Cardiopulmonary cerebral resuscitation in small animals—A clinical practice review. Part II

Abstract

Objective: To review the principles and practice of cardiopulmonary cerebral resuscitation (CPCR) in veterinary medicine, and to incorporate recommendations from the human International Guidelines 2000 Conference on cardiopulmonary resuscitation and emergency cardiovascular care. Data sources: Both clinical and experimental studies from the human and veterinary literature were reviewed for this manuscript. Summary: Cardiopulmonary cerebral resuscitation consists of basic life support measures, advanced life support measures, and post-resuscitation care. Part I of this article introduced the evidence-based recommendations from human medicine and reviewed basic life support. Part II of this article reviews advanced life support, including drug therapy and electrical defibrillation based upon the electrocardiographic rhythm present at the time of cardiopulmonary arrest (CPA). Post-resuscitation care is discussed, with a particular focus on optimizing perfusion to the brain, kidneys, and gastrointestinal tract. Several currently investigational methods that may improve future patient outcomes are also addressed. Conclusions: Advanced life support techniques provide methods to augment CPCR efforts. As with basic life support, recent recommendations to improve advanced life support in humans may be also be applied to veterinary patients. However, clinical research evaluating these interventions in veterinary CPCR is necessary. Post-resuscitation care requires vigilant monitoring and aggressive support to ensure vital organ perfusion and maximize patient outcomes.(J Vet Emerg Crit Care 2003; 13(1): 13±23)

The Association of Shelter Veterinarians’ 2016 Veterinary Medical Care Guidelines for Spay-Neuter Programs

“…Rounds may also include equipment inspections, record keeping for emergencies, reviews of difficult cases, and morbidity-mortality rounds. [24][25][26] Standard emergency equipment, including a source of oxygen and means of ventilation (eg, an anesthesia machine or manual resuscitator a ) and emergency drugs and reversal agents dated for current use, must be readily available in ample supply in all situations. In addition, emergency drug charts containing volumes of drugs to be administered by body weight (on the basis of the concentration of drug available) should be readily accessible to facilitate rapid preparation of doses.…”

“…However, the ability to perform intubation when medically indicated, including rapid intubation in emergency situations, is required for all spay-neuter programs. 25,27 If intubation is performed as a standard part of an anesthetic protocol, having an anesthesia team that possesses the required skills for this maneuver is critical to success. 24 The anesthetist must verify the placement of the endotracheal tube by direct visualization or by the use of a capnograph.…”

Open‐Chest Cardiopulmonary Cerebral Resuscitation

“…Studies have shown that twohanded cardiac massage can be more beneficial than providing cardiac massage with one hand, though this will be limited by patient size, heart size, patient conformation, the entry site into the thoracic cavity, and the availability of appropriate instruments such as rib retractors. 6,28 The heart can be palmed if it is small enough, squeezed between two hands, or pressed up against the inside of the thoracic cavity to compress the chambers (see Fig. 17.5).…”

“…5 Now, closed-chest CPCR is generally instituted first unless specific situations or disease conditions exist that may be indications for immediate open-chest CPCR. 5,6 A full discussion of closed-chest CPCR can be found in Chapter 16, Cardiopulmonary Cerebral Resuscitation.…”

“…7 After closed-chest CPCR has been chosen as the first method of CPCR, there is controversy regarding whether and when one should abandon closed-chest efforts and proceed to open-chest CPCR. Some literature recommends initiating open-chest CPCR if there is no response to external chest compressions within 2-5 minutes, 6,[8][9][10][11] while others allow 5-10 minutes of closed-chest CPCR. 5,[12][13][14][15] There is a consensus, however, that if the healthcare team is going to perform open-chest CPCR, it should be initiated relatively early in the resuscitation effort.…”