Is a palpable pulse always restored during cardiopulmonary resuscitation in a patient with a left ventricular assist device?

Haglund NA, Schlendorf K, Keebler M, Gupta C, Maltais S, Ely EW, Lenihan D
Am J Med Sci. 2014 347 (4): 322-7

PMID: 24508865 · DOI:10.1097/MAJ.0000000000000219

End-stage heart failure patients are being supported with continuous flow left ventricular assist devices (CF-LVAD) in increasing numbers. The severe physiologic and pharmacologic derangements associated with end-stage heart failure therapies predispose these patients to delirium. During a delirious episode, a patient may inadvertently disconnect CF-LVAD equipment, which may have dangerous consequences. Unfortunately, it is not yet routine to use readily available clinical monitoring tools to allow early detection of delirium in this high-risk population. The authors present a case of acute hyperactive delirium leading to pump power disconnection and cardiopulmonary arrest occurring 7 days after CF-LVAD implantation. The case highlights the need for delirium awareness in the cardiovascular intensive care unit and the unique challenges associated with resuscitation of CF-LVAD patients. The authors propose that cardiovascular intensive care unit patients undergo at least twice daily delirium monitoring and provide a novel resuscitation algorithm for patients who have CF-LVADs.

MeSH Terms (11)

Adult Algorithms Arrhythmias, Cardiac Cardiopulmonary Resuscitation Delirium Heart-Assist Devices Heart Arrest Heart Failure Hemodynamics Humans Male

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