In a patient with a ventricular assist device (VAD), what action should be performed during BLS?

• A. Perform CPR
• B. Defibrillate immediately
• C. Remove the device
• D. Delay CPR until device check

Answer: (A)

When a patient with a VAD is in cardiac arrest, the priority is immediate high-quality chest compressions to maintain perfusion. The VAD may keep blood moving, but it does not guarantee adequate flow during arrest, and a pulse can be misleading or absent despite ongoing poor perfusion. Start CPR right away, while calling for help and bringing an AED to the scene. Do not delay CPR to check the device or to remove it, and only shock if the rhythm analysis (by the AED or monitor) indicates a shockable rhythm.