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Technological advances in both electrical and mechanical cardiac support devices mean that more people are living with them, including people in their homes. Thus, familiarity by EMS clinicians is important to effect optional care and safe transport.

Critical patients who are being supported by IABPs, ECMO, or nonportable VADs require special attention by expert teams when they must be transferred from one facility to another. Among the team members must be a specialist in managing the support device. Planning is key to moving patients safely and effectively.

EMS clinicians are likely to encounter patients with portable VADs, even if infrequently. Ideally, they would know of such patients in their communities before they are summoned for an emergency condition. In any case, they should be able to rapidly identify the presence of a VAD and the need for determination of whether or not pulsatile flow is expected. Patients with VAD‐related problems often require fluid resuscitation, unless the issue is a rare pump failure or power failure. In those cases, the dedicated hand pump should be used to restore blood flow or CPR initiated if the VAD has no hand pump. For problems not immediately indicating a VAD malfunction, such as stroke or GI bleeding, the patient should be treated as he or she would be in the absence of the VAD. It is prudent to attempt to get the patient to the hospital where the VAD was placed if feasible and appropriate.

EMS clinicians should be aware when their patient has a pacemaker or ICD. If the patient’s problem relates to a cardiac dysrhythmia, it is important to assess the ICD or pacemaker function. With a magnet, function can be suspended if it is emitting inappropriate, excessive electrical impulses or shocks.

EMS physicians should be capable of performing pericardiocentesis. Although ultrasound may be a helpful adjunct, the procedure can done using anatomical landmarks.