Advanced cardiovascular life support algorithm for the management of the hospitalized unresponsive patient on continuous flow left ventricular assist device support outside the intensive care unit.
Over the past decade, continuous flow left ventricular assist devices (CF-LVADs) have become the mainstay of therapy for end stage heart failure. While the number of patients on support is exponentially growing, at present there are no American Heart Association or European Society of Cardiology Advanced Cardiovascular Life Support guidelines for the management of this unique patient population. We propose an algorithm for the hospitalized unresponsive CF-LVAD patient outside of the intensive care unit setting. Key elements of this algorithm are: creation of a dedicated LVAD code pager and LVAD code team; early assessment and correction of LVAD malfunction; early determination of blood flow using Doppler technique in carotid and femoral arteries; prompt administration of external chest compressions in the absence of Doppler flow; bedside veno-arterial extracorporeal membranous oxygenation support if no response to resuscitation measures; and early consideration for stroke.
New York Presbyterian Hospital, Columbia University, New York, USA my2249@cumc.columbia.edu.
Melana
M
Yuzefpolskaya
New York Presbyterian Hospital, Columbia University, New York, USA.
Nir
N
Uriel
New York Presbyterian Hospital, Columbia University, New York, USA.
Margaret
M
Flannery
New York Presbyterian Hospital, Columbia University, New York, USA.
Natalie
N
Yip
New York Presbyterian Hospital, Columbia University, New York, USA.
Kanika
K
Mody
New York Presbyterian Hospital, Columbia University, New York, USA.
Barbara
B
Cagliostro
New York Presbyterian Hospital, Columbia University, New York, USA.
Hiroo
H
Takayama
New York Presbyterian Hospital, Columbia University, New York, USA.
Yoshifumi
Y
Naka
New York Presbyterian Hospital, Columbia University, New York, USA.
Ulrich P
UP
Jorde
New York Presbyterian Hospital, Columbia University, New York, USA.
Sumeet
S
Goswami
New York Presbyterian Hospital, Columbia University, New York, USA.
Paolo C
PC
Colombo
D022561:Advanced Cardiac Life Support / Q000295:instrumentation*; D000465:Algorithms; D019468:Disease Management; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D007362:Intensive Care Units
Left ventricular assist devices; advanced cardiovascular life support; heart failure