Lung lobe torsion in 35 dogs and 4 cats.

The purpose of this study was to assess survival to discharge of animals with surgical or postmortem confirmation of a lung lobe torsion (LLT) as well as to evaluate pre-operative effusion, lung lobe affected, and patient size as prognostic indicators. Medical records search identified 35 dogs and 4 cats with a confirmed diagnosis including 17 small-breed dogs, 18 large-breed dogs, 3 domestic shorthair cats, and 1 minskin cat. Lobes affected included right middle (n = 18), left cranial (n = 18), right cranial (n = 2), left caudal (n = 1), and accessory (n = 1). Two animals died before surgery; the remaining 37 animals underwent thoracotomy. All treated small-breed dogs and cats survived; 12/18 large-breed dogs survived, with an overall survival to discharge of 87%. Pre-operative pleural effusion and affected lung lobe did not affect survival to discharge in this population. Small dogs and cats with LLT appear to have an excellent survival to discharge following thoracotomy and the survival is good in larger dogs.

Torsion de lobe pulmonaire chez 35 chiens et 4 chats. Le but de cette étude est d'évaluer le taux de survie jusqu'à la sortie d'hôpital, chez des animaux ayant eu confirmation chirurgicale ou post-mortem de torsion de lobe pulmonaire (TLP), ainsi que d'évaluer la présence d'épanchement pleural, le lobe pulmonaire affecté et la taille des patients en tant que facteurs pronostics. Les dossiers médicaux de 35 chiens et 4 chats avec un diagnostic de TLP confirmé furent identifiés, comprenant 17 chiens de petite race, 18 chiens de grande race, 3 chats Européens et 1 Minskin. Les lobes pulmonaires affectés étaient le lobe moyen droit (n = 18), le lobe cranial gauche (n = 18), le lobe cranial droit (n = 2), le lobe caudal gauche (n = 1) et le lobe accessoire (n = 1). Deux animaux décédèrent avant chirurgie, et une thoracotomie fut pratiquées chez les 37 animaux restant. Tous les chiens de petites races et les chats survécurent à leur chirurgie; 12/18 des chiens de grande race survécurent, et le taux de survie global était de 87 %. La présence d'épanchement pleural et le lobe pulmonaire affecté n'avaient pas d'influence sur la probabilité de survie dans cette population. Le taux de survie au congé hospitalier semble excellent chez les chiens de petite taille et les chats diagnostiqués avec une torsion de lobe pulmonaire et il est bon pour les chiens de grande taille.(Traduit par les auteurs).

Does do not resuscitate (DNR) always mean DNR? Exploring DNR orders in small animal veterinary medicine.

This study investigated the use of and adherence to do not resuscitate (DNR) orders in small animal veterinary medicine. A link to a survey of respondent characteristics and clinical scenarios in which interpretation of the DNR order was questionable was distributed by e-mail to veterinarians in specialty and general practice, veterinary technicians, and veterinary students on veterinary e-mail lists in North America and Europe. Complete responses were obtained from 648 individuals, including 493 veterinarians, 58 veterinary technicians, and 97 veterinary students. Men, experienced veterinarians, and respondents participating in multiple cardiopulmonary resuscitation (CPR) events yearly were more likely to perform CPR despite DNR orders. Veterinarians in North America were more likely to provide CPR, compared to those elsewhere. Most respondents would override a DNR in the case of an in-hospital iatrogenic cardiac arrest or unexpected arrest during sedation, but would provide CPR when requested by owners, even if judged futile. Codes are not routinely suspended for patients undergoing anesthesia or regularly re-evaluated during hospitalization. Key clinical message: Inconsistency surrounding the assignment of and adherence to DNR orders in veterinary patients should be considered when establishing protocols for discussion and implementation of CPR codes.

Est-ce que ne pas réanimer (DNR) signifie toujours DNR? Exploration des consignes DNR en médecine vétérinaire des petits animaux. La présente étude visait à examiner l'utilisation et l'adhésion aux consignes de ne pas réanimer (DNR) en médecine vétérinaire des petits animaux. Un lien à un sondage des caractéristiques des répondants et des scénarios cliniques dans lesquels l'interprétation de la consigne DNR était questionnable fut distribué par courriel à des vétérinaires en pratique spécialisée et générale, des techniciens vétérinaires, et des étudiants vétérinaires sur des listes de courriel vétérinaire en Amérique du Nord et en Europe. Des réponses complètes furent obtenues de 648 individus, incluant 493 vétérinaires, 58 techniciens vétérinaires, et 97 étudiants vétérinaires. Les hommes, les vétérinaires avec expérience, et les répondants participant à de multiples évènements de réanimation cardiorespiratoire (CPR) annuellement étaient plus susceptibles d'effectuer des manoeuvres de CPR malgré des consignes DNR. Les vétérinaires nord-américains étaient plus susceptibles d'effectuer des manoeuvres de CPR comparativement à ceux d'ailleurs. La plupart des répondant ne respecterait pas une consigne DNR lors d'un arrêt cardiaque iatrogénique en clinique ou un arrêt imprévu lors de la sédation, mais effectuerait des manoeuvres de CPR lorsque demandées par les propriétaires, même si elles sont jugées futiles. Les codes ne sont pas suspendus de routine pour les patients soumis à une anesthésie ou réévalués régulièrement durant l'hospitalisation. Message clinique clé : L'incohérence entourant l'attribution et l'adhésion aux consignes de DNR chez les patients vétérinaires devrait être considérée lors de l'établissement de protocoles de discussion et de mise en place de codes de CPR.(Traduit par Dr Serge Messier).

Vasopressor use in 41 critically ill cats (2007-2016).

This study describes the use of vasopressors in critically ill cats. Records of 41 cats hospitalized in the ICU were evaluated. Signalment, blood pressure, underlying conditions, evidence of sepsis, type of treatment (surgical versus non-surgical), vasopressor type and duration, adverse events attributed to vasopressors, and survival were recorded. Twenty-one cats (51%) had an underlying disease considered amenable to surgical treatment while 20 (49%) cats did not. Evidence of sepsis was present in 24 (59%) cats. Thirty-four cats developed a Doppler blood pressure (DBP) > 80 mmHg during therapy, and 29 cats became normotensive (DBP > 90 mmHg). Seven cats did not increase their DBP to > 80 mmHg. All cats received dopamine and/or norepinephrine and 6 cats also received other vasopressors. Sixteen cats survived (39%). Surgical intervention was associated with a higher survival (P = 0.004). Critically ill hypotensive cats may benefit from administration of vasopressors.

Utilisation de vasopressine chez 41 chats en état critique (2007­2016). Cette étude décrit l'utilisation de vasopresseurs chez les chats en condition critique. Les dossiers médicaux de 41 chats hospitalisés ont été évalués. Le signalement, pression sanguine, conditions sous-jacentes, évidence de sepsis, type de traitement (chirurgical contre médical), type de vasopresseurs et durée, effets adverses reliés à l'utilisation des vasopresseurs et survie ont été comptabilisés. Vingt et un chats (51 %) avaient une condition sous-jacente susceptible au traitement chirurgical contrairement aux 20 autres chats (49 %). L'évidence de sepsis était présente dans 24 (59 %) chats. Trente-quatre chats ont développé une pression sanguine au Doppler (DBP) > 80 mmHg durant le traitement et 29 chats sont devenus normotensifs (DBP > 90 mmHg). Sept chats n'ont pas eu d'augmentation de leur DBP > 80 mmHg. Tous les chats ont reçu de la dopamine et/ou de la norépinéphrine et 6 chats ont reçus d'autres vasopresseurs. Seize chats ont survécu (39 %). Une intervention chirurgicale est associée à un plus grand taux de survie (P = 0,004). Les chats hypotensifs en condition critique peuvent bénéficier de l'utilisation de vasopresseurs.(Traduit par les auteurs).

A Novel Model for Teaching Primary Care in a Community Practice Setting: Tufts at Tech Community Veterinary Clinic.

Providing veterinary students with opportunities to develop clinical skills in a realistic, hands-on environment remains a challenge for veterinary education. We have developed a novel approach to teaching clinical medicine to fourth-year veterinary students and technical high school students via development of a primary care clinic embedded within a technical high school. The primary care clinic targets an underserved area of the community, which includes many of the participating high school students. Support from the veterinary community for the project has been strong as a result of communication, the opportunity for veterinarians to volunteer in the clinic, and the careful targeting of services. Benefits to veterinary students include the opportunity to build clinical competencies and confidence, as well as the exposure to a diverse client population. The financial model of the clinic is described and initial data on outcomes for case load, clinic income, veterinary student evaluations, and high school students' success in passing the veterinary assisting examination are reported. This clinical model, involving a partnership between a veterinary school and a technical high school, may be adoptable to other clinical teaching situations.

Accuracy of a computed tomography bronchial wall thickness to pulmonary artery diameter ratio for assessing bronchial wall thickening in dogs.

Computed tomography is increasingly being used in veterinary medicine to evaluate animals with pulmonary signs such as coughing, tachypnea, and exercise intolerance, however, a quantitative measure of bronchial wall thickening has yet to be validated in veterinary medicine. Canine chronic bronchitis is a disease that is characterized histologically by thickening of the bronchial walls. Thoracic CT images of 16 dogs with chronic bronchitis and 72 dogs presenting for conditions unrelated to cough were evaluated. A ratio comparing the bronchial wall thickness to the adjacent pulmonary artery diameter was obtained in the right and left cranial and caudal lung lobes. There was no significant difference in dogs with chronic bronchitis or unaffected dogs between the left and right hemithorax, patient weight, patient age, image slice thickness, or CT machine used. Dogs with chronic bronchitis were found to have a significantly greater ratio than unaffected dogs (P < 0.001). The ratios in the cranial lung lobes were found to be significantly greater than the caudal lung lobes in both chronic bronchitis and unaffected dogs (P < 0.001). A receiver operating characteristic curve of the ratios in the cranial lung lobes had an area under the curve of 0.912, indicating high accuracy in predicting for bronchial wall thickening. A ratio of ≥ 0.6 in the cranial lung lobes was found to have a sensitivity of 77% and specificity of 100% in predicting for the presence of chronic bronchitis, and we propose using this cut-off as supportive of bronchial wall thickening on CT.

A proof-of-concept study evaluating cardiac compression techniques for cardiopulmonary resuscitation in laying hens (Gallus gallus).

OBJECTIVE: To determine in adult chickens which of 3 CPR techniques, sternal compressions (SC), SC with interposed caudal coelomic compressions (ICCC), or lateral compressions (LC), results in the highest mean systolic (SAP), diastolic (DAP), and mean arterial pressure (MAP) as measured directly from the carotid artery. DESIGN: Prospective, nonblinded, experimental crossover study. SETTING: University teaching hospital laboratory. ANIMALS: Ten retired laying hens. INTERVENTIONS: Birds were sedated, anesthetized, and placed in dorsal recumbency. A carotid artery catheter was placed to directly measure arterial pressure. Ventricular fibrillation was induced with direct cardiac stimulation using a 9-Volt battery. Each bird then received 2 minutes of the 3 different cardiac compression techniques in a random order by 3 different compressors, with the compressor order also randomized. Birds were subsequently administered IV epinephrine, and transthoracic defibrillation was attempted. At the end of experimentation, each bird was euthanized, and simple gross necropsies were performed. Linear mixed models followed by pairwise paired t-tests were performed to evaluate differences in pressures generated by each technique. MEASUREMENTS AND MAIN RESULTS: The primary study outcomes were SAP, DAP, and MAP over 2 minutes of compressions for each compression technique. Pressures from ICCC (SAP: 27.6 ± 5.3 mm Hg, DAP: 18.7 ± 5.2 mm Hg, MAP: 21.7 ± 5.2 mm Hg) were significantly higher than those from LC (SAP: 18.9 ± 5.4 mm Hg, DAP: 11.6 ± 4.1 mm Hg, MAP: 14.1 ± 4.5 mm Hg). Pressures from SC (SAP: 24.5 ± 6.4 mm Hg, DAP: 15.2 ± 4.3 mm Hg, MAP: 18.3 ± 5.0 mm Hg) were not significantly different from ICCC or LC. CONCLUSIONS: External compressions can generate detectable increases in arterial pressure in chickens with ventricular fibrillation. SC with ICCC generated significantly higher arterial pressures than LC. SC alone generated blood pressures that were not significantly different from those generated by SC with ICCC or LC.

Intranasal and intravenous apomorphine outperform ropinirole ocular drops for induction of emesis in dogs within ten minutes: a randomized, controlled clinical trial.

OBJECTIVE: The primary goal was to compare the efficacy of administration of apomorphine (APO) administered by intranasal (IN), transconjunctival (TC), SC and IV routes with ropinirole eye drops for induction of emesis in dogs with a secondary goal to evaluate the time of emesis as well as difficulty in administration. ANIMALS: 125 client-owned dogs. METHODS: Dogs were randomly enrolled between October 1, 2021, and March 30, 2022, into groups of 25: IV APO, IN APO, TC APO, SC APO, and ropinirole eye drops. The IV, SC, and TC groups were dosed at 0.03 mg/kg, the IN group was dosed at 0.06 mg/kg, and the ropinirole group was dosed according to manufacturer guidelines. Data collected included success rate of emesis within 600 seconds, time to emesis, time to administer, and difficulty score. Results were compared to IV with P values and CIs being adjusted for multiple comparisons. RESULTS: Emesis was successful within 600 seconds using IV APO in 22 of 25 dogs. By comparison, IN APO induced emesis in 18 of 25 dogs (P = .63). Ropinirole (14/25), SC APO (6/25), and TC APO (4/25) were significantly less successful (P = .047, P = < .001, and P < 0.001, respectively). When emesis was successful, it occurred most rapidly with TC APO, followed by IN APO and then ropinirole. It was most difficult to administer IV APO and TC APO. CLINICAL RELEVANCE: Similar to IV APO, IN APO was a rapid, easy, and effective method of inducing emesis in dogs and should be considered when IV administration is not possible. Ropinirole was easy to administer but successfully induced emesis less reliably within a 10-minute timeframe. APO administered TC using the commercially compounded injectable formulation was ineffective.

Viscoelastic coagulation monitoring parameters in cats with acute arterial thromboembolism.

BACKGROUND: Hypercoagulability has been documented in cats with cardiac disease. However, hemostatic parameters, including viscoelastic coagulation monitoring (VCM) have not been reported in cats with arterial thromboembolism (ATE). HYPOTHESIS/OBJECTIVES: Compare VCM parameters in cats with acute cardiogenic ATE and in control cats. ANIMALS: Sixteen cats with ATE and 30 control cats. METHODS: Multicenter university-based prospective study. Cardiogenic ATE was diagnosed based on physical examination and by ultrasonographically-diagnosed left atrial enlargement. Viscoelastic coagulation monitor analysis, CBC, serum biochemistry profile and coagulation profile were performed at admission in cats with ATE. Analysis from healthy control cats was performed using blood collected by direct venipuncture. Our objective was comparison of VCM parameters clot time (CT), clot formation time (CFT), alpha angle (Angle), maximum clot formation (MCF), amplitude at 10 and 20 minutes (A10 and A20, respectively) and clot lysis index at 30 and 45 minutes (LI30 and LI45, respectively) between ATE and control cats. RESULTS: Cats with ATE had a decreased angle compared to control cats, with a median (range) of 43° (30-48°) compared to 47° (14-59°; P = .01). The parameters A10, A20 and MCF were decreased in ATE cats compared to control cats with a median (range) of 19 units (8-32) compared to 22 units (6-38), 24.5 units (11-40) compared to 29 units (10-47) and 29.5 units (13-44) compared to 33.5 units (14-53), respectively (P = .01, .01 and .01, respectively). The parameters CT, CFT, LI30 and LI45 were similar between groups (P = .22, .09, .62 and .34, respectively). CONCLUSIONS AND CLINICAL IMPORTANCE: Cats with cardiogenic ATE cats have VCM parameters consistent with hypocoagulability compared with healthy cats.

Resource setting impacts neonatal but not maternal survival in bitches treated for dystocia: 243 cases (2015-2020).

OBJECTIVE: To compare maternal and fetal outcomes of dystocia managed surgically and nonsurgically at referral hospitals (RHs) versus community medicine clinics (CMCs), determine the rate of C-section, and evaluate the incidence of hypoglycemia and hypocalcemia in bitches presented with dystocia. ANIMALS: Bitches presented with dystocia at 2 RHs and 2 CMCs. METHODS: Information on signalment, presence of hypoglycemia and/or hypocalcemia, diagnostic imaging performed, nonsurgical and surgical interventions performed, maternal and fetal outcomes, and total cost of care was obtained from the electronic medical records of bitches presenting for dystocia between October 2015 and October 2020. Descriptive statistics were performed and outcome compared between RHs and CMCs using a Fisher exact test, with a P < .05 considered significant. RESULTS: 230 bitches were evaluated with 243 separate episodes of dystocia, with 183 (75%) episodes treated at an RH and 60 (25%) at a CMC. There was a low incidence of hypoglycemia (5% [9/178]) and ionized hypocalcemia (1% [2/164]). Seventy-three percent (177/243) of bitches underwent surgical intervention, 25% (61/243) received nonsurgical management, and 2% (5/243) transferred to their primary veterinarian. There was no difference in survival for bitches operated at an RH compared with a CMC. However, bitches operated at an RH were more likely (P = .04) to be discharged with at least 1 live neonate. CLINICAL RELEVANCE: In bitches diagnosed with dystocia, hypoglycemia and hypocalcemia were rare. The majority of bitches underwent a C-section. The setting where the C-section was performed did not impact maternal survival.

Establishment of a reference interval for thiamine concentrations in healthy dogs and evaluation of the prevalence of absolute thiamine deficiency in critically ill dogs with and without sepsis using high-performance liquid chromatography.

OBJECTIVE: To determine the normal reference interval (RI) for thiamine concentrations in healthy dogs and investigate the prevalence of thiamine deficiency in critically ill dogs with and without sepsis. DESIGN: Prospective, observational, multicenter study, conducted between 2019 and 2021. SETTING: Two veterinary university teaching hospitals. ANIMALS: A total of 109 dogs were enrolled into 3 groups: 40 healthy dogs, 33 dogs with suspected or confirmed sepsis and evidence of tissue hypoperfusion (Doppler blood pressure ≤90 mm Hg or plasma lactate ≥3 mmol/L), and 36 dogs with other critical illnesses and evidence of tissue hypoperfusion. INTERVENTIONS: For each dog, CBC, serum biochemistry, plasma lactate concentration, whole-blood thiamine concentration, blood pressure, vital parameters, Acute Patient Physiologic and Laboratory Evaluation (APPLE)fast score, and clinical outcomes were recorded, alongside basic patient parameters and dietary history. Whole-blood thiamine pyrophosphate (TPP) concentrations were measured using high-performance liquid chromatography. MEASUREMENTS AND MAIN RESULTS: The RI for whole-blood TPP in healthy dogs was 70.9-135.3 µg/L. Median TPP concentrations were significantly lower in septic dogs compared to healthy controls (P = 0.036). No significant difference in median TPP concentrations was found between septic dogs and nonseptic critically ill dogs, or between healthy dogs and nonseptic critically ill dogs. TPP concentrations were below the normal RI in 27.3% of septic dogs, compared to 19.4% of nonseptic critically ill dogs (P = 0.57). No correlations were found between TPP concentrations and lactate concentrations, age, body condition scores, time since last meal, RBC count, serum alanine aminotransferase, APPLEfast scores, or patient outcomes. CONCLUSIONS: TPP concentrations were significantly lower in septic dogs compared to healthy controls, with an absolute thiamine deficiency found in 27.3% of septic dogs. The established TPP RI allows for further investigation of thiamine deficiency in critically ill dogs.

2024 RECOVER Guidelines: Advanced Life Support. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR.

OBJECTIVE: To systematically review the evidence and devise clinical recommendations on advanced life support (ALS) in dogs and cats and to identify critical knowledge gaps. DESIGN: Standardized, systematic evaluation of literature pertinent to ALS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by ALS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk:benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization. SETTING: Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS: Seventeen questions pertaining to vascular access, vasopressors in shockable and nonshockable rhythms, anticholinergics, defibrillation, antiarrhythmics, and adjunct drug therapy as well as open-chest CPR were reviewed. Of the 33 treatment recommendations formulated, 6 recommendations addressed the management of patients with nonshockable arrest rhythms, 10 addressed shockable rhythms, and 6 provided guidance on open-chest CPR. We recommend against high-dose epinephrine even after prolonged CPR and suggest that atropine, when indicated, is used only once. In animals with a shockable rhythm in which initial defibrillation was unsuccessful, we recommend doubling the defibrillator dose once and suggest vasopressin (or epinephrine if vasopressin is not available), esmolol, lidocaine in dogs, and/or amiodarone in cats. CONCLUSIONS: These updated RECOVER ALS guidelines clarify the approach to refractory shockable rhythms and prolonged CPR. Very low quality of evidence due to absence of clinical data in dogs and cats continues to compromise the certainty with which recommendations can be made.

Defining sepsis in small animals.

OBJECTIVE: To discuss the definitions of sepsis in human and veterinary medicine. DESIGN: International, multicenter position statement on the need for consensus definitions of sepsis in veterinary medicine. SETTING: Veterinary private practice and university teaching hospitals. ANIMALS: Dogs and cats. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Sepsis is a life-threatening condition associated with the body's response to an infection. In human medicine, sepsis has been defined by consensus on 3 occasions, most recently in 2016. In veterinary medicine, there is little uniformity in how sepsis is defined and no consensus on how to identify it clinically. Most publications rely on modified criteria derived from the 1991 and 2001 human consensus definitions. There is a divergence between the human and veterinary descriptions of sepsis and no consensus on how to diagnose the syndrome. This impedes research, hampers the translation of pathophysiology insights to the clinic, and limits our abilities to optimize patient care. It may be time to formally define sepsis in veterinary medicine to help the field move forward. In this narrative review, we present a synopsis of prior attempts to define sepsis in human and veterinary medicine, discuss developments in our understanding, and highlight some criticisms and shortcomings of existing schemes. CONCLUSIONS: This review is intended to serve as the foundation of current efforts to establish a consensus definition for sepsis in small animals and ultimately generate evidence-based criteria for its recognition in veterinary clinical practice.

2024 RECOVER Guidelines: Updated treatment recommendations for CPR in dogs and cats.

OBJECTIVE: After the 2012 Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR Guidelines, this is an update of evidence-based consensus guidelines for Basic Life Support (BLS), advanced life support (ALS), and periarrest monitoring. DESIGN: These RECOVER CPR Guidelines were generated using a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for evidence evaluation and translation of this evidence into clear and actionable clinical instructions. Prioritized clinical questions in the Population, Intervention, Comparator, and Outcome (PICO) format were used as the basis to conduct systematic literature searches by information specialists, to extract information from relevant publications, to assess this evidence for quality, and finally to translate the findings into treatment recommendations. These recommendations were reviewed by the RECOVER writing group and opened for comment by veterinary professionals for 4 weeks. SETTING: Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS: A total of 40 worksheets were prepared to evaluate questions across the 3 domains of BLS, ALS and Monitoring, resulting in 90 individual treatment recommendations. High-dose epinephrine is no longer recommended, and atropine, if used, is only administered once. Bag-mask ventilation is prioritized over mouth-to-nose ventilation in nonintubated animals. In addition, an algorithm for initial assessment, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug dosing table are provided. CONCLUSIONS: While the majority of the BLS and ALS recommendations remain unchanged, some noteworthy changes were made due to new evidence that emerged over the past 10 years. Indirectness of evidence remains the largest impediment to the certainty of guidelines formulation and underscores an urgent need for more studies in the target species of dogs and cats.

ACVIM consensus statement on the treatment of immune thrombocytopenia in dogs and cats.

Management of immune thrombocytopenia (ITP) in dogs and cats is evolving, but there are no evidence-based guidelines to assist clinicians with treatment decisions. Likewise, the overall goals for treatment of ITP have not been established. Immunosuppressive doses of glucocorticoids are the first line treatment, but optimal treatment regimens beyond glucocorticoids remain uncertain. Additional options include secondary immunosuppressive drugs such as azathioprine, modified cyclosporine, and mycophenolate mofetil, usually selected based on clinician preference. Vincristine, human IV immunoglobulin (hIVIg), and transfusion of platelet or red blood cell-containing products are often used in more severe cases. Splenectomy and thrombopoietin receptor agonists are usually reserved for refractory cases, but when and in which patient these modalities should be employed is under debate. To develop evidence-based guidelines for individualized treatment of ITP patients, we asked 20 Population Intervention Comparison Outcome (PICO) format questions. These were addressed by 17 evidence evaluators using a literature pool of 288 articles identified by a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations. These were integrated by treatment domain chairs and then refined by iterative Delphi survey review to reach consensus on the final guidelines. In addition, 19 non-PICO questions covering scenarios in which evidence was lacking or of low quality were answered by expert opinion using iterative Delphi surveys with panelist integration and refinement. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The rigorous consensus process identified few comparative treatment studies, highlighting many areas of ITP treatment requiring additional studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Diagnosis of Immune Thrombocytopenia in Dogs and Cats.

Association between the COVID-19 global pandemic and the prevalence of cats presenting with urethral obstruction at two university veterinary emergency rooms.

OBJECTIVES: The aim of this study was to investigate a potential association between the COVID-19 pandemic stay-at-home orders and the prevalence of emergency room presentations for urethral obstruction (UO) in feline patients. METHODS: Medical records and hospital census were retrospectively searched to identify the total number of cats and total number of male cats with UO presenting to two academic veterinary medical centers from 22 March to 10 August in the years 2018 (123), 2019 (137) and 2020 (175). Cats were grouped based on the year of presentation and the proportions of UO cases relative to all cats presenting to the emergency rooms during the same time frame. Absolute (year of interest - reference year) and relative ([year of interest - reference year]/[reference year]) change in prevalence was determined. These were compared for each year using a two-sample z-test. RESULTS: The absolute and relative prevalence of UO presentations across the combined population increased significantly during the COVID-19 pandemic in comparison with 2018 (2.2% and 59%, respectively; P = 0.0003) and 2019 (1.9% and 48%, respectively; P = 0.0021). For the individual institutions, a significant increase in UO presentations was found for institution A when comparing 2020 with both 2018 (P = 0.0072) and 2019 (P = 0.0073), but not for institution B (P = 0.057 and P = 0.18, respectively). No significant differences were found when 2018 and 2019 were compared across the combined population or within institutions. CONCLUSIONS AND RELEVANCE: The results of this study demonstrate an increased prevalence of UO during the initial months of the COVID-19 pandemic, which may be related to environmental change and stress imposed by stay-at-home orders.

Rapid resolution of hyperfibrinolysis in dogs with spontaneous hemoperitoneum following surgical control of hemorrhage.

OBJECTIVE: To estimate the point prevalence and duration of hyperfibrinolysis (HF) in dogs undergoing surgical control of spontaneous hemoperitoneum (SHP). DESIGN: Prospective observational study. SETTING: Single veterinary teaching hospital. ANIMALS: Forty-five client-owned dogs with SHP were screened for HF. Eighteen HF dogs treated surgically were studied. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Dogs with SHP and evidence of shock admitted for surgical control of hemorrhage were screened for HF. Blood samples were collected for PCV, total plasma protein, platelet count, and thromboelastography with 50 U/mL of tissue plasminogen activator at presentation and every 8 hours postoperatively until 72 hours, discharge, or death. HF was defined as a tissue plasminogen activator-activated thromboelastography lysis percentage measured 30 minutes after maximum amplitude (LY30) of ≥20%. LY30 values were compared to a cohort of samples obtained from healthy dogs (n = 22). The point prevalence of HF in all dogs screened was 40% (18/45 dogs), and the mean LY30 at baseline for HF dogs was 48.9% (±24.2%), which was significantly higher than that of control dogs (4.8% ± 7.1%, P < 0.001) and non-HF dogs (1.9% ± 5.7%, P < 0.001). In HF dogs, there was a significant decrease in LY30 between baseline and 8 hours (P < 0.0001) and between 8 and 16 hours (P = 0.035) but no significant change thereafter. LY30 at 8 hours (4%, range: 0%-23.4%) was not statistically different from control dogs (6.5%, range: 1.2%-32.8%, P = 0.664) suggesting early resolution of HF in this population. Only 2 of 18 dogs were persistently hyperfibrinolytic at 24 hours. Malignancy was diagnosed in 12 of 18 dogs (66.6%), while a benign etiology occurred in 6 of 18 dogs (33.3%). All HF dogs survived to discharge. CONCLUSIONS: HF occurs in some dogs with hypovolemic shock due to hemoperitoneum but resolves rapidly following surgical control of bleeding without antifibrinolytic medications. Routine postoperative use of antifibrinolytics in dogs with hemoperitoneum in dogs undergoing surgical control of bleeding may not be warranted.

Evaluation of automated external defibrillator designed for people in dogs.

OBJECTIVE: To determine if human automated external defibrillators (AEDs) could successfully record cardiac electrical activity in dogs, make appropriate recommendations regarding shock delivery, and characterize skin preparation required for a readable ECG based on dog haircoat characteristics. DESIGN: Prospective study of AED use in dogs conducted between January and March 2021. SETTING: University teaching hospital. ANIMALS: Three groups of client-owned dogs were evaluated. Group 1 consisted of 23 healthy dogs with sinus rhythms, group 2 consisted of 9 dogs with documented cardiac arrhythmias, and group 3 consisted of 9 dogs receiving CPR following naturally occurring cardiopulmonary arrest. MATERIALS AND METHODS: Haircoat characteristics and clipping or ECG paste required to obtain a readable ECG were recorded. The time interval from a readable ECG by the investigator until AED shock advisement was measured. Correctness of shock advice was recorded. Analyses were performed using commercial statistical software. P-values <0.05 were considered significant. RESULTS: The attending veterinarian judged the ECG on the AED to be readable in all dogs. Time to shock advisement in all dogs was median 18 (range: 7-180) seconds. Dogs with heavy, long, or double haircoats required clipping in 24 of 27 (89%) cases to obtain a readable ECG. ECG paste on the AED pad was required in 36 of 40 dogs (90%) in order to obtain a readable ECG. The AED advice for delivery of shock was appropriate in 51 of 52 (98%) queries of the machine across all groups. CONCLUSIONS: Human AEDs can successfully record cardiac electrical activity in dogs. AEDs appropriately recommend delivery of a shock most times, contingent on skin preparation. Dogs with double, long, or heavy haircoats should be clipped prior to pad application. ECG paste will aid AED reading in all haircoat types. Further investigation is warranted into AED use in dogs, particularly in general practices.

Reassessment Campaign on Veterinary Resuscitation (RECOVER) Initiative small animal CPR registry report 2016-2021.

OBJECTIVE: To introduce the Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR registry and report cardiopulmonary arrest (CPA) and CPR event data collected to date. DESIGN: International, multi-institutional veterinary CPR registry data report. SETTING: Veterinary private practice and university teaching hospitals. ANIMALS: Data from 514 dogs and 195 cats undergoing CPR entered in the RECOVER CPR registry between February 2016 and November 2021. INTERVENTIONS: The RECOVER CPR registry is an online medical database created for standardized collection of hospital, animal, arrest, and outcome information on dogs and cats undergoing CPR. Data were collected according to the veterinary Utstein-style guidelines for standardized reporting of in-hospital CPR in dogs and cats. Case records were downloaded, duplicate and incomplete cases were removed, and summary descriptive data were reported. MEASUREMENTS AND MAIN RESULTS: Sixteen hospitals in the United States, Europe, and Australia contributed data on 709 CPR events to the registry. One hundred and forty-two (28%) dogs and 58 (30%) cats attained return of spontaneous circulation (ROSC), 62 (12%) dogs and 25 (13%) cats had ROSC >20 minutes, and 14 (3%) dogs and 4 (2%) cats survived to hospital discharge. The reason for CPR discontinuation was reported as owner choice in 321 cases (63%). The most common suspected causes for CPA were respiratory failure (n = 142, 20%), heart failure (n = 86, 12%), and hemorrhage (n = 76, 11%). CONCLUSION: The RECOVER CPR registry contains the first multicenter data set on small animal CPR. It confirms poor outcomes associated with CPA, emphasizing the need for large-sized studies to gain adequate information on characteristics associated with favorable outcomes.

Diagnosis and management of a laryngeal cyst in a domestic shorthair cat.

Case summary: A 7-year-old male neutered domestic shorthair cat was presented with a 3-month history of dyspnea when exercising and increased respiratory noise when purring. Initial radiographs identified a suspected laryngeal mass. Point-of-care ultrasound found a fluid-filled structure on the larynx, which was drained percutaneously. The cat initially recovered well but, due to recurrence of clinical signs, a CT scan was performed, which confirmed the presence of a laryngeal cyst that was subsequently surgically resected. Histopathological analysis was consistent with a suspected thyroglossal cyst. Relevance and novel information: This is only the second report of a laryngeal cyst in the cat. While malignant laryngeal disease may be more prevalent in the cat, benign differentials should be considered as treatment could be curative, as was observed in this case.

The use of caffeine as a respiratory stimulant in a cat.

OBJECTIVE: To report the use of caffeine as a respiratory stimulant in a cat with hypoventilation. CASE SUMMARY: A cat was mechanically ventilated due to persistent hypercapnia (Pet co2  > 75 mm Hg) following median sternotomy and thymectomy. After 3 days of mechanical ventilatory support, the cat would initiate breaths but failed weaning due to persistent hypercapnia. Following administration of intravenous caffeine (total 12 mg/kg over 24 h), respiratory and mental status rapidly improved. The cat was subsequently extubated and able to maintain Pvco2  < 50 mm Hg. The cat was later diagnosed with myasthenia gravis. Quality of life 13 months after discharge was reported as excellent by her owner. NEW OR UNIQUE INFORMATION PROVIDED: Caffeine may be considered as a respiratory stimulant in cats with hypoventilation.