Abstract
Purpose Current ACLS guidelines do not include any specific recommendation for pts on CF- LVAD support. Inability to assess blood pressure with routine sphygmomanometer and possible LVAD damage by CPR, make emergent medical assessment and management particularly challenging in this patient population. We propose an algorithm for Advanced Life Support in hospitalized unresponsive LVAD patients. Methods and Materials Key elements of this algorithm are: i) an “LVAD code” which is different from a regular emergency response system by not only alerting the code team, but also LVAD NP/RN, cardiothoracic surgery and cardiac fellows to arrive promptly on the scene; ii) emergent echocardiography; iii) prompt assessment of LVAD function; ii) early consideration for stroke as cause of unresponsiveness due to the high incidence of thromboembolism in this patient population; iv) importance of assessing blood flow using Doppler technique in carotid and femoral artery; v) recommendation for CPR only in the absence of blood flow; vi) consideration for bedside VA-ECMO if no response to resuscitation measures. [ figure 1 ] Results Figure Conclusions We propose a new algorithm for emergent care of unresponsive hospitalized LVAD patients.
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