Medic Basics

Devices

Unresponsive Patient With an LVAD Algorithm

Assess perfusion before compressions

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

Each step lists what to do, then the choices that lead on. In the app the algorithm is tapped through one decision at a time.

1 Assess airway, breathing and perfusion

  • No pulse is expected: use skin color, capillary refill, mentation, Doppler MAP and EtCO₂
  • Listen over the chest for the pump hum; check the controller and power

Perfusing (MAP over 50, EtCO₂ over 20) → step 2Not perfusing → step 3

2 Perfusing: find the cause of unresponsiveness

  • Stroke (bleeding risk on anticoagulation), hypoglycemia, overdose, arrhythmia
  • Call the VAD team; bring the backup controller and batteries

End of this path.

3 Restart the pump

  • Check power cable and driveline connections; change batteries
  • Swap to the backup controller if the controller has failed

Pump restarts and perfusion returns → step 2Still not perfusing → step 4

4 Start chest compressions

  • Compressions are recommended when the pump cannot be restarted and perfusion is absent (AHA 2017); dislodgement risk is low
  • Defibrillate shockable rhythms without disconnecting the pump
  • Call the VAD team

End of this path.

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