CPR for People with Mechanical Circulatory Support

August 2, 2017

CPR for People with Mechanical Circulatory Support

  1. Mark S. Link, MD

A Scientific Statement clarifies diagnosis and support of patients with these devices.

  1. Mark S. Link, MD

This American Heart Association Scientific Statement is the first ever to focus on cardiopulmonary resuscitation (CPR) in patients with ventricular assist devices (VADs) and other methods of mechanical support.

Sponsoring Organization: American Heart Association

Target Audience: Clinicians providing care to patients on mechanical support.

Background

Mechanical support devices, such as VADs for left, right, and both ventricles (LVADs, RVADs, and BiVADs), are increasingly used in medicine, both as bridges to transplantation and as destination devices. Caring for patients with these devices who experience cardiopulmonary arrest involves special considerations.

Key Points

  • Most current mechanical support devices are continuous-flow; thus, a palpable pulse will be absent.

  • Blood pressure

    • Automated blood pressure (BP) cuffs accurately assess BPs only in approximately 50% of patients.

    • In most cases where a BP is present, a manual sphygmomanometer and a Doppler ultrasound probe can measure it.

  • The two most common causes of VAD pump failures are disconnection of the power and failure of the driveline.

    • The critical workup in an unresponsive patient with a VAD is to check the power supply and the connections.

    • Patients should be transported with their backup power supplies because the receiving hospitals may lack that equipment.

  • Echocardiography is a valuable tool for evaluation of VAD performance.

  • Patients with mechanical devices who experience out-of-hospital arrest with a mean arterial pressure <50 mm Hg (roughly the BP to maintain consciousness) should receive CPR.

  • Patients with mechanical devices in ventricular tachycardia or ventricular fibrillation may still have a perfusing rhythm and be conscious; these patients should not receive CPR.

  • Patients with total artificial hearts do not respond to CPR and should not receive medications or CPR.

Comment

Mechanical devices are increasing in prevalence, and patients with these devices are living at home. The decision to resuscitate these patients involves unique considerations. For example, two common etiologies of cardiopulmonary arrest in these patients are interruptions in the power supply and drive train failure.

Dr. Link was a member of the writing committee for this Scientific Statement.

Editor Disclosures at Time of Publication

  • Disclosures for Mark S. Link, MD at time of publication Editorial boards UpToDate; Heart Rhythm; Circulation; EP Lab Digest Leadership positions in professional societies Heart Rhythm Society (Chair, CME Compliance Committee); American Heart Association (Chair, ACLS Writing Group; Member, Emergency Cardiovascular Care)

Citation(s):

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.