Outcomes of Cardiac Arrest and Cardiopulmonary Resuscitation in Patients With Left Ventricular Assist Device; an Insight From a National Inpatient Sample

Barssoum, Kirolos; Patel, Harsh; Rai, Devesh; Kumar, Ashish; Hassib, Mohab; Othman, Hasan F.; Thakkar, Samarthkumar; Karyoni, Ahmed El; Idemudia, Osarenren; Ibrahim, Fadi; Salem, Tala; Shariff, Mariam; Jabri, Ahmad; Elbadawi, Ayman; Khodjaev, Soidjon; Bandyopadhyay, Dhrubajyoti; Aronow, Wilbert S.; Parikh, Vishal; Rao, Mohan; Park, Soon

doi:10.1016/j.hlc.2021.05.096

Cited by 6 publications

(7 citation statements)

References 20 publications

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“…This resulted in a trend toward fewer CPR performances toward the end of this period. Additionally, age, female sex, peripheral vascular disease, history of CABG, and ventricular tachycardia were independently associated with in-hospital mortality [45]. Regarding life-threatening LVAD complications, the MOMENTUM 3 trial showed fewer strokes, major bleedings, and reoperations to replace or remove a malfunctioning device as well as lower mortality for third generation centrifugal continuous-flow pumps than second generation axial continuousflow devices [46].…”

Section: Long-term Resultsmentioning

confidence: 99%

Common Complications and Cardiopulmonary Resuscitation in Patients with Left Ventricular Assist Devices: A Narrative Review

Zaloznik Djordjevic,

Özkan,

Göncz

et al. 2023

Medicina

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Heart failure remains a major global burden regarding patients’ morbidity and mortality and health system organization, logistics, and costs. Despite continual advances in pharmacological and resynchronization device therapy, it is currently well accepted that heart transplantation and mechanical circulatory support represent a cornerstone in the management of advanced forms of this disease, with the latter becoming an increasingly accepted treatment modality due to the ongoing shortage of available donor hearts in an ever-increasing pool of patients. Mechanical circulatory support strategies have seen tremendous advances in recent years, especially in terms of pump technology improvements, indication for use, surgical techniques for device implantation, exchange and explantation, and postoperative patient management, but not in the field of treatment of critically ill patients and those undergoing cardiac arrest. This contemporary review aims to summarize the collected knowledge of this topic with an emphasis on complications in patients with left ventricular assist devices, their treatment, and establishing a clear-cut algorithm and the latest recommendations regarding out-of-hospital or emergency department management of cardiac arrest in this patient population.

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Section: Long-term Resultsmentioning

confidence: 99%

Common Complications and Cardiopulmonary Resuscitation in Patients with Left Ventricular Assist Devices: A Narrative Review

Zaloznik Djordjevic,

Özkan,

Göncz

et al. 2023

Medicina

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“…But the authors advise that this finding must be interpreted with caution since the two groups differed based on several variables that were independent risk factors for mortality. Of note, the authors also reported a declining rate of utilization of chest compressions over the time period studied, and this was hypothesized to be due to increasing uncertainty regarding the safety and efficacy of chest compressions in the VAD population ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

Chest Compressions in Pediatric Patients With Continuous-Flow Ventricular Assist Devices: Case Series and Proposed Algorithm

Esangbedo

Yu²

2022

Front. Pediatr.

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Patients with continuous flow ventricular assist devices (CF-VAD's) in the systemic ventricle (left ventricle or single ventricle) often have no palpable pulses, unreliable pulse oximetry waveforms and non-pulsatile arterial waveforms despite hemodynamic stability. When circulatory decompensation occurs, standard indicators to begin cardiopulmonary resuscitation (CPR) which are used in other pediatric patients (i.e., significant bradycardia or loss of pulse) cannot be applied in the same fashion. In this population, there may already be pulselessness and development of bradycardia in and of itself would not trigger chest compressions. There are no universal guidelines to dictate when to consider chest compressions in this population. As such, there may be a delay in decision-making or in recognizing the need for chest compressions, even in patients hospitalized in intensive care units (ICU) and cared for by experienced staff who perform CPR regularly. We present four examples of pediatric cardiac ICU patients from a single center who underwent CPR between 2018 and 2019. Based on this case series, we propose a decision-making algorithm for chest compressions in pediatric patients with CF-VADs in the systemic ventricle.

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“…There are surgical concerns around a risk of anastomotic rupture during chest compressions as the LVAD outflow graft lies in close proximity to the sternum. However, the limited evidence available suggests this risk may have been overestimated particularly in the late post-operative phase [ 6 – 8 ]. The dominant issue is the fact that contemporary rotary LVADs have a non-occlusive (valve-less) blood path.…”

Section: Uk Lvad Emergency Algorithm Developmentmentioning

confidence: 99%

“…Importantly patients with LVADs who require CPR have a very poor outcomes [ 6 ] which raises ethical questions around whether management should focus allowing death with dignity rather than administering extreme interventions. These are considerations that should be discussed with patients when they are well enough to consider their wishes and should be written into advanced care and treatment escalation plans.…”

Section: Uk Lvad Emergency Algorithm Developmentmentioning

confidence: 99%

“…As recently as 2017, after one year of LVAD therapy, 93% of patients had an adverse clinical event including issues with haemocompatibility related adverse events, infection, right ventricular failure and aortic regurgitation [ 5 ]. When cardiac arrest occurs in LVAD recipients, the mortality rate is over 60% [ 6 ]. The combination of a lack of reliable clinical signs and high risk of complications makes LVAD recipients very vulnerable, particularly if the need for resuscitation arises.…”

Section: Introductionmentioning

confidence: 99%

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British societies guideline on the management of emergencies in implantable left ventricular assist device recipients in transplant centres

Akhtar,

Baston,

Berman

et al. 2024

Intensive Care Med

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An implantable left ventricular assist device (LVAD) is indicated as a bridge to transplantation or recovery in the United Kingdom (UK). The mechanism of action of the LVAD results in a unique state of haemodynamic stability with diminished arterial pulsatility. The clinical assessment of an LVAD recipient can be challenging because non-invasive blood pressure, pulse and oxygen saturation measurements may be hard to obtain. As a result of this unusual situation and complex interplay between the device and the native circulation, resuscitation of LVAD recipients requires bespoke guidelines. Through collaboration with key UK stakeholders, we assessed the current evidence base and developed guidelines for the recognition of clinical deterioration, inadequate circulation and time-critical interventions. Such guidelines, intended for use in transplant centres, are designed to be deployed by those providing immediate care of LVAD patients under conditions of precipitous clinical deterioration. In summary, the Joint British Societies and Transplant Centres LVAD Working Group present the UK guideline on management of emergencies in implantable LVAD recipients for use in advanced heart failure centres. These recommendations have been made with a UK resuscitation focus but are widely applicable to professionals regularly managing patients with implantable LVADs. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-024-07382-y.

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Outcomes of Cardiac Arrest and Cardiopulmonary Resuscitation in Patients With Left Ventricular Assist Device; an Insight From a National Inpatient Sample

Cited by 6 publications

References 20 publications

Common Complications and Cardiopulmonary Resuscitation in Patients with Left Ventricular Assist Devices: A Narrative Review

Common Complications and Cardiopulmonary Resuscitation in Patients with Left Ventricular Assist Devices: A Narrative Review

Chest Compressions in Pediatric Patients With Continuous-Flow Ventricular Assist Devices: Case Series and Proposed Algorithm

British societies guideline on the management of emergencies in implantable left ventricular assist device recipients in transplant centres

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