Page 38 - Feline Cardiology

CARDIOPULMONARY CEREBRAL RESUSCITATION

No palpable pulse + no palpable/audible heartbeat +
no spontaneous respirations

Initiate chest compressions
• Lateral recumbency
• Rate of compressions: Mimic patient's normal resting heart rate
• Cat: 140/minute Clinical Entities

Attach electrocardiographic (ECG) monitor
Intubate airway Place intravenous
• Ensure adequate contact between clips catheter
• Brief pause(s) in chest and patient (e.g., use alcohol + gel) to
compressions as needed avoid artifact mimicking fibrillation
for tube placement
• Ensure mouth gag is
placed securely Administer reversal
• Ensure accurate Is the rhythm ventricular fibrillation? agents if sedatives/
intubation of trachea analgesics were
given in excess
(visualize tube in glottis) • Wavy baseline without clear QRS complexes, T waves, or P waves
Yes • Ensure contact between ECG clips and patient is EXCELLENT—
use isopropyl alcohol
• Stop chest compressions briefly, to eliminate motion artifact
• ALWAYS check more than one channel/ECG lead Initiate fluid therapy
• Crystalloid (e.g.,
Inflate cuff judiciously No sodium chloride 0.9%,
Positive pressure ventilation Defibrillate lactated Ringer’s
using 40%–100% oxygen solution, Plasmalyte
• 12–20 breaths/minute External: Internal: Asystole 148, Normosol R)
• Coinciding with cardiac For most cases If pericardial or → Epinephrine 40 ml/kg.
compressions is likely • Turn defibrillator pleural effusion, (1:10 000) 0.02−0.2 • Consider simultaneous
beneficial; continue on pneumothorax ml/kg IV; if colloids if hypo-
steady rhythm of • Charge (5 J/kg) • Turn defibrillator no response, albuminemic
respirations irrespective • Rapidly clip hair on repeat epinephrine
of cardiac compressions (15 seconds) over • Charge (0.5 J/kg) Ventricular tachycardia
both hemithoraces • Rapidly clip hair; (pulseless)
• Apply defibrillator thoracotomy (30 → Lidocaine 2 mg/kg
gel (NOT ultra- seconds) IV bolus
Spontaneous Persistent sound gel) to skin • Apply paddles → Check for hypo- Administer IV Monitor:
respirations apnea and paddles directly to ventricles kalemia and treat drugs and additional • Arterial blood
± regains • Apply paddles to (pericardiotomy if (0.25 mEq/kg/h) fluids as indicated pressure (BP)
consciousness patient: “apex” on pericardial if serum K < 3.0 • Pulse oximetry
left, “sternum” on effusion), on mEq/l (if return of
right opposite sides of → Repeat lidocaine
• Ensure no contact heart bolus if venticular spontaneous
circulation)
between humans • Ensure no contact tachycardia persists
Titrate/ Either mea- and patient, table, between humans → May give lidocaine • Central venous
wean from sure arterial or defibrillator and patient, table, as constant rate pressure (if
ventilation as blood gas • Administer shock or defibrillator infusion 40−80 jugular catheter
for an anesthetic (rule out • Administer shock microg/kg/min IV in place)
recovery patient hyperventila- Supraventricular
tion, e.g., if tachycardia
PCo 2 < 20- (> 240/min; QRS
25 mmHg) complexes look
or if not normal) Vasopressin 0.4 µg/kg
available, → Vagal maneuver IV for hypotension, or
continue Persistent Other to slow heart rate dopamine 2−5 µg/kg/min
ventilation ventricular Normal rhythm and better identify IV for hypotension
until onset fibrillation sinus the rhythm
of sponta- rhythm Sinus bradycardia Sodium bicarbonate 8.4%
neous (< 100/min in cats) 0.5−1 mEq/kg IV
respirations → Atropine 0.04 mg/kg IV for confirmed metabolic
If ineffective, repeat once acidosis, or for arrest
>10 minutes. 0.5−1 mEq/kg IV
If still ineffective, may Solution is 8.4% (= 84 mg/ml
Good work use epinephrine 1:10 000 = 1 mEq/ml)
Ensure ongoing 0.02−0.2 ml/kg IV
effective perfusion Not sure → Confirm good Mannitol 1 g/kg IV over 15−30
Double- Monitor mentation, contact between ECG
check clips and patient, stop minutes for
diagnosis cranial nerves, chest compressions cerebral edema
respirations, BP Solution is 20% (0.2 g/ml)
Continue ECG for a few seconds to Corticosteroids (controversial)
monitoring end motion artifact.
If rhythm diagnosis
Ventricular is still unclear, record
fibrillation Other rhythm strip and consult
cardiologist immediately
Defibrillate again Continue monitoring and treatment
• No treatment is more effective Goals:
for a patient in ventricular fibrillation • A perfusing rhythm (good pulse)
than electrical defibrillation • Spontaneous respirations
• Increase dose to 8 J/kg, then • Improving mentation and
12 J/kg if necessary normal neurologic function
Figure 5.1. Algorithm for treatment, monitoring, and decision-making during cardiopulmonary cerebral resuscitation. Copyright 2004,
Etienne Côté; modified with permission.
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