9
Total Artificial Heart
Î It is important to note that as the ventricles are removed, these
patients do not produce an ECG tracing (ie, it is a flat line).
Î Chest compressions are ineffective, and epinephrine can raise
afterload and lead to worsening pump function.
Î The pump compensates quite well in vasodilated states such as sepsis
and should maintain adequate output for a few hours.
Î The most common cause of hemodynamic collapse after discharge
home is kinking of the drivelines.
Î Figure 8 provides an algorithm for evaluation and treatment of a
patient with a TAH who is altered mentally, unresponsive, or in
respiratory distress.
Table 1. Basic Differences in Performing Resuscitation in
Patients With Mechanical Circulatory Support
Mechanical
Support
Type
Perfusion
(Pulse
Check) ECG
Defibrillation/
Cardioversion
Chest
Compressions ACLS Drugs
p-RVAD Pulsatile Present Acceptable Acceptable Acceptable
p-LVAD Pulsatile Present Acceptable Acceptable Acceptable
p-BiVAD Pulsatile Present Acceptable Acceptable Acceptable
cf-RVAD Pulsatile Present Acceptable Acceptable Acceptable
cf-LVAD Absent
pulsatile
Present Acceptable Acceptable Acceptable
cf-BiVAD Absent
pulsatile
Present Acceptable Acceptable Acceptable
TAH Pulsatile Absent Unacceptable Unacceptable Unacceptable
