Differences in the clinical practice of small animal CPR before and after the release of the RECOVER guidelines: Results from two electronic surveys (2008 and 2017) in the United States and Canada

Abstract

Objective: To assess whether the clinical approach to CPR has changed following the publication of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) guidelines in 2012. Design: Internet-based survey. Setting: Academia and referral practice. Subjects: Four hundred and ninety-one small animal veterinarians in clinical practice in the United States and Canada. Interventions: An internet-based survey assessing the clinical approach to small animal CPR was circulated with the assistance of veterinary professional organizations on 2 separate occasions: prior to (2008) and following (2017) publication of the 2012 (RECOVER) guidelines. Survey questions identical to both surveys solicited details of clinician approaches to CPR preparedness, basic life support (BLS), and advanced life support (ALS). Respondents were grouped into level of expertise (board-certified specialists [BCS, n = 202] and general practitioners in emergency clinics [GPE, n = 289]), and year of response to the survey (2008, n = 171; 2017, n = 320). Measurements and Main Results: Compliance with the RECOVER guidelines pertaining to CPR preparedness (P < 0.01), BLS (P < 0.01), and ALS P < 0.01) was consistently higher in respondents to the 2017 survey compared to those of the 2008 survey.

Self-Reported Clinical Practice of Small Animal Cardiopulmonary Resuscitation and Compliance With RECOVER Guidelines Among Veterinarians in Eight Western European Regions

“…Interestingly, the 4 regions with the highest proportion of specialists and resident respondents (18–43%) were also the only 4 regions to obtain a total compliance score above 0%. An improvement in RECOVER guideline compliance and awareness has been previously demonstrated when comparing veterinarians with specialist training to those in general practice and our study supports this finding ( 17 , 18 , 20 ). Due to a low response rate, the present study is underpowered to enable subdivision between specialists and general practitioners within each region.…”

“…In 2019 the Federation of Veterinarians of Europe reported the demographics of the European veterinary population, listed by country, and shows the demographic data presented in our study to be reflective of the veterinary population in clinical practice within each region ( 19 ). Median age of respondents was similar to previously published veterinary CPR performance studies, with the average respondent being aged between 32 and 41 years old ( 17 , 18 , 20 ). The most commonly reported age group for European veterinarians in a large demographic survey is 30–44 years ( 19 ).…”

“…An electrical defibrillator may be considered specialized equipment and the likely infrequent utilization combined with the moderate expense and training required could reasonably prohibit availability in veterinary hospitals. Donaldson et al did not use access to a defibrillator as a requirement for ALS compliance and report much higher rates of ALS compliance in North American veterinarians than found in our study ( 20 ). Although ALS compliance scores improved in almost all European regions if defibrillator access is excluded from score assignment, guideline compliance remains woefully inadequate.…”

“…To optimize cardiac output during CPR, overly low and high chest compression rates should be avoided as they can lead to incomplete chest recoil between compressions, impaired venous return and decreased coronary and cerebral perfusion pressure ( 40 , 41 ). The most likely factor for inadequately chosen ventilation and chest compression rates in our study is unawareness of most recent veterinary CPR guideline recommendations, which could potentially be improved with wider guideline dissemination as has been shown in North America ( 20 ). Once again, those countries with the lowest RECOVER awareness (France, Switzerland, and Portugal) had the highest BLS incompliance.…”

“…Assignment of a compliance score was based on evaluation of factors selected by the authors, and in line with those used in previous CPR guideline compliance surveys ( 17 , 18 , 20 ). A requirement for achieving complete compliance is frequent training and resource availability which are both situational dependent and often outside of the control of the individual respondent.…”