title: Is a palpable pulse always restored during cardiopulmonary resuscitation in a patient with a left ventricular assist device?
abstract: 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.
authors: Divisions of Cardiovascular Medicine (NAH, KS, MK, CG, DL) and Cardiothoracic Surgery (SM), Vanderbilt University Medical Center, Nashville, Tennessee; and VA-GRECC (Geriatric Research Education Clinical Center) (EWE), VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Nicholas A
authors: NA
authors: Haglund
authors: Kelly
authors: K
authors: Schlendorf
authors: Mary
authors: M
authors: Keebler
authors: Charu
authors: C
authors: Gupta
authors: Simon
authors: S
authors: Maltais
authors: E Wesley
authors: EW
authors: Ely
authors: Daniel
authors: D
authors: Lenihan
mesh_terms: D000328:Adult; D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000628:therapy; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D003693:Delirium / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006323:Heart Arrest / Q000628:therapy; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D006353:Heart-Assist Devices / Q000009:adverse effects* / Q000523:psychology; D006439:Hemodynamics; D006801:Humans; D008297:Male