No Pulse? No Problem. Navigating Left Ventricular Assist Device Emergencies in the Emergency Department

Left ventricular assist devices (LVADs) are increasingly used in patients with advanced heart failure. As their prevalence grows, emergency physicians (EPs) are more likely to encounter these patients. However, LVAD-supported physiology differs from native cardiac function and can lead to unique complications. Prompt recognition and appropriate initial management are critical.

The objective of this literature review is to examine carefully selected pieces of literature regarding the initial assessment, stabilization, and emergency management of patients with LVADs. Not all EPs are comfortable with LVADs, and we hope that this review will help identify key physiologic principles, common complications, and practical algorithms that can guide frontline EPs in delivering timely and effective care to this complex patient population.

The emergency management of patients with LVADs requires a nuanced understanding of altered physiology, an approach to rapid stabilization, and device-specific complications. EPs can lack familiarity with essential LVAD principles, including interpreting non-pulsatile vital signs and identifying unique complications such as pump thrombosis, driveline infections, and right heart failure. While evidence supports early consultation with LVAD coordinators, standardized protocols remain inconsistent across institutions. Focused training and greater dissemination of evidence-based summaries and guidelines are necessary to help close knowledge gaps and improve outcomes in this growing patient population.

Incorporating evidence-based research and promoting familiarity with LVAD physiology and complications can enhance both patient safety and provider readiness in these high-stakes encounters.