• Nicholas A Haglund, Kelly Schlendorf, Mary Keebler, Charu Gupta, Simon Maltais, E Wesley Ely, and Daniel Lenihan.
• Divisions of Cardiovascular Medicine (NAH, KS, MK, CG, DL) and Cardiothoracic Surgery (SM), Vanderbilt University Medical Center, Nashville, Tennessee; and VA-GRECC (Geriatric Research Education Clinical Center) (EWE), VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, Tennessee.
• Am. J. Med. Sci. 2014 Apr 1; 347 (4): 322-7.

AbstractEnd-stage heart failure patients are being supported with continuous flow left ventricular assist devices (CF-LVAD) in increasing numbers. The severe physiologic and pharmacologic derangements associated with end-stage heart failure therapies predispose these patients to delirium. During a delirious episode, a patient may inadvertently disconnect CF-LVAD equipment, which may have dangerous consequences. Unfortunately, it is not yet routine to use readily available clinical monitoring tools to allow early detection of delirium in this high-risk population. The authors present a case of acute hyperactive delirium leading to pump power disconnection and cardiopulmonary arrest occurring 7 days after CF-LVAD implantation. The case highlights the need for delirium awareness in the cardiovascular intensive care unit and the unique challenges associated with resuscitation of CF-LVAD patients. The authors propose that cardiovascular intensive care unit patients undergo at least twice daily delirium monitoring and provide a novel resuscitation algorithm for patients who have CF-LVADs.

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