RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 7: Clinical guidelines

Abstract

Objective -To present a series of evidence-based, consensus guidelines for veterinary CPR in dogs and cats. Design -Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. Questions in five domains were examined: Preparedness and Prevention, Basic Life Support, Advanced Life Support, Monitoring, and Post-Cardiac Arrest Care. Standardized worksheet templates were used for each question, and the results reviewed by the domain members, by the RECOVER committee, and opened for comments by veterinary professionals for 4 weeks. Clinical guidelines were devised from these findings and again reviewed and commented on by the different entities within RECOVER as well as by veterinary professionals. Setting -Academia, referral practice and general practice. Results -A total of 74 worksheets were prepared to evaluate questions across the five domains. A series of 101 individual clinical guidelines were generated. In addition, a CPR algorithm, resuscitation drug-dosing scheme, and postcardiac arrest care algorithm were developed. Conclusions -Although many knowledge gaps were identified, specific clinical guidelines for small animal veterinary CPR were generated from this evidence-based process. Future work is needed to objectively evaluate the effects of these new clinical guidelines on CPR outcome, and to address the knowledge gaps identified through this process. (J Vet Emerg Crit Care 2012; 22(S1): 102-131)

Management of an anaphylactoid crisis due to mast cell degranulation in a dog during general anaesthesia

“…Our response followed the current recommendation for cardiopulmonary cerebral resuscitation, namely ensuring an adequate airway, breathing and circulation (Fletcher and others 2012). …”

Preparing and training for CPR

“…Any delay in starting CPR is associated with significant reductions in survival to discharge from hospital and with neurological status decay (Fletcher and others 2012). Having an area of the practice that is always ready, organised and functional for CPR will facilitate its initiation in a timely manner.…”

“…In 2012, the RECOVER (REassessment Campaign On VEterinary Resuscitation) Initiative presented a series of evidence-based consensus guidelines for veterinary CPR in cats and dogs (Fletcher and others 2012). These guidelines cover CPR-related topics in five domains:…”

Cardiopulmonary resuscitation in small animals

“…This is a change from previous guidelines in which three countershocks delivered in rapid succession were recommended. Resumption of chest compressions after each defibrillation attempt has been shown to increase myocardial perfusion, and is more likely to make conversion successful than the immediate administration of another shock (Fletcher and others 2012). …”

“…Positive inotropes (eg, dobutamine, dopamine) or vasopressors (eg, epinephrine, norepinephrine, vasopressin) may be required to treat persistent hypotension (mean arterial pressure [MAP] below 80 mmHg) and are usually delivered as a CRI titrated to effect. There is some evidence that a few hours of hypertension postresuscitation (MAP above 120 to 150 mmHg) may actually have a beneficial effect on neurological outcome (Fletcher and others 2012). Peripheral perfusion may be further evaluated by serial serum lactate and urine output measurements.…”