Chinese expert consensus on emergency management of patients with implantable left ventricular assist device (2026 edition)_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Dingqian ¹ , MA Guoguang ² , HAO Guangwei ² ,  WANG Xianqiang ³ ,  WANG Chunsheng ¹ ,  SUN Xiaoning ¹

1. Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China;
2. Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China;
3. Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P. R. China;

Corresponding?author：

WANG Xianqiang, Email: qiangxianwang@163.com; WANG Chunsheng, Email: wang.chunsheng@zs-hospital.sh.cn; SUN Xiaoning, Email: sun.xiaoning@zs-hospital.sh.cn

Keywords：

Implantable left ventricular assist device; emergency management; low flow; pump thrombosis; right ventricular failure; cardiopulmonary resuscitation; expert consensus

DOI：

10.7507/1007-4848.202601105

Video：

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Standardizing the emergency assessment and management process for patients with implantable continuous-flow left ventricular assist device (LVAD) in emergency and intensive care settings is of great significance for reducing delays in diagnosis and treatment, lowering the mortality associated with LVAD-related emergencies, and improving overall prognosis and long-term survival. To this end, a multidisciplinary expert committee was convened to develop this consensus, integrating international evidence-based findings with clinical practice experience in China, with an emphasis on highlighting the characteristics of domestically manufactured devices. The aim is to establish an actionable standardized emergency management protocol to enhance clinical identification and response efficiency, reduce the risk of LVAD-related emergencies, and improve patient outcomes. Using a modified Delphi method, this consensus proposes a structured decision-making pathway that integrates an "ABC" rapid assessment with parallel device troubleshooting, prioritizing the use of point-of-care echocardiography for hemodynamic evaluation and complication assessment. Key emergency scenarios covered include low-flow alarms, pump thrombosis, right heart dysfunction, bleeding and anticoagulation imbalance, arrhythmias, and cardiac arrest. This consensus applies to implantable continuous-flow LVADs commonly used in China, including domestically manufactured devices such as Corheart 6, CH-VAD, EVAHEART, and HeartCon, as well as the imported device HeartMate 3.

1.	Saeed D, Feldman D, El Banayosy A, et al. The 2023 International Society for Heart and Lung Transplantation guidelines for mechanical circulatory support: a 10-year update. J Heart Lung Transplant, 2023, 42(7): e1-e222.
2.	Chaudhry SP, DeVore AD, Vidula H, et al. Left ventricular assist devices: a primer for the general cardiologist. J Am Heart Assoc, 2022, 11(24): e027251.
3.	Mehra MR, Uriel N, Naka Y, et al. A fully magnetically levitated left ventricular assist device: final report. N Engl J Med, 2019, 380: 1618-1627.
4.	Hollis IB, Jennings DL, Krim S, et al. An ISHLT consensus statement on strategies to prevent and manage hemocompatibility related adverse events in patients with a durable, continuous-flow ventricular assist device. J Heart Lung Transplant, 2024, 43(8): 1199-1234.
5.	中國生物醫學工程學會機械循環支持分會, 中國心室輔助裝置專家共識委員會. 中國左心室輔助裝置植入術后早期重癥監護管理專家共識 (2024年). 中國循環雜志, 2024, 39(8): 729-750.Chinese Society of Biomedical Engineering Mechanical Circulatory Support Branch, Chinese Expert Consensus Committee on Ventricular Assist Devices. Expert consensus on early postoperative intensive care management after left ventricular assist device implantation (2024). Chin Circ J, 2024, 39(8): 729-750.
6.	中國醫師協會心血管內科醫師分會. 左心室輔助裝置植入全程管理專家共識 (2023年). 中國循環雜志, 2023, 38: 1125-1138.Cardiovascular Physicians Branch of Chinese Medical Doctor Association. Expert consensus on whole-course management of left ventricular assist device implantation (2023). Chin Circ J, 2023, 38: 1125-1138.
7.	Salewski C, Rustenbach CJ, Marinos SL, et al. Left ventricular assist device (LVAD)-related major adverse events account for a low number of emergency room admissions in HeartMate 3? patients: a 10-year retrospective study. Biomedicines, 2025, 13(7): 1702.
8.	Barssoum K, Patel H, Rai D, et al. Outcomes of cardiac arrest and cardiopulmonary resuscitation in patients with left ventricular assist device; an insight from a national inpatient sample. Heart Lung Circ, 2022, 31: 246-254.
9.	Saeed O, Jermyn R, Kargoli F, et al. Blood pressure and adverse events during continuous flow left ventricular assist device support. Circ Heart Fail, 2015, 8: 551-556.
10.	Akhtar W, Baston VR, Berman M, et al. British societies guideline on the management of emergencies in implantable left ventricular assist device recipients in transplant centres. Intensive Care Med, 2024, 50(4): 493-501.
11.	Cao D, Arens AM, Chow SL, et al. Part 10: adult and pediatric special circumstances of resuscitation: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2025, 152(16_suppl_2): S578-S672.
12.	Guglin M, Hirsch JR, Tanawuttiwat T, et al. How to diagnose and manage emergency medical conditions in patients on left ventricular assist device support: a clinician's field guide. Trends Cardiovasc Med, 2025, 35(3): 186-194.
13.	國家心血管病專家委員會護理專業委員會, 馬艷, 吳榮, 等. 左心室輔助裝置植入患者術后護理專家共識. 中華護理雜志, 2024, 59(14): 1687-1690.Nursing Professional Committee of the National Cardiovascular Disease Expert Committee, Ma Y, Wu R, et al. Expert consensus on postoperative care of patients with a left ventricular assistant device. Chin J Nurs, 2024, 59(14): 1687-1690.
14.	賈莉, 黃珈雯, 孫力. 左心室輔助裝置植入圍術期藥學監護專家共識. 今日藥學, 2025. [Epub ahead of print].Epub ahead of print Jia L, Huang JW, Sun L. Expert consensus on perioperative pharmaceutical monitoring for left ventricular assist device implantation. Pharm Today, 2025. [Epub ahead of print].
15.	Givertz MM, DeFilippis EM, Colvin M, et al. HFSA/SAEM/ISHLT clinical expert consensus document on the emergency management of patients with ventricular assist devices. J Card Fail, 25(7): 494-515.
16.	Akhtar W, Gamble B, Kiff K, et al. Mechanical life support algorithm developed by simulation for inpatient emergency management of recipients of implantable left ventricular assist devices. Resusc Plus, 2022, 10: 100254.
17.	Lankheet S, Pieterse MM, Rijnhout R, et al. Validity and success rate of noninvasive mean arterial blood pressure measurements in cf-LVAD patients: a technical review. Artif Organs, 2022, 46(12): 2361-2370.
18.	Ogami T, Naka Y, Sanchez J, et al. Incidence and cause of persistent low flow alarm after HeartMate 3 left ventricular assist device insertion. J Heart Lung Transplant, 2020, 39(4): S404.
19.	Ben Avraham B, Crespo-Leiro MG, Filippatos G, et al. HFA of the ESC position paper on the management of LVAD supported patients for the non LVAD specialist physician: executive summary. ESC Heart Fail, 2021, 8(6): 4394-4408.
20.	Bernhardt AM, Copeland H, Deswal A, et al. The International Society for Heart and Lung Transplantation/Heart Failure Society of America guideline on acute mechanical circulatory support. J Heart Lung Transplant, 2023, 42(12): 1770.
21.	Ahsan I, Faraz A, Mehmood A, et al. Clinical approach to manage gastrointestinal bleeding with a left ventricular assist device (LVAD). Cureus, 2019, 11(12): e6341.
22.	Theeuwes C, Frost M, Vierecke J. Prolonged cardiopulmonary resuscitation with Lucas device in a patient with left ventricular assist device. J Heart Lung Transplant, 2023, 42(4): S356.
23.	Azeli Y, Barbería E, Fernández A, et al. Chest wall mechanics during mechanical chest compression and its relationship to CPR-related injuries and survival. Resusc Plus, 2022, 10: 100242.
24.	陳海波, 周星彤, 卿平, 等. 左心室輔助裝置植入患者的術前評估與管理. 中國心血管雜志, 2024, 29(1): 1-4.Chen HB, Zhou XT, Qing P, et al. Pre-procedure evaluation and management for patients with left ventricular assist devices implantation. Chin J Cardiovasc Med, 2024, 29(1): 1-4.
25.	Parameshwar J, Hogg R, Rushton S, et al. Patient survival and therapeutic outcome in the UK bridge to transplant left ventricular assist device population. Heart, 2019, 105(4): 291-296.
26.	Yannopoulos D, Bartos J, Raveendran G, et al. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial. Lancet, 2020, 396(10265): 1807-1816.

1. Saeed D, Feldman D, El Banayosy A, et al. The 2023 International Society for Heart and Lung Transplantation guidelines for mechanical circulatory support: a 10-year update. J Heart Lung Transplant, 2023, 42(7): e1-e222.
2. Chaudhry SP, DeVore AD, Vidula H, et al. Left ventricular assist devices: a primer for the general cardiologist. J Am Heart Assoc, 2022, 11(24): e027251.
3. Mehra MR, Uriel N, Naka Y, et al. A fully magnetically levitated left ventricular assist device: final report. N Engl J Med, 2019, 380: 1618-1627.
4. Hollis IB, Jennings DL, Krim S, et al. An ISHLT consensus statement on strategies to prevent and manage hemocompatibility related adverse events in patients with a durable, continuous-flow ventricular assist device. J Heart Lung Transplant, 2024, 43(8): 1199-1234.
5. 中國生物醫學工程學會機械循環支持分會, 中國心室輔助裝置專家共識委員會. 中國左心室輔助裝置植入術后早期重癥監護管理專家共識 (2024年). 中國循環雜志, 2024, 39(8): 729-750.Chinese Society of Biomedical Engineering Mechanical Circulatory Support Branch, Chinese Expert Consensus Committee on Ventricular Assist Devices. Expert consensus on early postoperative intensive care management after left ventricular assist device implantation (2024). Chin Circ J, 2024, 39(8): 729-750.
6. 中國醫師協會心血管內科醫師分會. 左心室輔助裝置植入全程管理專家共識 (2023年). 中國循環雜志, 2023, 38: 1125-1138.Cardiovascular Physicians Branch of Chinese Medical Doctor Association. Expert consensus on whole-course management of left ventricular assist device implantation (2023). Chin Circ J, 2023, 38: 1125-1138.
7. Salewski C, Rustenbach CJ, Marinos SL, et al. Left ventricular assist device (LVAD)-related major adverse events account for a low number of emergency room admissions in HeartMate 3? patients: a 10-year retrospective study. Biomedicines, 2025, 13(7): 1702.
8. Barssoum K, Patel H, Rai D, et al. Outcomes of cardiac arrest and cardiopulmonary resuscitation in patients with left ventricular assist device; an insight from a national inpatient sample. Heart Lung Circ, 2022, 31: 246-254.
9. Saeed O, Jermyn R, Kargoli F, et al. Blood pressure and adverse events during continuous flow left ventricular assist device support. Circ Heart Fail, 2015, 8: 551-556.
10. Akhtar W, Baston VR, Berman M, et al. British societies guideline on the management of emergencies in implantable left ventricular assist device recipients in transplant centres. Intensive Care Med, 2024, 50(4): 493-501.
11. Cao D, Arens AM, Chow SL, et al. Part 10: adult and pediatric special circumstances of resuscitation: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2025, 152(16_suppl_2): S578-S672.
12. Guglin M, Hirsch JR, Tanawuttiwat T, et al. How to diagnose and manage emergency medical conditions in patients on left ventricular assist device support: a clinician's field guide. Trends Cardiovasc Med, 2025, 35(3): 186-194.
13. 國家心血管病專家委員會護理專業委員會, 馬艷, 吳榮, 等. 左心室輔助裝置植入患者術后護理專家共識. 中華護理雜志, 2024, 59(14): 1687-1690.Nursing Professional Committee of the National Cardiovascular Disease Expert Committee, Ma Y, Wu R, et al. Expert consensus on postoperative care of patients with a left ventricular assistant device. Chin J Nurs, 2024, 59(14): 1687-1690.
14. 賈莉, 黃珈雯, 孫力. 左心室輔助裝置植入圍術期藥學監護專家共識. 今日藥學, 2025. [Epub ahead of print].Epub ahead of print Jia L, Huang JW, Sun L. Expert consensus on perioperative pharmaceutical monitoring for left ventricular assist device implantation. Pharm Today, 2025. [Epub ahead of print].
15. Givertz MM, DeFilippis EM, Colvin M, et al. HFSA/SAEM/ISHLT clinical expert consensus document on the emergency management of patients with ventricular assist devices. J Card Fail, 25(7): 494-515.
16. Akhtar W, Gamble B, Kiff K, et al. Mechanical life support algorithm developed by simulation for inpatient emergency management of recipients of implantable left ventricular assist devices. Resusc Plus, 2022, 10: 100254.
17. Lankheet S, Pieterse MM, Rijnhout R, et al. Validity and success rate of noninvasive mean arterial blood pressure measurements in cf-LVAD patients: a technical review. Artif Organs, 2022, 46(12): 2361-2370.
18. Ogami T, Naka Y, Sanchez J, et al. Incidence and cause of persistent low flow alarm after HeartMate 3 left ventricular assist device insertion. J Heart Lung Transplant, 2020, 39(4): S404.
19. Ben Avraham B, Crespo-Leiro MG, Filippatos G, et al. HFA of the ESC position paper on the management of LVAD supported patients for the non LVAD specialist physician: executive summary. ESC Heart Fail, 2021, 8(6): 4394-4408.
20. Bernhardt AM, Copeland H, Deswal A, et al. The International Society for Heart and Lung Transplantation/Heart Failure Society of America guideline on acute mechanical circulatory support. J Heart Lung Transplant, 2023, 42(12): 1770.
21. Ahsan I, Faraz A, Mehmood A, et al. Clinical approach to manage gastrointestinal bleeding with a left ventricular assist device (LVAD). Cureus, 2019, 11(12): e6341.
22. Theeuwes C, Frost M, Vierecke J. Prolonged cardiopulmonary resuscitation with Lucas device in a patient with left ventricular assist device. J Heart Lung Transplant, 2023, 42(4): S356.
23. Azeli Y, Barbería E, Fernández A, et al. Chest wall mechanics during mechanical chest compression and its relationship to CPR-related injuries and survival. Resusc Plus, 2022, 10: 100242.
24. 陳海波, 周星彤, 卿平, 等. 左心室輔助裝置植入患者的術前評估與管理. 中國心血管雜志, 2024, 29(1): 1-4.Chen HB, Zhou XT, Qing P, et al. Pre-procedure evaluation and management for patients with left ventricular assist devices implantation. Chin J Cardiovasc Med, 2024, 29(1): 1-4.
25. Parameshwar J, Hogg R, Rushton S, et al. Patient survival and therapeutic outcome in the UK bridge to transplant left ventricular assist device population. Heart, 2019, 105(4): 291-296.
26. Yannopoulos D, Bartos J, Raveendran G, et al. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial. Lancet, 2020, 396(10265): 1807-1816.

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