Retrospective study of gross and histopathologic lesions associated with closed chest cardiopulmonary resuscitation in dogs

Abstract

To investigate and characterise the incidence of iatrogenic complications secondary to closed chest cardiopulmonary resuscitation in dogs.Materials and MethOds: Necropsy reports and histologic sections of tissues were retrospectively examined from 180 dogs that had received closed chest cardiopulmonary resuscitation to determine lesions associated with resuscitation. results: The most common complication was pulmonary haemorrhage (81/163, 49.7%, 95% confidence interval: 42.1 to 57.3), although only nine dogs had pulmonary haemorrhage of at least moderate severity. Liver fractures occurred in 16 of 180 cases (8.9%, 95% confidence interval: 5.5 to 14.0). Blood loss of >15% of blood volume into the abdomen and/or thorax occurred in 13 of 180 cases (7.2%, 95% confidence interval: 4.2 to 12.1). clinical significance: Significant haemorrhage secondary to cardiopulmonary resuscitation may decrease the chances of achieving the return of spontaneous circulation or may cause or compound ischemic damage to critical organs if the return of spontaneous circulation is achieved. Following successful cardiopulmonary resuscitation, animals should be screened for cavitary or pulmonary haemorrhage, as significant haemorrhage could be a factor in recurrence of cardiac arrest.

A proof‐of‐concept study evaluating cardiac compression techniques for cardiopulmonary resuscitation in laying hens (Gallus gallus)

“…In adult chickens, CPR compressions did not appear to frequently cause gross pathological changes (eg, massive hepatic fractures, pulmonary hemorrhage, or follicular rupture), although 2 chickens did experience small hepatic fractures at the margins of the liver lobes. In dogs, pulmonary hemorrhage is frequently noted after CPR and can often result in post‐ROSC complications and death 18–20 . The apparent lack of pulmonary hemorrhage in the current study may result from the relatively “protected” dorsal position of avian lungs 7 .…”

“…In dogs, pulmonary hemorrhage is frequently noted after CPR and can often result in post-ROSC complications and death. [18][19][20] The apparent lack of pulmonary hemorrhage in the current study may result from the relatively "protected" dorsal position of avian lungs. 7 Nevertheless, it remains possible that overexuberant compressions on their own or in combination with an individual chicken's pathology (eg, hepatic lipidosis) could result in significant internal injuries.…”

Chronic pericarditis and recurrent pericardial effusion of unknown origin in a kitten: a case report

“…In 2021, a study investigated iatrogenic lesions after CPR in dogs and found an overall occurrence of hemopericardia in 4.8% of patients. Notably, all 8 patients who received ICI exhibited complications, including hemopericardium, hemothorax, hemomediastinum, and cardiac and pulmonary hemorrhage ( 8 ). In the cat reported here, both scenarios could be possible.…”

“…As potential causes for PE, feline infectious peritonitis (FIP) ( 2 , 3 ), congestive heart failure ( 4 ), neoplasms such as lymphoma ( 5 ) or sarcoma ( 6 ), and inflammatory diseases ( 7 ) are described. Regardless of this, cardiopulmonary resuscitation (CPR) and especially intracardiac injections (ICIs) are known risk factors for iatrogenic damage to the heart and pericardium in dogs, potentially leading to PE ( 8 ). Pericarditis can be linked to conditions such as bacterial infections ( 9 – 11 ), FIP ( 2 ), migrating foreign bodies ( 12 , 13 ), hypereosinophilic syndrome ( 14 ), lymphoma ( 15 ), and peritoneopericardial diaphragmatic hernia repair ( 16 ).…”