Comprehensive CPR and Emergency Cardiac Arrest Management in Veterinary Medicine

What does CPR stand for?

Cardiopulmonary Resuscitation

What is cardiopulmonary arrest (CPA)?

The cessation of spontaneous respirations and lack of a perfusing heart rhythm.

What can cause CPA in previously healthy animals?

Trauma, critical illness, or anesthesia complications.

What are some risk factors for CPA?

Underlying cardiac disorders, respiratory disease, severe trauma, shock, acid-base and electrolyte disorders, seizures, anemia, increased vagal stimulation, and general anesthesia.

What is the first step in a resuscitation effort?

Alert other team members to the crisis and move the patient to a centralized area.

What does basic life support for CPR consist of?

Chest compressions and ventilation.

What is the recommended rate of chest compressions for cats and dogs under 15 lbs?

120 to 130 compressions per minute.

What technique is used for chest compressions in larger dogs over 15 lbs?

Compressions are applied to the largest part of the chest, allowing passive blood flow based on changes in intrathoracic pressure.

How should chest compressions be monitored for effectiveness?

Using a Doppler blood pressure probe on the cornea or an ETCO2 monitor.

What is the purpose of interposed abdominal compressions during CPR?

To enhance venous return to the heart.

What is the function of an Ambu bag during CPR?

To secure the airway and deliver assisted breathing, either with 100% oxygen or room air.

What is the target respiratory rate during CPR?

8 to 12 respirations per minute.

What acupuncture point can stimulate respiration during CPR?

Governor Vessel 26, located at the nasal philtrum.

What are the three main arrest rhythms identifiable on ECG?

Asystole, Pulseless Electrical Activity (PEA), and Ventricular Fibrillation.

What is asystole?

Complete cessation of all mechanical and electrical activity of the heart.

What is Pulseless Electrical Activity (PEA)?

When the heart's electrical system is functioning but there is no mechanical heartbeat.

What is the treatment of choice for ventricular fibrillation?

Defibrillation using an electrical defibrillator.

What is the preferred route for drug administration during CPR?

The IV route.

What does the acronym NAVEL stand for in drug administration during CPR?

Naloxone, Atropine, Vasopressin, Epinephrine, Lidocaine.

What should be done if a patient has arrested from hypovolemic or hemorrhagic shock?

Fluid boluses should be given during CPR to restore vascular volume.

What is a 'Do Not Resuscitate' (DNR) order?

An agreement between the owner and clinician that resuscitation is not in the best interest of the patient.

What should be discussed with owners of critically ill animals upon admission?

Their wishes regarding CPR in case of CPA.

What is the survival rate for pets experiencing CPA?

Very poor, with up to 82% undergoing another CPA within 12 hours.

Amiodarone

5mg/kg IV (over 5-10 minutes). Indications: refractory, unstable ventricular tachycardias. Adverse effects: arrhythmias, hypotension, anaphylaxis (rare).

Atropine

0.05mg/kg IV. Indications: bradyarrhythmias, vagally mediated arrests, AV block. Adverse effects: arrhythmias, tachycardia, decreased GI motility.

Calcium gluconate, 10%

0.5-1 mL/kg (over 10 minutes to effect). Indications: hyperkalemia. Adverse effects: arrhythmias, hypercalcemia.

Epinephrine

0.01 mg/kg IV. Indications: Asystole ("flatline), PEA (pulseless electrical activity). Adverse effects: arrhythmias, hypertension.

Lidocaine

2 mg/kg IV. Indications: ventricular tachyarrhythmias. Adverse effects: vomiting, neurologic signs (especially in cats---use with caution in cats).

Magnesium sulfate, 200 mg/mL

0.25 mEq/kg IV (over 10-15 minutes to effect). Indications: Refractory, unstable ventricular tachycardias. Adverse effects: bradycardia, hypotension.

Vasopressin

0.8 U/kg IV. Indications: asystole, PEA (can be used in place of second dose of epinephrine). Adverse effects: arrhythmias, hypertension.