Can You Do CPR on an LVAD Patient? What You Need to Know

CPR can be performed on an LVAD patient, but it needs some precautions. But here is something you can do: understand LVAD emergency care in advance so you can act appropriately or take the necessary action in an emergency. Let’s start with a scenario of a caregiver for someone with a ventricular assist device, and suddenly, they become unconscious. The first thing that comes to your mind is to perform CPR. But then you start hesitating by thinking if chest compression damages the LVAD device inside the heart, or can I even perform the CPR on them in the first place? This can be a moment of anxiety for a caregiver or the first responder. 

In this guide, we will talk about the CPR on an LVAD patient, so you must know everything you need to know.

What is an LVAD, and how does it work?

A Left Ventricular Assist Device (LVAD) is a mechanical heart pump surgically implanted in patients with Heart Failure. It helps the heart to pump blood and supply it throughout the body when the heart can no longer do it effectively on its own. 

The LVAD device consists of an internal LVAD pump implanted in the heart and the external components, including the controller and batteries. The driveline connects the internal pump to the external components. LVAD patients whose hearts fail to pump blood benefit from this device, as it restores blood flow to the body. 

Modern LVAD types include HeartMate, which uses continuous-flow technology. It means blood moves in a steady stream rather than in pulses. This is important to understand because this affects how we assess and respond to emergencies in patients with an LVAD device.

What does CPR do?

Cardiopulmonary resuscitation (CPR) is an emergency procedure that involves chest compression and rescue breath. When the heart stops beating effectively, this procedure is performed manually to circulate oxygenated blood. Compression physically squeezes the heart between the sternum and spine, which pushes blood to the brain and other vital organs.

CPR extends the critical time until advanced medical help arrives. But for LVAD patients, it should be performed with unique steps. Most of the time, it should be applied with proper guidance and learning. 

Can you perform CPR on an LVAD patient?

Yes, you can perform CPR on an LVAD patient, but with some important limitations. 

Many of you might think that LVAD patients need CPR, but do you know that not performing it on an LVAD patient can be just as dangerous as performing it incorrectly? Because the device is implanted in the chest cavity, conventional steps of CPR carry some risks that don’t apply to the general population.

The key principle approved by the medical professionals includes: If the patient is pulseless, unresponsive, and not breathing, and you know that LVAD is not functioning, then you can perform CPR on such patients.

Signs of a Medical Emergency in an LVAD Patient

Recognizing an LVAD emergency early can prevent it from progressing into full cardiac arrest. Here are some of the signs that you should be aware of:

• Alarms from the LVAD controller: Alarm sounds like beeping or visual alerts indicate that there is a problem, such as a power failure, low blood flow, or any other device malfunction. 

• Loss of consciousness or confusion: When the mental status changes immediately, it could be a sign of low blood supply to the brain.

• Dizziness, fainting, or extreme fatigue: If you feel any of these signs, then it indicates that the device is not supplying blood according to the body's demand.

• Skin Color Changes: Pale or grayish skin is a visual sign of compromised blood supply.

• Driveline site issues: Redness, swelling, or disconnection at the driveline site is alarming.

• No audible hum from the device: A functioning LVAD usually produces a faint, steady hum. So, complete silence may indicate pump failure

Because LVAD patients live without a normal pulse, standard pulse checks are unreliable. The absence of a wrist or neck pulse does not automatically mean the patient is in cardiac arrest — the device may simply be maintaining continuous flow. This is one of the most critical points in the caregiver guide for LVAD patients’ education.

When should CPR be started on an LVAD patient?

CPR should be started when all of the following conditions are present:

1. The patient is not responsive to touch or your voice

2. The patient’s breathing is compromised and is not normal

3. The LVAD device is not working or showing any of the signs discussed above.

How to Assess an LVAD Patient before CPR

Before starting chest compressions, make a quick assessment of the patient that may take 30 to 60 seconds. Here are some of the important steps: 

Checking the LVAD Controller: Look at the controller display. A functioning controller typically shows a green light and stable flow readings. Red lights, alarming sounds, or a blank screen suggest device failure.

Looking for Driveline Disconnection: The driveline or the cable running from the pump to the external controller should be connected at all times. A disconnected or visibly damaged driveline is a medical emergency that requires immediate attention.

Evaluating Skin Color and Mental Status: Evaluate the skin color and check for the patient’s mental status. A patient who is confused but responding may have a low blood supply rather than cardiac arrest.

Mean Arterial Pressure (MAP) Considerations: Standard blood pressure cuffs often cannot detect systolic and diastolic readings in continuous-flow LVAD patients. Instead, clinicians use a Doppler ultrasound to measure Mean Arterial Pressure. A MAP below 50 mmHg is dangerously low perfusion.

CPR Guidelines for LVAD Patients

The American Heart Association (AHA) acknowledges that traditional BLS or Basic Life Support protocols need modification for LVAD patients. Their guidelines recommend that:

• You should try to restore LVAD functioning before starting chest compression when the device is the likely cause of hemodynamic compromise.

• Start CPR if the device is not working and the patient meets the criteria of cardiac arrest

• Make sure that the caregivers and first responders for LVAD patients are trained for device assessment and LVAD emergency care.

Steps to Take During LVAD Emergency

In case of emergency, you should take these steps to receive the right medical attention on time:

Call Emergency Medical Services Immediately

Do not delay calling 911 (or your local emergency number) at the first sign of a serious problem. Inform them that the patient has an LVAD so the responding team can prepare appropriately.

Contact the LVAD Coordinator

Every LVAD patient is assigned a coordinator through their implanting center. This person provides real-time guidance over the phone during emergencies. Their number should be stored in the patient's LVAD Heartmate bag to make it accessible quickly.

Check Power Supply and Connections

Many LVAD emergencies are very simple to resolve, as they may involve something as simple as a depleted battery or a loose connection. Look for both batteries in the LVAD vest battery pockets and check the connection of the drivelines and the controller. 

Assess Breathing and Responsiveness

Speak loudly to the patient, tap their shoulders firmly, and look for chest rise. If there is no response and no normal breathing, your patient may be experiencing cardiac arrest.

Begin CPR if Recommended by Medical Guidance

If your LVAD coordinator confirms that CPR should be given, then you need to follow his instructions. Start chest compression, and place your hands slightly above the standard place to avoid damage to the LVAD pump inside the heart.

Why CPR on LVAD Patients Can Be Complicated?

Here are some of the reasons why CPR on an LVAD patient is different and is associated with some risks and complications:

• The LVAD pump is implanted in the left ventricle, and compression can cause some damage to it. The surgical connection between the pump and the heart tissue can get disrupted.

• Chest compression can also worsen the position of an already displaced driveline.

• Many LVAD patients are on medications to keep the blood thin to prevent clot formation in the pump. It increases the chances of internal bleeding.

• The standard method of checking pulse does not work on LVAD patients due to continuous blood flow, so caregivers must not confuse things with the absence of pulse.

• You will need special equipment to monitor blood pressure, as standard BP cuffs are not reliable in such conditions.

Final Thoughts

Performing CPR on an LVAD patient is possible, but it requires careful attention and understanding of their specific needs. It is essential to recognize the signs of an emergency and know when to take action. Always check the LVAD controller and look for any issues with the driveline before starting CPR. Caregivers and first responders should know about the care for LVAD patients to help them effectively in case of emergencies. 

FAQs

Can anyone perform CPR on an LVAD patient?

If the patient is unconscious and the device is not working, you can perform CPR, but always call 911 first to reach the LVAD coordinator for guidance.

Will CPR break or ruin the LVAD?

Compressions come with the risk of device damage, but if the patient is showing clear signs of cardiac arrest, CPR is the appropriate response, and you may need to perform this.

How do I know if an LVAD is working?

A functioning LVAD produces a hum sound and shows readings on the controller of stable flow. So, if you are dealing with a device that is completely silent or beeping an alarm, it might indicate that the device is not working properly.