VTNE Review: Cardiopulmonary Cerebral Resuscitation (CPCR)

emergency drug dose for vasopressin

0.8U/kg IV

emergency drug dose for epinephrine

0.01-0.02 mg/kg IV

emergency drug dose for atropine

0.04 mg/kg IV

emergency drug dose for naloxone

0.03-1.0 mg/kg IV

chest compressions

• provide some gas exchange by passively moving air into and out of the larger conducting airways

• avoid interruption in chest compressions; avoid delay greater than 10 seconds

• placed in right lateral recumbency

• animals between 7-10 kgs should have compressions performed over the 4th-6th intercostal space at the costochondral junction

• aim for about 30% compression of the thoracic wall

• compressions administered at a rate of 80-100 bpms

what should not be used to stimulate respiration?

doxapram as it has been shown to decrease cerebral blood flow and increase cerebral oxygen demand

what respiratory rate should be performed?

8-10 breaths per minute (1 breath every 6-8 seconds)

what drugs can be given intratracheal?

epinephrine, atropine, naloxone, lidocaine, and vasopressin; diluted with sterile water (5-10mls)

• IT doses are 2-2.5 times the IV doses except for epinephrine

• epinephrine increased 3-10 times the IV dosage

why not to administer IV fluid boluses during CPCR?

may decrease coronary perfusion pressure as a result of the increased right atrial pressure

epinephrine

• one of the most effective adrenergic drugs used

• positive inotrope and possesses potent vasoconstrictor effects

• can induce ventricular fibrillation this an electrical defibrillator can be useful

• dose repeated every 3-5 minutes or until ROSC

atropine

• anticholinergic that decreases vagal tone and may halt the progression of unstable bradycardia to asystole in the arresting patient

• increases sinoatrial node automaticity and atrioventricular conduction

• absolutely recommended for the patient with bradycardia and imminent arrest

vasopressin

• newer agent used in CPCR

• induces marked peripheral vasoconstriction, improving cerebral and coronary perfusion

• no direct cardiac effects

• dose repeated every 3-5 minutes or until ROSC

why not to use sodium bicarbonate?

generates CO2 and worsens acidemia

what is recommended after defibrillating?

one shock, immediately followed by uninterrupted chest compressions for a minimum of two minutes prior to assessing the ECG rhythm

recommended dosing for defibrillator

2-4 joules/kg for a monophasic defibrillator

1-2 joules/kg for a biphasic defibrillator

amiodarone

• class 3 antiarrhythmic that prolongs action potential duration and refractory period

• the recommended drug for treatment of continued ventricular fibrillation after defibrillation

• 5 mg/kg IV slowly over 10 minutes (diluted)

how to treat post arrest patients

• minimum FiO2 of 40% should be maintained via an oxygen kennel, tent, endotracheal tube if still intubated, mask, or nasal catheter

• active warming should not be prioritized but trembling or shivering should be prevented

• if recumbent, placed on a flat surface with the head and neck elevated about 20 degrees (not with towels or pillows)

• urinary catheter to keep patient clean and monitor urine output

• frequent turning to prevent ulcer formation

• enteral nutrition

• ECG monitored closely for at least 24 hours post arrest