Page 40 - Feline Cardiology

Chapter 5: Cardiopulmonary Arrest and Cerebral Resuscitation 33

Figure 5.3. Electrocardiogram of ventricular fibrillation. There is a chaotic, patternless cardiac rhythm with no discernible organized Clinical Entities
ventricular activity. The rate is approximately 600/minute. Lead III. 25 mm/sec; 1 cm = 1 mV.

during CPCR. Additional information is available in tory rate, and no higher (despite excitement, avoid
Chapter 30. overventilation). The depth of the respirations should
be similar to those observed in a normal cat (the
Synchronizing the Complete chest rises and falls by 3–4 cm) and if a manometer
Resuscitative Effort is in line, positive pressure should not exceed 20 cm
Ideally, resuscitative efforts involve several members of H 2O (20 mm Hg).
the veterinary team, although effective CPCR may be 5. A third team member, if available, places an intrave-
delivered by a single individual. When others are avail- nous catheter or ensures its patency if one is already
able to help, the following order of tasks may be optimal: present. This team member, or a fourth, if available,
connects an ECG monitor (with printer, if possible,
1. Identification of the arrested patient and indication to document and review the cardiac rhythm) to the
for CPCR by the first observer. This person calmly patient, usually connected with a combination of iso-
but deliberately calls for assistance if such assistance propyl alcohol and ultrasound or defibrillation gel
is within earshot and leads the resuscitation effort for lasting contact.
unless/until handing over the task to another 6. Blood pressure should be monitored with a Doppler
resuscitator. unit by any team member aware of the location of
2. The first observer examines the airway (A) and, the palmar metacarpal (forelimb) or plantar metatar-
barring obvious airway obstruction, begins chest sal (hindlimb) artery, and proper technique, in the
compressions at a rate of 140/minute in the cat. cat (see Figure 21.10 in Chapter 21).
3. The first observer must also identify any immediately 7. A separate team member, or one involved in the other
complicating factors that could reduce the efficacy of tasks above, must record time and nature of treat-
CPCR, and initiate their correction promptly. ments administered and results of monitoring into
Examples include drug overdose, iatrogenic anes- the patient’s arrest record, because recall and time
thetic complication (e.g., pop-off valve closed, lack perception are poor in the arrest setting.
of oxygen flow, endotracheal tube problem), and 8. The individual leading resuscitative efforts should
severe acid-base or electrolyte imbalances. Large- transfer the task of administering chest compressions
volume pericardial or pleural effusions, pneumotho- to another team member when that team member
rax, rib fractures, and large intrathoracic masses becomes available. This allows the leader to make
interfering with efficacy of chest compressions are all decisions regarding management (e.g., drug adminis-
indications to proceed immediately to open-chest tration, adjustments in monitoring, troubleshooting)
cardiac compressions. based on physical signs of the patient’s response, ECG
4. A second CPCR team member is tasked with estab- findings, and other results of monitoring. The leader
lishing the airway, virtually always via endotracheal also should ideally be detached in order to commu-
intubation but possibly via tracheostomy (mindful nicate with the patient’s owners in a calm, frank
of potential tracheostomy-related complications) if manner that helps guide whether to pursue CPCR as
the upper airway is completely obstructed by a mass well as to convey the patient’s status accurately.
or foreign body. Once this is accomplished, the There is no fixed duration of CPCR; in one series,
second team member begins ventilations at a range the 3 feline CPA survivors that went home had a
of 10–14/minute to mimic the normal cat’s respira- return of spontaneous circulation within 15 minutes