cardiopulmonary cerebral resuscitation (cpcr)
TRANSCRIPT
![Page 1: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/1.jpg)
Cardiopulmonary Cerebral Resuscitation (CPCR)
Danielle Berube DVM, DACVECCUpstate Veterinary Specialties
September 17, 2016
![Page 2: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/2.jpg)
Outline
• Introduction– Definitions– Outcome– Who is at risk
• Basic Life Support• Advanced Life Support• RECOVER Initiative• Summary and updates
![Page 3: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/3.jpg)
Definitions
• Respiratory arrest– Cessation of breathing
• Cardiopulmonary arrest– Cessation of effective and spontaneous perfusion and
breathing (no palpable pulse, no heart sounds)• CPR vs CPCR– Cardiopulmonary resuscitation– Cardiopulmonary cerebral resuscitation
![Page 4: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/4.jpg)
Outcomes
• Overall poor prognosis– Survival to discharge 6-7%
• Re-arrest rates– 68% dogs and 37% cats Survival to discharge
![Page 5: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/5.jpg)
• Large prospective observational study that investigated many aspects of CPR
• Survival to discharge: 6% dogs and 3% cats• Simple anesthetic arrest (only 3 cases)– 33% survived to discharge
![Page 6: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/6.jpg)
Dogs WithCPA
ROSC58%
No ROSC23%
ROSC < 20 min: 23% Euth: 10% Repeat CPA:13%
ROSC > 20 min: 35%
No longer alive at 24 hr. Euth: 21% Repeat CPA: 4%
Alive at 24 hr.10% Euth: 4%
Repeat CPA:
0Survive to Discharge6%
![Page 7: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/7.jpg)
Outcome• We often cannot change what happened to the
patient prior to arrest• We can change staff and equipment variables that
affect outcome• Successful outcomes are dependent on– Staff preparedness– Stocked crash area– Working and available equipment– TEAM WORK
![Page 8: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/8.jpg)
Outcome: Staff Preparedness
• Recognize patients at risk• Didactic training and hands on practice– Refresher every 6 months
• Centrally located crash cart– Routinely checked
• Algorithm and dosing charts
![Page 9: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/9.jpg)
Outcome: Staff Preparedness
• Standardized CPR guidelines in human medicine improved outcome after in hospital CPA:– 2000: 13.7%– 2009: 22.3%
![Page 10: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/10.jpg)
Who is at risk?• Trauma• Respiratory system disease• Septicemia• Prolonged seizures• Cardiac disease• Vagal stimulation• Anesthetic agents• Severe metabolic disease
![Page 11: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/11.jpg)
Goals of CPCR
• Provide artificial respiration and cardiovascular support until Return of Spontaneous Circulation (ROSC) – Coronary perfusion pressure– Cerebral perfusion pressure
• Identify cause and treat immediately
![Page 12: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/12.jpg)
Goals: Coronary Perfusion Pressure
• = Aortic diastolic pressure – right atrial pressure
![Page 13: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/13.jpg)
Goals: Cerebral Perfusion Pressure
• = mean arterial pressure – intracranial pressure
![Page 14: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/14.jpg)
CPR/CPCR
• Be prepared– Determine if a pet is breathing or if it has a
heartbeat– Training, supplies, cognitive aids
• Don’t panic!– Try to remain calm but efficient
• Call for help– CPCR is labor intensive and is more likely to be
successful with a team rather than an individual
![Page 15: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/15.jpg)
CPR/CPCR
• First, follow your ABC’s (basic life support)– Airway– Breathing – Circulation/chest compressions
• Then, think about your DEF’s (advanced life support)– Drugs– Electrical defibrillation/ECG/End tidal CO2– Fluid therapy
![Page 16: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/16.jpg)
CPR/CPCR
• First, follow your ABC’s (basic life support)– Circulation/chest compressions– Airway– Breathing
• Then, think about your DEF’s (advanced life support)– Drugs– Electrical defibrillation/ECG/End tidal CO2– Fluid therapy
![Page 17: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/17.jpg)
Recover: JVECC 22 (S1) 2012, S102-S131
![Page 18: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/18.jpg)
Basic Life Support
Recover: JVECC 22 (S1) 2012, S102-S131
![Page 19: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/19.jpg)
Basic Life Support
• CIRCULATION– Check for heart beat/pulse– Do not assume there is no heart beat or pulse just
because they are not breathing– Place patient in lateral recumbancy • Preferably right
– If no heart beat or pulse begin chest compressions
![Page 20: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/20.jpg)
Basic Life Support
• CIRCULATION/CHEST COMPRESSIONS– Goal• Maximize blood to the heart and brain• Restore pulmonary CO2 elimination and O2 uptake by
providing pulmonary blood flow– Small patients• One hand thumb and forefingers
Cardiac pump theory
Recover: JVECC 22 (S1) 2012, S102-S131
![Page 21: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/21.jpg)
Basic Life Support
• CIRCULATION/CHEST COMPRESSIONS– Large patients• Hands on top of one another at a 90 angle• Widest part of chest• Elbows straight• Bend at the waist
Thoracic pump theory
Recover: JVECC 22 (S1) 2012, S102-S131
![Page 22: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/22.jpg)
Basic Life Support
• CIRCULATION– Chest compressions – where• Cardiac Pump - patients <15kg (<33 pounds)
– Compress directly over the heart– Point of the elbow
• Thoracic Pump- patients >15 kg or barrel chested breeds– Compress at the widest part of thorax (usually further
back/caudal)
![Page 23: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/23.jpg)
Basic Life Support• CIRCULATION/CHEST COMPRESSIONS• Minimize interruptions to <10 seconds and switch out
every 2 minutes or upon checking vitals• Including for intubation, blood draws, drug
administration
![Page 24: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/24.jpg)
Basic Life Support
• Circulation/Chest compressions– How hard• Compress thoracic wall by ~1/3-1/2
– What rate• At least 100 compressions/minutes• “Stayin’ Alive” vs. “Another One Bites the Dust”
– What rhythm• 1:1 cycle (equal time spent compressing as allowing
chest to expand)
![Page 25: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/25.jpg)
Basic Life Support
• AIRWAY – If agonal or not breathing obtain airway– Check airway for any obstruction to flow• Tilt head slightly back and extend the neck• Carefully, pull tongue forward and down to better
visualize • Use suction if needed• Use manual palpation if needed
![Page 26: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/26.jpg)
Basic Life Support
• AIRWAY– Ensure proper tube placement• Visualize placement• Auscult for breath sounds• Observe for chest excursions• ETCO2
– Esophageal intubation-zero
![Page 27: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/27.jpg)
Basic Life Support
• BREATHING– Connect to a resuscitation/ambu bag– Provide positive pressure ventilation up to 20 cm
H20– 100% oxygen, 8-10 breaths/minute– Inspiratory time 1 sec– Tidal volume 10 ml/kg– Avoid hyperventilation
![Page 28: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/28.jpg)
Basic Life Support
• BREATHING– Trouble shooting• High pressure needed to generate breath
– Pleural space disease– Pulmonary disease– Tube obstruction
• No chest excursion– Inappropriate endotracheal tube placement– Cuff leaking– See above
![Page 29: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/29.jpg)
Recover: JVECC 22 (S1) 2012, S102-S131
![Page 30: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/30.jpg)
Advanced Life Support
Recover: JVECC 22 (S1) 2012, S102-S131
![Page 31: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/31.jpg)
Advanced Life Support: Monitoring
• Monitoring– ECG• Asystole (22.8 – 72%)• Pulseless electrical activity (11 - 23.3%)• Sinus bradycardia (19 - 23% )• Ventricular fibrillation (2 – 19.8%)
– ETCO2• Proportional to pulmonary blood flow• Low: poor prognosis
![Page 32: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/32.jpg)
Advanced Life Support: Monitoring
• Attach ECG– White lead – Right front– Black lead – Left front– Green lead – Right hind– Red lead – Left hind
• Minimal alcohol or use conducting gel• Rhythm diagnosis– Administer appropriate drugs
![Page 33: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/33.jpg)
Asystole• No rhythm on ECG• Survival rate in people nearly 0%• Treatment options– Atropine– Epinephrine– Vasopressin
![Page 34: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/34.jpg)
Pulseless Electrical Activity (PEA)• Aka electromechanical dissociation• Human survival 1-4%• Treatment options:– Epineprhine– Atropine– Vasopressin– Treat underlying cause
![Page 35: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/35.jpg)
Sinus Bradycardia
• Sinus rate < 60 dog/ <160 cat with palpable pulses• Treatment– Atropine– Reverse offending sedatives– Treat suspected underlying cause
![Page 36: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/36.jpg)
Ventricular Fibrillation• Course V Fib
– 30% response rate– SVT or sinus rhythm common when converted
• Fine V Fib– 5% conversion rate– Asystole converted rhythm
• Predisposing causes– Hypokalemia– Hypomagenesemia
www.mauvila.com
www.resuscitationcentral.com
![Page 37: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/37.jpg)
Advanced Life Support
• DRUG ADMINISTRATION– Intravenous• Ideal mode• Central large bore catheter best• Peripheral typically easier during arrest• Consider venous cutdown early• If peripheral catheter, flush with 5-50 ml flush to reach
the heart
![Page 38: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/38.jpg)
Jugular Cut Down• Quickly clip and prep area over jugular vein• 1-2 cm incision made through skin (#10 or #11 blade) parallel
to the vessel• Vessel dissected free from tissue• Hemostats to lift/isolate vessel• Catheter placed directly into vessel• Secure in place by suturing
Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care Fig 4.5
![Page 39: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/39.jpg)
Intraosseous Catheter• DRUG ADMINISTRATION– Intraosseus
• For small patients and exotics• All medications can be given
– Equipment• Jamshidi bone marrow needle• 18-30g hypodermic needles• Spinal needle
– IO catheter sites• Trochanteric fossa of femur• Wing of the ilium• Greater tubercle of the humerus
![Page 40: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/40.jpg)
Advanced Life Support• DRUG ADMINISTRATION
– Intratracheal• Double dose• Dilute with saline to 5-6 ml• Flush to carina with red rubber catheter• Give two deep breaths• DO NOT GIVE SODIUM BICARBONATE via this route
– NAVEL• Naloxone• Atropine• Vasopressin• Epinephrine• Lidocaine
![Page 41: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/41.jpg)
Advanced Life Support
• Common drugs – Epinephrine– Atropine– Vasopressin– Dextrose– Sodium bicarbonate
– Calcium gluconate, insulin
– Reversal agents• Naloxone, flumazenil,
antisedan
![Page 42: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/42.jpg)
Vasopressors
• Increased vascular resistance to redirect blood flow to core– Epinephrine• Low dose (0.01 mg/kg) recommended every 4-5 min
– Vasopressin• 0.8 U/kg• Can be used interchangeably or in combination with
epinephrine
![Page 43: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/43.jpg)
Parasympatholytics
• Atropine– Extensively studied in CPR– 0.04 mg/kg every 4-5 minutes
![Page 44: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/44.jpg)
Antiarrhythmic drugs
• Ventricular tachycardia– Lidocaine 2mg/kg IV
• Ventricular fibrillation– Electrical defibrillation– If no response: amiodarone 2.5-5 mg/kg IV or IO• Risk of allergic reaction
![Page 45: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/45.jpg)
Reversal Angents
• Naloxone (Reverses opioids)– 0.04 mg/kg IV
• Flumazenil (Reverses Benzodiazepines)– 0.01 mg/kg IV
• Atepamazole (Reverses alpha2 agonists)– 0.05 mg/kg IV
![Page 46: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/46.jpg)
Advanced Life Support: Alkalinizing Agents
• Sodium bicarbonate• Indications– Prolonged CPA ( >10-15 min) with severe
metabolic acidosis ( pH <7)• 1mEq/kg dilute IV
![Page 47: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/47.jpg)
Available at VECCS.org
![Page 48: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/48.jpg)
Advanced Life Support
• Tricks or “short cuts” to remember doses– Epinephrine: 0.1ml per 20 lbs– Atropine: 1.0 ml per 20 lbs – Naloxone: 1.0ml per 20 lbs– Flumazenil: 1.0 ml per 20 lbs
![Page 49: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/49.jpg)
Advanced Life Support
• ELECTRICAL DEFIBRILLATION– Reserved for ventricular fibrillation
– 4-6 J/kg (40 J per 20 lbs)
![Page 50: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/50.jpg)
Electrical Defibrillation
• ELECTRICAL DEFIBRILLATION– Conducting gel for the paddles– Rinse off alcohol if present– Put patient in dorsal recumbancy– Place paddles on either side of chest– Charge paddles– Yell “Clear” and make sure staff is clear– Immediately resume CPR for 2 minutes before
assessing rhythm
![Page 51: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/51.jpg)
Advanced Life Support: IV Fluids
• Fluid therapy– Shock fluid therapy reserved for hypovolemic
patients only– IVF contraindicated in euvolemic patients• IVF therapy can decrease coronary perfusion
Coronary perfusion pressure = aortic diastolic pressure – right atrial pressure
![Page 52: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/52.jpg)
Advanced Life Support
• Ideal additional monitoring– ETCO2
• With ROSC see a steady increase in value• Humans with ETCO2 not reaching above 12mmHg
during arrest did not have ROSC– Obtain blood for stat labs• PCV/TS, BG, electrolytes and pH
Fig 9: Capnography in dogs: Compendium October 2004
![Page 53: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/53.jpg)
• ETCO2 </= 10 mmHg after 20 minutes of CPCR accurately predicts death
• “Cardiopulmonary resuscitation may reasonably be terminated in such patients”
![Page 54: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/54.jpg)
Additionally…
• Things to anticipate– Large dogs or patients with intrathoracic disease may
require open chest CPR– If no venous access
• Get red rubber ready for intratracheal administration • Be prepared for cut down
![Page 55: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/55.jpg)
Open Chest CPR
• Indications– Pleural space disease– Pericardial effusion– Penetrating chest wounds/chest wall trauma– Heavy patient/large breeds/incompressible thorax– Intra –operative arrests– No ROSC after 2-5 minutes of closed chest CPR– Post cardiothoracic surgery, chest/abdomen is already
open
![Page 56: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/56.jpg)
RECOVER Initiative
• Reassessment Campaign on Veterinary Resuscitation• VECCS and ACVECC worked together to evaluate
resuscitation and how it is applied clinically• Adapted the approach taken by the American Heart
Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR)
• Results published in JVECC as supplemental volume in June 2012
![Page 57: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/57.jpg)
RECOVER Initiative
• Divided into 7 parts focusing on evidence and knowledge gap analysis– Part I: Evidence analysis and consensus process:
collaborative path toward small animal CPR guidelines– Part II: Preparedness and prevention– Part III: Basic Live support– Part IV: Advanced life support– Part V: Monitoring– Part VI: Post cardiac arrest care– Part VII: Clinical guidelines
![Page 58: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/58.jpg)
RECOVER Initiative
• Divided into 7 parts focusing on evidence and knowledge gap analysis– Part I: Evidence analysis and consensus process:
collaborative path toward small animal CPR guidelines– Part II: Preparedness and prevention– Part III: Basic Live support– Part IV: Advanced life support– Part V: Monitoring– Part VI: Post cardiac arrest care– Part VII: Clinical guidelines
![Page 59: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/59.jpg)
RECOVER Initiative
• Preparedness and Prevention– Equipment and supply delays or failure resulted in
delay of CPCR in 18% of cases– Routine training and review– Use of flow charts/dosing charts– Team leader during arrest– De-brief following successful or unsuccessful CPCR
![Page 60: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/60.jpg)
RECOVER Initiative
• Basic Life Support– Chest compressions
• Large dogs: hands over widest part of chest• Small dogs: hands directly over heart• Very small dogs/cats: circumferential• 100-120 compressions per minute
– Ventilation• Continuous compression and ventilation• 10 breaths per minute
– Cycles• Rotate compressors every 2 minutes
![Page 61: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/61.jpg)
RECOVER Initiative
• Advanced Life Support– Epinephrine: low dose every 3-5 minutes– Atropine– Vasopressin: 0.8 units/kg as a substitute or in
combination with epinephrine– Defibrillation: in cases of V-fib– 100% O2
– IVF: not recommended if euvolemic
![Page 62: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/62.jpg)
RECOVER Initiative
• Monitoring– ETCO2: use for monitoring of ROSC– Additional monitoring can be considered but
should NOT interrupt compressions• ECG• Doppler• Electrolytes
– Use along with auscultation of heart and lungs (do not use as sole device)
![Page 63: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/63.jpg)
RECOVER Initiative
• Post Cardiac Arrest Care
![Page 64: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/64.jpg)
Updates Since RECOVER INITIATIVE
• Metabolic acidosis and hyperlactatemia (100%)
• Respiratory acidosis:– 88% during CPR – 61% following ROSC
• Hyperkalemia 65%
• Decreased iCa 18%• Hypoglycemia 21%• Hyperglycemia 62%
Take away message: Point of care testing may be important during CPR
![Page 65: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/65.jpg)
Updates Since RECOVER INITIATIVE
• Since RECOVER initiative this hospital showed:– Increased use of capnography– Increased use of suction to aid in intubation
• RECOVER guidelines altered CPR teaching
![Page 66: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/66.jpg)
Updates Since RECOVER INITIATIVE
• To provide recommendations for reviewing and reporting CPR events in dogs and cats
• Template for standardized reporting• Will allow high quality veterinary CPR
research, improve data comparison and serve as the foundation for veterinary CPR registries
![Page 67: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/67.jpg)
Summary
• Be Prepared– All staff know what to look for– All staff know where supplies are
• Check for breathing and pulses • Follow your ABC’s (or BACs) and then the
DEF’s• Record what was done and when.• Remember, this is a TEAM effort.
![Page 68: Cardiopulmonary Cerebral Resuscitation (CPCR)](https://reader038.vdocuments.mx/reader038/viewer/2022102703/58a3bfad1a28ab62218b663d/html5/thumbnails/68.jpg)
Questions
• Thank You!• References available upon request