Page 2159 - Cote clinical veterinary advisor dogs and cats 4th

1078 Cardiopulmonary Resuscitation

○ Clippers • Anesthetized patient: use physiologic moni- • Monitoring includes ECG and capnography
○ Footstool toring (e.g., ECG, capnography, esophageal and should be initiated during the first CPR
VetBooks.ir ○ Syringes and hypodermic needles • Call for help. ○ A 3-lead ECG to determine the arrest
stethoscope) to identify absence of effective
• Supplies
cycle.
circulation.
○ Intravenous catheters
rhythm
○ Suture material
Start BLS with chest compressions:
○ Tape and gauze • Initiate BLS immediately. ○ The rhythm guides drug administration
and defibrillation.
○ Conductive gel for defibrillator • Animal in left or right lateral recumbency ○ Nonshockable rhythms: asystole and
• Drugs • Position yourself on the dorsal side of the pulseless electrical activity (PEA)
○ Epinephrine animal. ○ Shockable rhythms: pulseless ventricular
○ Vasopressin • Position shoulders vertically above the tachycardia (pVT) and ventricular fibril-
○ Atropine compression point. lation (VF)
○ Amiodarone or lidocaine • Elbows locked, with compression force ○ Chest compressions need to be interrupted
○ Naloxone originating from core muscles for ECG interpretation.
○ Flumazenil • Stack your hands to generate one focal ○ This 5-second pause for rhythm check
○ Atipamezole compression point. should occur every 2 minutes.
○ Calcium gluconate • Compression point varies with chest con- ○ ETCO 2 of < 10 mm Hg: poor efficacy
○ 50% dextrose formation or size of animal: ○ ETCO 2 of < 10 mm Hg: review CPR
○ Sodium bicarbonate ○ Highest point of chest in round-chested technique, and improve chest compression
• Cognitive aids dogs (e.g., Labrador) quality
○ CPR algorithm ○ Over the heart in keel-chested dogs (e.g., ○ A sudden increase in ETCO 2 indicates
○ Dosing chart greyhound) ROSC.
○ Over the heart in small dogs (<7 kg) or ○ Pulse oximetry and noninvasive blood
Anticipated Time cats pressure measurement are not useful
• On recognition of CPA, CPR should be ○ Circumferential in small dogs or cats; one during CPR.
initiated with minimum delay and continued hand reaches around sternum to compress ○ Collect a blood sample early, and analyze
until return of spontaneous circulation the heart, and the other reaches around for electrolyte, acid-base, glucose, and
(ROSC) is achieved, or extending the the back severe anemia.
resuscitation effort further is considered ○ Over the mid-sternum in flat-chested dogs • Drug administration can occur by intrave-
futile or is abandoned due to owner choice. (e.g., English bulldog), with the animal nous (IV), intraosseous (IO), or endotracheal
• There is no definitive duration of CPR in dorsal recumbency (ET) route:
beyond which the resuscitation effort is • Compression rate: 100-120 compressions/ ○ Place IV or IO access with minimal
futile. The decision to discontinue CPR min interruption of chest compressions.
should rather be based on comorbidities, • Compression depth: one-third to one-half ○ Consider cut-down technique for venous
the reversibility of the cause of CPA, and of the chest width cannulation.
patient response to CPR (e.g., end-tidal CO 2 • Allow the chest to fully expand between two ○ IO access in very small or neonatal patients
concentration [ETCO 2 ]). chest compressions. ○ Administer IO drugs and doses as
• In animals with minimal pre-arrest morbidity • Avoid or minimize interruption in chest for IV.
(e.g., anesthetic overdose), it is reasonable compressions for intubation or vascular ○ Chase IV/IO drugs with a flush of isotonic
to conduct CPR for at least 20 minutes. access. crystalloids (5 mL in cats and small dogs;
• Deliver chest compressions in uninterrupted 20 mL in a larger dog).
Preparation: Important cycles of 2 minutes. ○ Double drug doses for ET.
Checkpoints Intubate and ventilate as early as possible: ○ Use long catheter to administer ET drugs,
• Staff should undergo theoretical and psycho- • Conduct orotracheal intubation, inflate the with the tip at the carina of the trachea,
motor skills training in CPR with refreshers cuff, and secure the tube. flush with isotonic saline.
every 6 months. • Initiate ventilation as follows: ○ Intracardiac injection is not recommended.
• Dosing chart and CPR algorithm displayed ○ Self-inflatable resuscitator bag or the • Drug dosages should be displayed in the
• Audited crash cart rebreathing bag of an anesthesia machine resuscitation area.
• Case record sheet to document the code ○ Supplemental oxygen • Drugs include vasopressors, atropine, antago-
• Resuscitation code from pet owners for ○ 10 breaths/min nists, bicarbonate, and antiarrhythmics.
animals at risk of CPA or undergoing general ○ Inspiratory time: 1 second ○ Epinephrine and vasopressin can be used
anesthesia ○ Tidal volume: 10 mL/kg as vasopressor to improve coronary and
○ No coordination with chest compressions cerebral perfusion. Both drugs can be
Possible Complications and required used interchangeably. Give vasopressors
Common Errors to Avoid • Only one rescuer present or intubation not in nonshockable rhythms and repeat every
• Delayed onset of CPR possible: 3-5 minutes (i.e., every second CPR cycle).
• Poor quality of chest compressions ○ Mouth-to-snout or bag-mask ventilation ○ Start with a low dose of epinephrine
• Excessive ventilation ○ Extend the animal’s neck to align with (0.01 mg/kg IV/IO).
• Routine administration of resuscitative fluid back. ○ Use only a high dose of epinephrine
volumes ○ Firmly close the animal’s mouth. (0.1 mg/kg IV/IO) in prolonged CPR
• Delay to initiate open-chest CPR when ○ Form a seal with your mouth around the (e.g., > 10 minutes).
indicated animal’s nares or with the mask around ○ Consider atropine administration in animals
the animal’s muzzle. with nonshockable rhythm, especially if a
Procedure ○ Give 2 short breaths (inspiratory time: vagal cause of CPA is suspected.
Recognize CPA: 1 second). ○ Use reversal agents for opioids, benzodiaz-
• Nonanesthetized animal: unconscious and ○ Immediately resume chest compressions. epines or alpha-2 adrenoceptor agonists, if
not breathing. You may assess the airway and ALS includes monitoring, vascular access, drug appropriate.
feel for a pulse or heartbeat, but complete administration, and defibrillation and should ○ Amiodarone is indicated when VF
in 10-15 seconds. minimally disrupt high-quality BLS. persists despite 2 or more defibrillation
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