CPR for People with Mechanical Circulatory Support

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.

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.