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When delivering shocks during CPR in a patient with an implantable cardioverter-defibrillator (ICD), one significant concern is the possibility of cardiovascular collapse. The presence of an ICD means that the device could be delivering its own shocks in response to a detected arrhythmia. However, if external shocks are administered simultaneously or shortly thereafter, it can lead to confusion in the heart's rhythm and may precipitate a cardiovascular collapse. This reaction occurs because the heart might be in a vulnerable state during resuscitation efforts, and the deliverance of shocks might not be appropriately timed to restore a viable rhythm effectively.

In general, providing effective CPR can be more complex when an ICD is involved, as the rescuer must be cautiously aware of the potential for both the ICD delivering inappropriate shocks and external shocks interfering with the heart’s recovery process. This complication emphasizes the need for careful assessment and coordination of CPR efforts when an ICD is present.