Abstract
Mechanical circulatory support (MCS) for patients with advanced heart failure (HF) is becoming more commonplace as technology has progressed and reliability of these systems has improved. We report our experience with three patients with cardiopulmonary arrest in the hospital and propose a protocol for the prompt assessment and treatment of an unresponsive patient with a LVAD in place. We presented three cases of unresponsive patients on LVAD support with low flow or no flow through the LVAD. Although all three of them were alive after resuscitation, none survived to discharge. In all three cases, there were no flaws in LVAD per se, with power source and controller appropriately attached, and the pump functioning normally. The low flow state was secondary to non-cardiac conditions (respiratory acidosis, dehydration, and stroke). In early 2017 we developed our algorithm for unresponsive LVAD patients. Utilization of LVAD flow, which can be obtained quickly and non-invasively at the bedside of a patient is used to direct resuscitation efforts in this proposed protocol. Rapid and standardized protocol for resuscitation of LVAD patients with in-hospital cardiopulmonary arrest is necessary to decrease morbidity and mortality. Further investigation regarding the best practice in this clinical scenario is evolving and further studies are needed.
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