Resuscitation of Patients with Durable Mechanical Circulatory Support and Acutely Altered Perfusion or Cardiac Arrest

Red Cross Guidelines

For patients with durable mechanical circulatory support devices who develop acutely impaired perfusion because of cardiac arrest and who are not in the immediate peri-device implantation period, consider providing chest compressions. (Good practice statement) REAFFIRMED
For patients with durable mechanical circulatory support devices who develop acutely impaired perfusion because of cardiac arrest, it is reasonable to minimize delays in initiating chest compressions by simultaneously assessing for device-related reversible causes of acutely impaired perfusion. (Good practice statement) REAFFIRMED
An algorithmic approach is recommended to concurrently assess and respond to acutely impaired perfusion in patients receiving durable mechanical circulatory support. REAFFIRMED

Insights

Mechanical circulatory support devices, including left ventricular assist devices (LVADs) and biventricular assist devices (BiVADs), have become indispensable in managing advanced heart failure by mechanically augmenting or replacing the heart’s pumping function, restoring systemic circulation and thereby improving end-organ perfusion. Patients with continuous-flow LVADs, however, do not have native heartbeats or pulses, complicating traditional assessments of perfusion and blood pressure and making identification of acutely altered perfusion and cardiac arrest challenging. This can lead to delays in the initiation of chest compressions and contribute to poor outcomes. In some cases, chest compressions are delayed due to the false belief that chest compressions are contraindicated in patients with LVADs. Chest compressions in patients with a mechanical circulatory device have not been reported to dislodge the device or alter device function.