Page 41 - Feline Cardiology

34 Section A: Clinical Entities

of the start of CPCR; CPA had been witnessed in all overall survival). However, the survival rate for
3 cases (2 perianesthesia, 1 suspected bethanechol nonanesthetic-related cardiac arrest is likely even lower;
toxicosis) (Waldrop et al. 2004). some survivors in these reports experienced cardiopul-
Clinical Entities OUTCOME that endotracheal intubation and immediate intrave-
monary arrest during general anesthesia, which implies

nous access were likely available. Probability of survival
The first sign of a positive response to CPCR generally
was even lower in cats with shock as the underlying
is the return of spontaneous circulation: the ECG indi-
cates a rhythm other than ventricular fibrillation or cause of arrest, but was higher when more individuals
were involved in the resuscitation effort (Hofmeister
asystole and a faint but unmistakable pulse is palpable. et al. 2009).
As the positive response continues, blood pressure Perhaps the most important aspect of CPCR remains
approaches or reaches the normal range, and spontane- the importance of anticipating it in the first place. The
ous respirations return. Since ventilation with supple- likelihood of survival is inevitably worse when a severe
mental oxygen is beneficial, but may also delay the illness or disturbance culminates in CPA compared to
return of spontaneous respirations, blood gas analysis is the likelihood of survival minutes or hours earlier.
useful to better titrate frequency, depth, and oxygen Therefore, ideal management of CPA consists of denying
content of manual ventilation. Here, as before, the pres- it the opportunity to occur.
ence of a mouth speculum is essential, because a cat that
regains motor function may otherwise transect an endo- REFERENCES
tracheal tube with one bite, inhaling a tube segment and
causing lower airway obstruction that could be fatal. Amir O, Schliamser JE, Nemer S, Arie M. Ineffectiveness of precordial
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mias. Pacing Clin Electrophysiol 2007;30:153–156.
respirations may be preceded or followed by skeletal ECC Committee, Subcommittees, and Task Force of the American
motor activity including abrupt head movements, move- Heart Association. 2005 American Heart Association guidelines
ment of the limbs, or chewing motions. The patient’s for cardiopulmonary resuscitation and emergency cardiovascular
signs during subsequent recovery from cardiopulmo- care. Circulation 2005;112:IV1–IV211.
nary arrest at this stage evolve in a way that resembles Hofmeister EH, Brainard BM, Egger CM, Kang S. Prognostic indica-
recovery from general anesthesia. Rearrest is common in tors for dogs and cats with cardiopulmonary arrest treated by
the minutes to hours following recovery, though much cardiopulmonary cerebral resuscitation at a university teaching
hospital. J Am Vet Med Assoc 2009;235:50–57.
less so in small animal patients that survive CPA to Kass PH, Haskins SC. Survival following cardiopulmonary resuscita-
hospital discharge (Waldrop et al. 2004). Ongoing moni- tion in dogs and cats. J Vet Emerg Crit Care 1992;2:57–65.
toring, and then measures to correct triggers (such as Plunkett SJ, McMichael M. Cardiopulmonary resuscitation in small
acid-base imbalances, drug toxicoses, hypoxemia, animal medicine: an update. J Vet Intern Med 2008;22:9–25.
anemia, or other disorders) that are identified, are the Rush JE, Wingfield WE. Recognition and frequency of dysrhythmias
during cardiopulmonary arrest. J Am Vet Med Assoc 1992;200:
two cornerstones of postarrest management. 1932–1937.
Three large retrospective clinical studies in cats Waldrop JE, Rozanski EA, Swanke ED, O’Toole TE, Rush JE. Causes
confirm that cardiac arrest carries a poor prognosis of cardiopulmonary arrest, resuscitation, management, and func-
even with intervention (Hofmeister et al. 2009; Kass tional outcome in dogs and cats surviving cardiopulmonary arrest.
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and Haskins 1992; Wingfield and Van Pelt 1992). Of Wingfield WE, Van Pelt DR. Respiratory and cardiopulmonary arrest
138 cats experiencing cardiopulmonary arrest and in dogs and cats: 265 cases (1986–1991). J Am Vet Med Assoc
receiving CPCR, 9 survived to hospital discharge (6.5% 1992;200:1993–1996.