11
Figure 8. Algorithm showing response to a patient with
a total artificial heart (TAH) with altered mental status,
unresponsiveness, or respiratory distress
Do not use ECG or telemetry
Pulse present No pulse present
Monitor respiratory
status (assist
ventilations if required)
• If unresponsive, check for
noncardiac etiologies for
possible causes
• Consider hypoglycemia,
stroke, hypoxia, or overdose
≥150
mm Hg
<90
mm Hg
Maintain SBP
≥90 mm Hg
Consider:
• Sublingual
nitroglycerin
• Furosemide 40 mg IV
• Assist patient with
self-administration of
hydralazine
Administer
NS bolus
(maximum
1 L
infusion)
Initiate transport to receiving hospital
Do not use:
• Manual or mechanical chest compressions
• ECG/defibrillation/pacing or AED
• Vasopressors (epinephrine or vasopressin)
• Antiarrythmic medications (lidocaine,
amiodarone, etc)
Check TAH driveline
Consider page to TAH
center coordinator or
physician if family has
information available
Has pulse
returned?
Check battery position
and power status
(replace if necessary)
Has pulse
returned?
Use backup driver
(if available)
Has pulse
returned?
• Administer NS
bolus (maximum 1 L
infusion)
• Monitor respiratory
status (assist
ventilations if
required)
YES
YES
YES
Use "pulse
present"
approach
NO
NO
NO
Check systolic
BP
<150 mm Hg
≥90 mm Hg
