Approach to an unresponsive patient with a left ventricular assist device

In most patients with an LVAD who are unresponsive or suspected of cardiac arrest, ACLS protocols should proceed without significant alteration. In patients who were recently implanted with an LVAD and are located in the hospital, CALS may be appropriate. An alternative approach that places an emphasis on the presence of an LVAD hum and restarting the device is endorsed by the American Heart Association.^[1]

LVAD: left ventricular assist device; ACLS: advanced cardiac life support; MAP: mean arterial pressure; CALS: cardiac surgery advanced life support.

* The MAP or "opening" pressure is the pressure at which sound is first noted by a handheld Doppler or auscultation while deflating a blood pressure cuff over the brachial artery. Further information on measurement of blood pressure in this scenario can be found in UpToDate topics on the management of patients with an LVAD.

¶ Under normal conditions, most patients with an LVAD do not have a palpable central or peripheral pulse.

Δ Each LVAD has 2 battery cables and a driveline that plug into the controller. In emergency scenarios, check to ensure that cables are fully plugged into the controller. Ensure that all other connections (eg, housings between cables and batteries) are tightly screwed or secured.

Reference:

Peberdy MA, Gluck JA, Ornato JP, et al. Cardiopulmonary resuscitation in adults and children with mechanical circulatory support: A scientific statement from the American Heart Association. Circulation 2017; 135:e1115.

Graphic 141496 Version 1.0

خرید پکیج

Approach to an unresponsive patient with a left ventricular assist device