Cardiopulmonary Resuscitation in Patients With Left Ventricular Assist Devices

n a bustling emergency room, a 62-year-old man with a HeartMate 3 (Abbott Cardiovascular) left ventricular assist device (LVAD) suddenly collapses, and a loud, continuous alarm sounds. The patient, who received an LVAD as lifelong therapy for end-stage heart failure (HF) 6 months earlier, was brought in by his family due to complaints of dizziness and shortness of breath. As the medical team rushes to initiate cardiopulmonary resuscitation (CPR), they quickly realize that usual protocols may not apply. The absence of a palpable pulse and the presence of the mechanical pump complicate their assessment and intervention strategies. Nobody is sure whether chest compressions can be safely performed. This real-life scenario underscores the unique challenges faced by health care providers when performing CPR in patients on LVAD support. In this viewpoint, we discuss the specialized knowledge, protocols, and unique physiological and mechanical considerations involved in performing CPR in this setting. Understanding these differences is crucial for ensuring effective resuscitation efforts, improving patient outcomes, and minimizing potential complications during CPR in this patient population.