Management of suspected cardiac arrest in a sedated or anesthetized patient with an LVAD

This figure summarizes our suggested approach to emergency management of suspected cardiac arrest in a monitored patient with an LVAD who is sedated or anesthetized. Signs include severe hypotension or unobtainable pulse, ECG evidence of a nonperfusing rhythm (VT, VF, severe bradycardia, asystole), rapidly decreasing or unobtainable O₂ saturation, or rapidly decreasing or low (≤10 mmHg) ETCO₂. In all cases, the LVAD team should be contacted immediately.

• LVADs provide nonpulsatile blood flow; thus, accurate assessment of presence of a pulse, BP, and O₂ saturation are difficult
• LVAD dysfunction is a possible cause of cardiac arrest, in addition to typical patient-related causes

This algorithm is intended for use in conjunction with additional UpToDate content on causes and recognition of intraoperative cardiac arrest, BLS and ACLS protocols, and management of patients with mechanical circulatory assist devices.