Cardiopulmonary Resuscitation in Small Animal Medicine: An Update

Abstract

In December 2005, the American Heart Association published new guidelines for cardiopulmonary cerebral resuscitation (CPCR) in humans for the 1st time in 5 years. Many of the recommendations are based on research conducted in animal species and may be applicable to small animal veterinary patients. One important change that may impact how CPCR is performed in veterinary medicine is the recommendation to avoid administration of excessive ventilatory rates because this maneuver severely decreases myocardial and cerebral perfusion, decreasing the chance of survival. The new guidelines also emphasize the importance of providing well-executed, continuous, uninterrupted chest compressions. Interruption of chest compressions should be avoided and, if necessary, should be minimized to o10 seconds. During defibrillation, immediate resumption of chest compressions for 2 minutes after a single shock, before reassessment of the rhythm by ECG, is recommended. This recommendation replaces previous recommendations for the delivery of 3 defibrillatory shocks in rapid succession. Allowing permissive hypothermia postresuscitation has been found to be beneficial and may increase success rate. Medications utilized in cardiopulmonary resuscitation, including amiodarone, atropine, epinephrine, lidocaine, and vasopressin, along with the indications, effects, routes of administration, and dosages, are discussed. The application of the new guidelines to veterinary medicine as well as a review of cardiopulmonary resuscitation in small animals is provided.

Zoo and Wildlife CPR

“…It is difficult to provide good lung expansion and tidal volumes when the endotracheal tube cuff is not inflated. High volume low pressure cuffs are preferred over low volume high pressure cuffs due to the risk of pressure necrosis of the tracheal mucosa (Plunkett & McMicheal 2008). In cases where the upper airway is obstructed by something that is not easily removed/corrected (masses or laryngeal collapse for example), a tracheostomy tube may be required to secure the airway.…”

“…It is therefore necessary to try and find the balance between hypoventilation (too few breaths or incomplete expansion of the lungs with each breath) and hyperventilation (giving too many breaths at to high a pressure such that cardiac output is impaired). Although this has not been determined in most species, given tidal volume requirements and respiratory rates are generally lower during CPCR than in healthy patients, 2/3 to the lower limit of the normal resting respiratory rate are typically chosen (Neumar et al 2010;Plunkett & McMicheal 2008).…”

“…When providing positive pressure ventilation for the CPCR patient, avoid over inflation of the lungs (if a pressure gauge is available, do not exceed 20 cmH20 pressure), yet make sure the chest rises with each breath delivered (Plunkett & McMicheal 2008). Make sure the endotracheal tube cuff is inflated to ensure adequate tidal volume delivery to the lungs.…”

Defibrillation

“…The doses traditionally used in veterinary medicine are 10% of the dose used for external defibrillation (0.2-0.5 J/kg). 35 …”

Letter to the Editor

“…In the article “Cardiopulmonary Resuscitation in Small Animal Medicine: An Update” published in January/February 2008 issue, pages 9–25,1 there is a table that indicates the use of amiodarone in cats, at the same dose as used in dogs, but I could not find any published study that has tested amiodarone in cats, other than acute experimental studies and in vitro studies, not related to specific feline diseases, but as animal models for human diseases.…”