Diagnosis and management of circulatory arrest in pediatric ventricular assist device patients: Presentation of two cases and suggested guidelines

IntroductionPediatric patients supported by ventricular assist devices (VADs) are becoming more common. No guidelines exist to provide an approach to diagnosis or management of circulatory arrest in these patients. We present two case reports of apparent circulatory arrest in pediatric VAD-supported patients at our institution.DiscussionDiagnosis of circulatory arrest in VAD-supported patients can be challenging, especially with non-pulsatile flow devices. Traditional methods of diagnosis, such as pulse check and blood pressure, may be unreliable. Etiology may be primary device failure though other etiologies need to be considered. Treatment of the circulatory arrest depends on the etiology and type of VAD device being used.ConclusionIn the absence of strong literature on the approach to these patients, we present these case reports and our local institutional guidelines as a starting point for discussion.