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Emergency Medical Services Protocols for Assessment and Treatment of Patients with Ventricular Assist Devices

Published online by Cambridge University Press:  06 March 2024

Emily L. Larson Open the ORCID record for Emily L. Larson [Opens in a new window] ,
JiWon Woo ,
Gyeongtae Moon ,
Kathy Liu ,
Matthew Vergel ,
Reed Jenkins ,
Kelly Jiang ,
Zachary Darby ,
Asa Margolis  and
Ahmet Kilic Open the ORCID record for Ahmet Kilic [Opens in a new window]
Emily L. Larson
Affiliation:
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
JiWon Woo
Affiliation:
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
Gyeongtae Moon
Affiliation:
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
Kathy Liu
Affiliation:
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
Matthew Vergel
Affiliation:
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
Reed Jenkins
Affiliation:
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
Kelly Jiang
Affiliation:
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
Zachary Darby
Affiliation:
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
Asa Margolis
Affiliation:
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
Ahmet Kilic*
Affiliation:
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland USA
*
Correspondence: Ahmet Kilic, MD 1800 Orleans St Zayed 7 Baltimore, Maryland 21287 USA E-mail: akilic2@jhmi.edu
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Abstract

Background:

Patients with ventricular assist devices (VADs) represent a growing population presenting to Emergency Medical Services (EMS), but little is known about their prehospital care. This study aimed to characterize current EMS protocols in the United States for patients with VADs.

Methods:

States with state-wide EMS protocols were included. Protocols were obtained from the state EMS website. If not available, the office of the state medical director was contacted. For each state, protocols were analyzed for patient and VAD assessment and treatment variables.

Results:

Of 32 states with state-wide EMS protocols, 21 had VAD-specific protocols. With 17 (81%) states noting a pulse may not be palpable, protocols recommended assessing alternate measures of perfusion and mean arterial pressure (MAP; 15 [71%]). Assessment of VAD was advised through listening for pump hum (20 [95%]) and alarms (20 [95%]) and checking the power supply (15 [71%]). For treatment, EMS prehospital consultation was required to begin chest compression in three (14%) states, and mechanical (device) chest compressions were not permitted in two (10%) states. Contact information for VAD coordinator was listed in a minority of five (24%) states. Transport of VAD equipment/backup bag was advised in 18 (86%) states.

Discussion:

This national analysis of EMS protocols found VAD-specific EMS protocols are not universally adopted in the United States and are variable when implemented, highlighting a need for VAD teams to partner with EMS agencies to inform standardized protocols that optimize these patients’ care.

Keywords

EMSheart failureLVADprehospitalVAD
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 39 , Issue 2 , April 2024 , pp. 136 - 141
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine

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