An Urban 9-1-1 System’s Experience with Left Ventricular Assist Device Patients

Goebel, Mat; Tainter, Christopher; Kahn, Christopher A.; Dunford, James V.; Serra, John; Pierce, Jodie; Donofrio, J. Joelle

doi:10.1080/10903127.2018.1532475

Cited by 7 publications

(8 citation statements)

References 21 publications

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“…This pattern is similar to that described previously in the literature, and is likely a manifestation of 24-hour care provided by the LVAD team and coordinators at our center and many others, which can facilitate expedited direct admission to LVAD trained units for suspected device-related complications and malfunctions [3] , [4] , [5] . The overall admission rate from the ED in our study is similar to those of prior evaluations, suggesting that the overwhelming majority of LVAD presentations to the ED result in admission [5] , [6] .…”

Section: Discussionsupporting

confidence: 83%

Patterns of emergency department utilization for LVAD patients compared with non-LVAD patients

Al‐Ani

Gul

Khatri

et al. 2020

IJC Heart & Vasculature

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Background Left ventricular assist device (LVAD) patients are vulnerable to over-utilization of resources. Methods and results We explored the pattern of emergency department (ED) presentations of LVAD patients and their costs compared with non-LVAD heart failure patients. ED visits between 7/2008 and 7/2017 were reviewed to identify 145 LVAD patients, and 435 patients with known heart failure were selected using propensity score matching for age and sex. ED evaluation metrics, hospitalization cost, and length of stay (LOS) were analyzed. Although the most common ED presentations and their frequency differed between groups, few were LVAD specific. LVAD patients were more likely to have taken personal vehicles or be flown to the ED. They had similar times to triage, rooming, and physician evaluation compared with non-LVAD patients. However, LVAD patients were noted to have a shorter time from physician assessment to disposition (109.8 min vs. 177.0 min, p < 0.001) and, overall, LVAD patients had shorter ED LOS (6.33 vs. 9.82 hrs, p = 0.0001). For patients admitted, no significant difference was found between groups in hospital LOS (6.67 vs 6.58 days, p = 0.928) or total cost ($28,766 vs $21,524, p = 0.087). Conclusion Shorter disposition times without increases in LOS or costs may identify a created healthcare disparity among LVAD patients.

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Section: Discussionsupporting

confidence: 83%

Patterns of emergency department utilization for LVAD patients compared with non-LVAD patients

Al‐Ani

Gul

Khatri

et al. 2020

IJC Heart & Vasculature

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“…Paramedics interventions at patients' homes are rare. Goebel et al [6] emphasize that the most frequently reported complaint is weakness followed by chest pain. In a group of 15 patients, only one required LVAD-specific interventions (battery switch).…”

Section: Medical Contact With Pati Entsmentioning

confidence: 99%

“…Training for healthcare professionals is essential as they have the potential to significantly affect patient outcomes in crisis situations. If possible, simulation training should be provided to present basic LVAD features [24,25]. With simulation, skills that are rarely used, and therefore at risk of being forgotten, are exercised and retained [26].…”

Section: Examinati Onmentioning

confidence: 99%

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Examination of a patient with left ventricular assist device in an emergency condition — proposal for adaptation of the ABCDE examination algorithm

Kłosiewicz

Zalewski

Podlewski

et al. 2022

Medical Research Journal

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“…Worldwide, about one million heart surgeries are performed annually, which require extracorporeal circulation (ECC) using the heart-lung machine [1]. The ECC includes various methods, such as dialysis, extracorporeal membrane oxygenation (ECMO) for respiratory support, extracorporeal life support (ECLS), and ventricular assist devices (VAD) for cardiac support [2][3][4]. During ECC, the contact of blood with foreign surfaces can lead to life-threatening activation of coagulation.…”

Section: Introductionmentioning

confidence: 99%

Application of Piezo-Based Measuring System for Evaluation of Nucleic Acid-Based Drugs Influencing the Coagulation

Kunnakattu

Hann

Kurz

et al. 2019

Sensors

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During open-heart surgery, the status of hemostasis has to be constantly monitored to quickly and reliably detect bleeding or coagulation disorders. In this study, a novel optimized piezo-based measuring system (PIEZ) for rheological monitoring of hemostasis was established. The applicability of the PIEZ for the evaluation of nucleic acid-based drugs influencing coagulation was analyzed. Thrombin aptamers such as NU172 might be used during extracorporeal circulation (ECC) in combination with a reduced heparin concentration or for patients with heparin-induced thrombocytopenia (HIT). Therefore, the effect of the coagulation inhibiting thrombin aptamer NU172 and the abrogation by its complementary antidote sequence (AD) were investigated by this rheological PIEZ system. After the addition of different NU172 concentrations, the coagulation of fresh human blood was analyzed under static conditions and using an in vitro rotation model under dynamic conditions (simulating ECC). The clotting times (CTs) detected by PIEZ were compared to those obtained with a medical reference device, a ball coagulometer. Additionally, after the circulation of blood samples for 30 min at 37 °C, blood cell numbers, thrombin markers (thrombin-antithrombin III (TAT) and fibrinopeptide A (FPA)) and a platelet activation marker (β-thromboglobulin (β-TG)) were analyzed by enzyme-linked immunosorbent assays (ELISAs). The increase of NU172 concentration resulted in prolonged CTs, which were comparable between the reference ball coagulometer and the PIEZ, demonstrating the reliability of the new measuring system. Moreover, by looking at the slope of the linear regression of the viscous and elastic components, PIEZ also could provide information on the kinetics of the coagulation reaction. The shear viscosity at the end of the measurements (after 300 s) was indicative of clot firmness. Furthermore, the PIEZ was able to detect the abrogation of coagulation inhibition after the equimolar addition of NU172 aptamer´s AD. The obtained results showed that the established PIEZ is capable to dynamically measure the hemostasis status in whole blood and can be applied to analyze nucleic acid-based drugs influencing the coagulation.

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An Urban 9-1-1 System’s Experience with Left Ventricular Assist Device Patients

Cited by 7 publications

References 21 publications

Patterns of emergency department utilization for LVAD patients compared with non-LVAD patients

Patterns of emergency department utilization for LVAD patients compared with non-LVAD patients

Examination of a patient with left ventricular assist device in an emergency condition — proposal for adaptation of the ABCDE examination algorithm

Application of Piezo-Based Measuring System for Evaluation of Nucleic Acid-Based Drugs Influencing the Coagulation

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