute demands in this setting.