Title : Safety and outcomes of cardiopulmonary resuscitation in patients with left ventricular assist devices
Abstract:
Annually, approximately 2,500 – 3000 patients in the United States receive left ventricular assist devices (LVADs), making it increasingly likely that healthcare providers and EMS will encounter cardiac emergencies in this population. Cardiopulmonary resuscitation (CPR) in LVAD patients remains controversial due to concerns about device dislodgement, bleeding, and uncertain perfusion outcomes. Despite guidelines supporting the use of chest compressions in specific circumstances, clinical evidence remains limited, although documented cases of successful resuscitation using chest compressions exist. Our research seeks to review the existing literature on the use of CPR, including manual chest compressions and automated systems such as the Lund University Cardiopulmonary Assist System (LUCAS), during cardiac arrest with the goal of evaluating hemodynamic and neurological outcomes of patients as well as device functionality post-arrest. Results of this research will serve to provide insights into best practices while identifying gaps in knowledge to guide future research and clinical care.
A systematic search of PubMed, EMBASE, MEDLINE, and Google Scholar identified studies evaluating CPR in adult LVAD patients. Case reports, case series, and retrospective reviews meeting inclusion criteria were analyzed with a total of 37 individual cases included.
The survival rate to hospital discharge (54%) for LVAD patients experiencing cardiac arrest with chest compressions was found to be notably higher than the general population. 55% of LVAD patients who survived cardiac arrest exhibited adequate neurological function upon discharge, consistent with neurological outcome rates in the general population of cardiac arrest survivors. No cases reported LVAD malfunction or dislodgement attributable to CPR, whether manual, LUCAS-assisted, or abdominal-only. Normal LVAD functionality post-cardiac arrest was documented in 34 patients (92%).
This systematic review supports the safety of chest compressions in LVAD patients during cardiac arrest, aligning with current American Heart Association and International Society for Heart and Lung Transplantation guidelines. Survival and neurological outcomes are promising, though limited by small sample size and inconsistent reporting. Further prospective studies are warranted to refine CPR protocols and optimize resuscitation strategies for this unique patient population.
