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Algorithms to guide ambulance clinicians in the management of emergencies in patients with implanted rotary left ventricular assist devices
  1. Christopher T Bowles1,
  2. Rachel Hards1,
  3. Neil Wrightson2,
  4. Paul Lincoln3,
  5. Shishir Kore4,
  6. Laura Marley5,
  7. Jonathan R Dalzell6,
  8. Binu Raj1,
  9. Tracey A Baker1,
  10. Diane Goodwin3,
  11. Petra Carroll1,
  12. Jane Pateman7,
  13. John J M Black8,
  14. Paul Kattenhorn9,
  15. Mark Faulkner10,
  16. Jayan Parameshwar3,
  17. Charles Butcher1,
  18. Mark Mason1,
  19. Alexander Rosenberg1,
  20. Ian McGovern1,
  21. Alexander Weymann1,
  22. Carl Gwinnutt11,
  23. Nicholas R Banner1,
  24. Stephan Schueler2,
  25. Andre R Simon1,
  26. David W Pitcher11
  1. 1 Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  2. 2 Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
  3. 3 Department of Cardiothoracic Transplantation, Papworth Hospital NHS Foundation Trust, Cambridge, UK
  4. 4 Department of Cardiothoracic Transplantation, Wythenshawe Hospital, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
  5. 5 Department of Cardiothoracic Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  6. 6 Scottish Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK
  7. 7 Anaesthetic Department, Royal Sussex County Hospital, Brighton, UK
  8. 8 Clinical Directorate, South Central Ambulance Service Foundation Trust, Oxfordshire, UK
  9. 9 East of England Ambulance Service Headquarters, Whiting Way, Melbourn, Cambs., SG8 6EN., East of England Ambulance Service Headquarters, Melbourn, Cambs, UK
  10. 10 London Ambulance Service, Medical Directorate Office, London, UK
  11. 11 Resuscitation Council, London, UK
  1. Correspondence to Dr Christopher T Bowles, Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, London UB9 6JH, UK; c.bowles{at}


Advances in left ventricular assist device (LVAD) therapy have resulted in increasing numbers of adult LVAD recipients in the community. However, device failure, stroke, bleeding, LVAD thrombosis and systemic infection can be life-threatening emergencies. Currently, four LVAD systems are implanted in six UK transplant centres, each of which provides device-specific information to local emergency services. This has resulted in inconsistent availability and content of information with the risks of delayed or inappropriate decision-making. In order to improve patient safety, a consortium of UK healthcare professionals with expertise in LVADs developed universally applicable prehospital emergency algorithms. Guidance was framed as closely as possible on the standard ABCDE approach to the assessment of critically ill patients.

  • clinical assessment
  • first responders
  • guidelines
  • prehospital care
  • clinical management
  • resuscitation
  • left ventricular assist device

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  • Contributors CTB chaired the consortium and is guarantor of the manuscript’s content. RH, NW, PL, SK, LM and JD and MF provided audit data. CTB, BR, JB, CB, MM, AR, IMG, CG, NRB, SS, AS and DP contributed to algorithm development. TB, DG, PC, JP, PK made contributions during the meetings. All authors contributed to the development of the manuscript and approved the final version.

  • Competing interests RH and AS have had remunerated consultancy agreements with Medtronic which provided funding for this initiative.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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