RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 4: Advanced life support.

OBJECTIVE: To systematically evaluate the evidence of the effect of advanced life support techniques on outcome in veterinary cardiopulmonary resuscitation (CPR) and to outline knowledge gaps. DESIGN: Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. SETTING: Academia, referral practice, and general practice RESULTS: Sixteen population, intervention, control group, outcome questions were evaluated to determine if recommendations could be made concerning drug therapy, including vasopressors, vagolytics, corticosteroids, reversal agents, buffer therapy, and correction of electrolyte disturbances. Electrical defibrillation strategies as well as other advanced interventions such as open-chest CPR, impedance threshold devices, and special considerations regarding anesthesia-related cardiopulmonary arrest (CPA) were also investigated. CONCLUSIONS: There is strong evidence supporting the use of standard-dose (0.01 mg/kg) epinephrine in CPR, as well as early electrical defibrillation for animals experiencing CPA due to ventricular fibrillation or pulseless ventricular tachycardia, preferentially using a biphasic defibrillator. For CPA due to certain causes and with the availability of advanced postcardiac arrest support, open chest CPR is preferred. Many knowledge gaps regarding other pharmacologic and advanced therapies were identified, and further studies are recommended to better systematically address these questions.

The clinical practice of CPCR in small animals: an internet-based survey.

OBJECTIVE: To characterize the provision of CPCR by small animal veterinarians in clinical practice and to assess how this practice varies among different levels of expertise. DESIGN: Internet-based survey. SETTING: Academia, referral practice, and general practice. SUBJECTS: Six hundred and two small animal veterinarians in clinical practice. Respondents were grouped a priori according to level of expertise: board-certified (ACVECC, ACVA, ECVAA) specialists; general practitioners in emergency clinics; general practitioners in general practice (GPG). INTERVENTIONS: Email invitations to the online questionnaire were disseminated via a veterinary internet platform and mailing list server discussion groups. Questions explored respondent characteristics, CPCR preparedness, infrastructural and personnel resources, and techniques of basic and advanced life support. MAIN RESULTS: In this group of practitioners, the majority (65%) were in general practice. GPG were more likely to perform CPCR <5 times per year and to have 3 or fewer members on their resuscitation team. Most practitioners have a crash cart and drug-dosing chart available. GPG were less likely to obtain resuscitation codes on their patients, and less likely to use end-tidal carbon dioxide monitoring or defibrillation. Intubation, oxygen supplementation, vascular access, and external thoracic compressions were widely used, however, GPG were more likely to use lower chest compression rates. Drugs used for CPCR differed among the groups with GPG more likely to use doxapram and glucocorticoids. CONCLUSIONS: CPCR is heterogeneously performed in small animal veterinary medicine; differences exist, both among and within different types of veterinarians with varying levels of expertise, in respect to available infrastructure, personnel and CPCR techniques used.