Left Ventricular Assist Device Multialarm Emergency: A High-Fidelity Simulation Case for Emergency Medicine Residents.
Introduction
As left ventricular assist devices (LVADs) become more prevalent in the treatment of patients with end-stage heart failure, emergency physicians must become experts in the management and resuscitation of patients with LVADs. As with other high-acuity, low-occurrence scenarios, managing the unstable LVAD patient makes for an ideal topic for simulation-based resident education.


Methods
By incorporating a high-fidelity HeartMate 3 LVAD task trainer, our program developed and executed a novel LVAD simulation activity for our emergency medicine resident physicians. In the scenario, a 65-year-old male with recent LVAD placement arrived at a community hospital with undifferentiated hypotension. Various device alarms activated during the scenario and required intervention. Ultimately, the patient was found to be in septic/hypovolemic shock and only survived with appropriate resuscitation. We implemented a postscenario survey to assess the effectiveness of the simulation activity and administered it to 27 residents.


Results
Content and delivery of our simulation were found to be effective; all survey questions regarding content and delivery obtained a mean score of 4.5 or greater on a 5-point Likert scale. Residents reported an overall high level of confidence in achieving most of the skill-based learning objectives (most scores > 4.1). The two objectives with the lowest confidence ratings were troubleshooting an LVAD and its various alarms (3.8) and demonstrating the ability to assess an LVAD patient (3.9).


Discussion
Our LVAD simulation activity was successful and also revealed several potential areas for future research and simulation improvement.
['Barnicle|Ryan|R|0000-0002-2100-3898', 'Boaglio|Sean|S|', 'Fitzgerald|Jillian|J|', 'Otterness|Karalynn|K|', 'Johnson|Scott|S|', 'Ahn|Christine|C|']
D000368:Aged D004635:Emergency Medicine D004636:Emergency Service, Hospital D006333:Heart Failure D006353:Heart-Assist Devices D000070856:High Fidelity Simulation Training D006801:Humans D008297:Male
Left Ventricular Assist Device Simulation Emergency Medicine LVAD Shock Cardiac Arrest Sepsis