What is the recommended action for an LVAD patient who is unresponsive with no detectable pulse?

• A. Consider CPR if the patient remains unresponsive
• B. Immediate defibrillation only
• C. Check pulse with palpation only
• D. No CPR; wait for device alarms

Answer: (A)

In LVAD patients, a lack of a palpable pulse does not always mean there is adequate perfusion, but if the patient is unresponsive and there is no detectable pulse, you treat it as cardiac arrest and start CPR immediately. The device alarms or device status should be checked, but you should not delay chest compressions while waiting for them. Begin CPR to maintain cerebral and coronary perfusion, and call for help. If a rhythm is later identified as shockable, defibrillate per protocol, but CPR should not be postponed.