title: In-hospital cardiopulmonary arrests in patients with left ventricular assist devices.
abstract: Background: Basic and advanced cardiac life support guidelines do not address resuscitation of patients with continuous-flow (CF) left ventricular assist devices (LVADs). As the population of LVAD patients increases, it becomes important to understand how to provide emergency care to such patients.
  
  
  RESULTS
  We retrospectively reviewed a consecutive series of patients with an implanted CF-LVAD who had an in-hospital cardiopulmonary arrest at our medical center from January 2011 to October 2013. We compared them with a matched cohort of patients without LVADs who had an inhospital cardiopulmonary arrest during the same time period. Code documentation was used to determine arrest characteristics, perfusion assessment techniques, and time to cardiopulmonary resuscitation (CPR) initiation. There were 415 in-hospital arrests during the study period, and 4% (n 5 16) occurred in patients with CF-LVADs. Response teams used various approaches to assess arterial perfusion, including palpation or Doppler of the arterial pulse and measurement of blood pressure by Doppler or arterial line. Nine of the 16 patients required CPR, but only 5 (56%) received CPR in !2 minutes. In the control group (n 5 32) of patients without an LVAD, 22 received CPR, which was initiated within 2 minutes in all (100%) of the patients.
  
  
  CONCLUSIONS
  Cardiopulmonary arrests in LVAD patients accounted for 4% of all arrests in our center. We identified important time delays in CPR initiation, highlighting the need to develop resuscitation guidelines for this patient population.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Garg
authors.forename: Colby R
authors.initials: CR
authors.lastname: Ayers
authors.forename: Catherine
authors.initials: C
authors.lastname: Fitzsimmons
authors.forename: Dan
authors.initials: D
authors.lastname: Meyer
authors.forename: Matthias
authors.initials: M
authors.lastname: Peltz
authors.forename: Brian
authors.initials: B
authors.lastname: Bethea
authors.forename: William
authors.initials: W
authors.lastname: Cornwell
authors.forename: Faris
authors.initials: F
authors.lastname: Araj
authors.forename: Jennifer
authors.initials: J
authors.lastname: Thibodeau
authors.forename: Mark H
authors.initials: MH
authors.lastname: Drazner
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality; D016022:Case-Control Studies; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D006333:Heart Failure / Q000401:mortality / Q000601:surgery; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis