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1404 Cardiopulmonary Cerebral Resuscitation

Cardiopulmonary Cerebral Resuscitation
VetBooks.ir Unresponsive, apneic patient

Initiate CPR immediately

Basic life support
1 full cycle = 2 minutes
uninterrupted compressions/ventilation
1 2
Chest compressions Ventilation

or

100-120/min 10/min C:V 30:2
• Lateral recumbency • Intubated in lateral recumbency • Interpose compressions
• 1/2 to 2/3 chest width • Simultaneous compressions
Advanced life support
3 4 5
Initiate monitoring Administer reversals
• Electrocardiogram (ECG) Obtain • Opioids – naloxone
• End-tidal CO (EtCO ) vascular access • Alpha-2 agonists – atipamezole
2
2
• >15 mm Hg = good compressions • Benzodiazepines – flumazenil
Evaluate patient Post-CPA
Check ECG ROSC algorithm

VF/Pulseless VT Asystole/PEA

• Continue BLS, charge defibrillator • Low-dose epinephrine and/or vasopressin
• Clear and give 1 shock every other BLS cycle
or Precordial thump if no defibrillator • Consider atropine every other BLS cycle
• With prolonged VF/VT, consider • With prolonged CPA > 10 min, consider
• Amiodarone or lidocaine • High-dose epinephrine
• Epinephrine/vasopressin every other cycle • Bicarbonate therapy
• Increase defibrillator dose by 50%

Basic life support
Change compressor • Perform 1 full cycle = 2 minutes

CPR algorithm chart. This chart summarizes the clinical guidelines most relevant to the patient presenting acutely in CPA. The box
surrounded by the gray dashed line contains, in order, the initial BLS and ALS actions to be taken when a patient is diagnosed with
CPA: (1) administration of chest compressions, (2) ventilation support, (3) initiation of ECG and EtCO monitoring, (4) obtaining
2
vascular access for drug administration, and (5) administration of reversal agents if any anesthetic/sedative agents have been
administered. The algorithm then enters a loop of 2-minute cycles of CPR with brief pauses between to rotate compressors, to
evaluate the patient for signs of ROSC, and to evaluate the ECG for a rhythm diagnosis. Patients in PEA or asystole should be
treated with vasopressors and, potentially, anticholinergic drugs. These drugs should be administered no more often than every
other cycle of CPR. Patients in VF or pulseless VT should be electrically defibrillated if a defibrillator is available, or mechanically
defibrillated with a precordial thump if an electrical defibrillator is not available. Immediately after defibrillation, another 2-minute
cycle of BLS should be started. The defibrillator dose can be increased by 50% after the first shock if a second shock is necessary.
ALS, Advanced life support; BLS, basic life support; CPA, cardiopulmonary arrest; CPR, cardiopulmomary resuscitation; C:V,
compression-to-ventilation ratio; EtCO , end-tidal CO ; PEA, pulseless electrical activity; ROSC, return of spontaneous circulation;
2
2
VF, ventricular fibrillation; VT, ventricular tachycardia.
(Modified from Fletcher DJ, et al: RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 7: Clinical guidelines. J Vet Emerg Crit Care.
22(S1):S102–S131, 2012.)
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