Prehospital Experience With Left Ventricular Assist Devices

Advancements in the heart failure armamentarium have increased left ventricular assist device (LVAD) use, including in emergency medical services (EMS).

We performed a retrospective review of patients with LVADs transported to the emergency department by 911 EMS from 2017 to 2021. Patient LVAD characteristics, EMS characteristics and interventions, and outcomes were reported.

There were 75 EMS transports of 25 patients. LVADs were destination therapy for 87% and used for a median 2.3 y. Patients most frequently presented for chest pain, with LVAD alarms present for 15%. An LVAD assessment was present for 24%. The LVAD team was contacted for 8% and hospital notified for 56%. Eight percent were priority one (immediate life-threat). Median length of stay was 4 d, with 81% admitted. One-year survival after EMS transport was 74.8% (95% confidence interval 61.6%-90.9%), with four in-hospital deaths and 39% returning to the emergency department within 30 d.

This study highlights LVAD patients' frequent high-acuity presentation to EMS, with associated high mortality and emergency department return. Additionally, it reveals gaps in the EMS care of these patients and provides an important opportunity to partner with EMS agencies to improve clinician education and the care of LVAD patients.