• death/mortality
• emergency department
• resuscitation

It was a long time ago.

He was blue. He was breathless and he was plugged in to an LVAD. The crew knew he needed to get to the LVAD Centre, but they didn’t think he would make it. They brought him to me instead. With some oxygen he felt better. His name was Leonardi and he gave a good history for pneumonia … fever, cough, yellow sputum.

He had signs at the left base and a belt with a bulky controller for his LVAD. There was no flashing light, no sound. It came as no surprise that he had no veins. While the Cardiologist phoned the LVAD Centre I put in a femoral line, checked a blood gas and started antibiotics. His central venous saturation was 15% … 15%? Turning back to Leonard it was obvious he was fading. From the LVAD Centre we learned that his LVAD was destination therapy for an ischaemic cardiomyopathy. We learned that he was not on the transplant list because of his lifestyle: he didn’t always attend the clinic and sometimes when he did he was intoxicated. He had turned up with a flat or almost flat battery once before… and yes when the battery is flat, truly flat, there is no flashing light, no alarm. A repeat gas and the venous saturation was only 5%. I pulled up a chair and held his hand …

The two articles published in this issue of the Journal would have provided a much needed guide to the technology of left ventricular assist devices (LVADs) and allowed a quicker diagnosis of the problem: a flat battery.1 2

Bowles et al propose algorithms to …