LVAD Poutpourri


    LVAD Poutpourri

    This is the last segment of the LVAD-oriented series of pearls. There are a number of LVAD-related complications to be aware of.

    Disclaimer: I am an emergency medicine resident, not a heart failure fellow. This is my synthesis of a potpourri of LVAD-related complications and emergent management options.

    Power shortage:

    Make sure the pump has enough battery life. This information is available on the controller.

    Pump thrombosis:

    Patients with LVAD’s can have clots inside the pump, and anywhere else with low flows (aortic valve, left ventricle). To prevent these complications, patients are anticoagulated (target INR 1.5-2.5) and placed on aspirin. Despite anticoagulation, 8-10% of people with LVAD’s ultimately have ischemic strokes. High power (pump is working harder to produce set speed), or changes in PI can clue  you in to the possibility of pump thrombosis. Hemolysis increases with pump thrombosis, and relevant laboratory studies should be sent when you are concerned about this diagnosis (LDH, haptoglobin, bilirubin). Management often involves anticoagulation with heparin; thrombolysis and emergent device exchange are options for refractory cases. Ultimately, discuss management with your LVAD team.


    After cardiac failure, infection is the second most common cause of death in patients with LVAD’s. The driveline (line that travels out of the body to the controller) and pump pocket are commons sites of infection. Gram positive organisms are the most common culprits of infection, though Pseudomonas aeruginosa is a gram negative pathogen of concern in this patient popultation. Initiating broad spectrum antibiotics is appropriate until culture data is available. CT can be useful in assessing for collection.

    GI bleeding: 

    GI bleeds are common in this population. Rectal exam early in the unstable patient. Hold anticoagulation. Tread lightly when considering actively reversing anticoagulation; discuss options with specialists early.


    Patients with LVAD’s are prone to arrythmias, and can appear reasonably stable (e.g. awake, talking, vfib). ECG early. Address the situation.


    Patients with LVAD’s are anticoagulated and have a holes in their hearts; they are prone to pericardial bleeding. Place a probe on the chest early.

    RV failure: 

    The septum is sucked into the LV (literally) and has less of a role in RV contractility. RV failure is relatively common in patients with LVAD’s, and is complicated to manage. Inotropes and pulmonary vasodilators may have a role. Pump speed can be adjusted. Again, management decisions should be made with the LVAD team involved.

    Suction events:

    The walls of the LV can get sucked into the inflow cannula, and the chamber can collapse. PI and flow will both decrease, and the device should alarm. This is generally addressed by the device decreasing its speed without operator input in order to try to release the wall. Hypovolemia puts a patient at risk for suction events – bolus fluids if this is a recurring problem


    Pratt, Alexandra K., Nimesh S. Shah, and Steven W. Boyce. “Left ventricular assist device management in the ICU.” Critical care medicine 42.1 (2014): 158-168.

    Slaughter, Mark S., et al. “Clinical management of continuous-flow left ventricular assist devices in advanced heart failure.” The Journal of Heart and Lung Transplantation 29.4 (2010): S1-S39.


    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • Ring Removal

      Over the past week, we’ve had a strange uptick in number of patients presenting to the ER with rings stuck on their finger. This is a quick review on the options that you have regardingRead more

    • TPA For Minor Stroke?

        So, you’re working in the ED when a new stroke code is activated. You walk over and see a young gentleman with the complaint of left facial tingling, right arm and leg weakness withRead more

    • Central Line Wizardry

      I was scrolling through twitter this morning when I came across a quick video from @CriticalCareNow for an awesome central line trick. And then I went to his feed and found some more. They areRead more

    • Let’s wait for the “official urinalysis”….?

      Chances are you order a urine dip or urinalysis on a good number of your patients each shift. But how good are these tests at helping us diagnose a urinary tract infection? The short answer:Read more

    • National Physician Suicide Awareness Day

      This past Tuesday (September 17th) was the first annual National Physician Suicide Awareness Day. CORD, ACEP, SAEM and a number of other EM organizations paired with organization from other specialties to raise awareness of theRead more

    • M is for morphine

      Remember MONA (morphine, oxygen, nitro, aspirin) from med school? Well, she may be just “A” now…. Over the years, all of these treatments (except for good old aspirin) have become somewhat controversial in the treatmentRead more

    • Meningitis Prophylaxis

      Have you ever taken care of really critical, undifferentiated patient, only later to find out that they were diagnosed with a serious, contagious illness? We are exposed to innumerable pathogens each day in the ED,Read more

    • The Betel Nut: an oral carcinogen

      Ever walk up to a stable, comfortable appearing patient at Elmhurst and their mouth/teeth are completely RED? Or maybe like a dark brownish/black color? Like this?? It really scared me the first I saw itRead more