Cardiopulmonary resuscitation outcomes of dogs and cats at a veterinary teaching hospital before and after publication of the RECOVER guidelines.

OBJECTIVES: To describe and compare cardiopulmonary resuscitation outcomes at a Swiss veterinary teaching hospital before and after publication of the Reassessment Campaign on Veterinary Resuscitation guidelines. MATERIALS AND METHODS: Between 2018 and 2020, hospital staff underwent various types of yearly Reassessment Campaign on Veterinary Resuscitation-based cardiopulmonary resuscitation trainings. Canine and feline cardiopulmonary resuscitation events during that period (post-Reassessment Campaign on Veterinary Resuscitation) and between 2010 and 2012 (pre-Reassessment Campaign on Veterinary Resuscitation) were identified and animal, arrest and outcome variables recorded retrospectively. RESULTS: Eighty-one animals were included in the pre-Reassessment Campaign on Veterinary Resuscitation group and 190 in the post-Reassessment Campaign on Veterinary Resuscitation group. Twenty-three percent in the pre-Reassessment Campaign on Veterinary Resuscitation group and 28% in the post-Reassessment Campaign on Veterinary Resuscitation group achieved return of spontaneous circulation and 1% and 4% survived to hospital discharge, respectively. Patients undergoing anaesthesia [odds ratio 4.26 (1.76 to 10.27)], elective [odds ratio 5.16 (1.06 to 25.02)] or emergent surgery [odds ratio 3.09 (1.20 to 8.00)], or experiencing cardiopulmonary arrest (CPA) due to arrhythmias [odds ratio 4.31 (1.44 to 12.93)] had higher odds of return of spontaneous circulation, while those with unknown cause of CPA [odds ratio 0.25 (0.08 to 0.78)] had lower odds. Undergoing cardiopulmonary resuscitation in the post-Reassessment Campaign on Veterinary Resuscitation period was not statistically significantly associated with return of spontaneous circulation [odds ratio 1.38 (0.68 to 2.79)]. CLINICAL SIGNIFICANCE: Unchanged odds of return of spontaneous circulation observed in this study could suggest that once-yearly cardiopulmonary resuscitation training is insufficient, effects of animal and tertiary referral hospital variables confounded results, guideline benefit is limited, or that compliance during clinical cardiopulmonary resuscitation efforts is too poor for guideline recommendations to have a positive impact.

[Small animal cardiopulmonary -resuscitation (CPR) in general practice]. / Kardiopulmonale Reanimation in der Kleintierpraxis.

INTRODUCTION: Cardiopulmonary arrest (CPA) is the acute cessation of systemic perfusion and ventilation. It leads to a lack of tissue oxygen delivery and, if not addressed quickly, will inevitably cause death. Cardiopulmonary resuscitation (CPR) is the only available treatment for CPA and several opportunities exist to improve the veterinary team's resuscitation approach and optimize small animal CPR patient outcomes. In 2012, the Reassessment Campaign on Veterinary Resuscitation (RECOVER) initiative generated evidence-based clinical guidelines to form the basis for training and practice of CPR in dogs and cats. When employing an evidence-based, standardized approach to small animal CPR, return of spontaneous circulation can be achieved in up to 58% of patients and up to 7% of dogs and 19% of cats can be discharged from the veterinary hospital alive. Survival for dogs and cats that suffer CPA is best in patients that suffer a peri-anesthetic arrest, so high quality CPR in the anesthesia patient population is of utmost importance and expected to be the most rewarding. To ensure the best possible outcomes for any patient suffering from CPA and undergoing CPR, a comprehensive resuscitation strategy is necessary, that includes preventive and preparedness measures, basic life support (chest compressions and ventilation), advanced life support (optimization of the patient status by targeted drug therapy, cardiac rhythm monitoring, and defibrillation), and post-cardiac arrest critical care. This article summarizes the most important RECOVER CPR guidelines for the small animal practitioner.

INTRODUCTION: L'arrêt cardiopulmonaire (ACP) est l'arrêt soudain de la perfusion systémique et de la ventilation. Il entraîne, s'il n'est pas traité rapidement, un manque d'apport en oxygène aux tissus qui conduira inévitablement au décès du patient. La réanimation cardio-pulmonaire (RCP) est le seul traitement disponible pour l'ACP. Les compétences d'une équipe vétérinaire quant à la gestion d'un ACP peuvent être améliorées afin d'optimiser les chances de réussite. Des directives cliniques ont été établies par l'initiative RECOVER (Reassessment Campaign on Veterinary Resuscitation) suite à une étude approfondie de la littérature scientifique. Ces recommandations servent de base à la formation et à la pratique de la RCP canine et féline. L'utilisation d'une technique standardisée de la RCP chez le chien et le chat permet de rétablir une circulation spontanée chez 58% des patients et de faire sortir d'hospitalisation jusqu'à 7% des chiens et 19% des chats. Les patients qui subissent un ACP péri-anesthésique ont un meilleur taux de survie. Des efforts dans la pratique de la RCP pour les patients sous anesthésie sont donc de la plus haute importance, de meilleurs résultats étant attendus dans ce contexte. Il est nécessaire de mettre en place une stratégie de réanimation complète afin de garantir les meilleures chances de survie possibles à tout patient souffrant d'ACP et subissant une RCP. Cette dernière comprend des mesures de prévention et de préparation, des soins de réanimation de base (compressions thoraciques et ventilation), des soins de réanimation avancés (optimisation de l'état du patient par une pharmacothérapie ciblée, surveillance du rythme cardiaque et traitements anti-arythmiques) et des soins intensifs à mettre en place après la RCP. Cet article résume les principales lignes directrices des recommandations RECOVER qui peuvent être mises en pratique par un vétérinaire généraliste.

The clinical practice of small animal CPR and compliance with RECOVER guidelines in Switzerland: an internet-based survey.

INTRODUCTION: Objective: In 2012, the Reassessment Campaign on Veterinary Resuscitation (RECOVER) published the first evidence-based small animal CPR guidelines. Even though a RECOVER-based CPR approach has been shown to improve patient outcomes, guideline awareness and compliance is necessary to see such benefits. Our study aimed to characterize Swiss small animal veterinary CPR practices and assess their compliance with RECOVER guidelines. Methods: A nationwide, internet-based survey was conducted, and invitations distributed via Swiss veterinary society mailing lists. Questions covered respondents' demographics, CPR preparedness, Basic Life Support (BLS) and Advanced Life Support (ALS) techniques, and awareness of RECOVER guidelines. Percentages of group total (95% confidence interval) were calculated. Results: One-hundred and fifty respondents were grouped by level of expertise into board-certified specialists (BCS, n = 19), veterinarians with additional post-graduate training (PGT, n = 27), and general practitioners with (GPE, n = 30), and without emergency duties (GPG, n = 74). Of BCS respondents, 58% (36-77%) were familiar with the RECOVER guidelines, compared to 8% (4-17%) of GPG. Large disparities in preparedness, BLS, and ALS techniques emerged among the levels of expertise. Incompliance with preparedness measures varied from 89% (69-98%) in BCS to 100% (95-100%) in GPG and was predominantly due to failure to attend regular CPR training. BLS compliance ranged from 26% (12-49%) in BCS to 5% (2-13%) in GPG, and incompliance was mostly characterized by targeting lower than recommended chest compression rates. ALS compliance varied from 21% (9-43%) in BCS to 0% (0-5%) in GPG and was compromised by limitations in the resuscitation environment such as lacking access to a defibrillator, monitoring equipment, and rescue drugs. Conclusion: Awareness of RECOVER guidelines in Switzerland is acceptable in specialists, but inadequate among general practitioners and CPR practices are largely not in agreement with RECOVER guidelines. An educational strategy is needed to improve Swiss small animal CPR knowledge and performance.

INTRODUCTION: Objectif: En 2012, la campagne de réévaluation de la réanimation vétérinaire(«Reassessment Campaign on Veterinary Resuscitation¼, RECOVER) a publié les premières lignes directrices sur la RCP fondées sur des preuves chez les petits animaux. Même s'il a été démontré qu'une approche de RCP basée sur le RECOVER améliore les résultats pour les patients, la connaissance de ces lignes directrices et leur respect sont nécessaires pour constater ces avantages. Notre étude visait à caractériser les pratiques de RCP dans les cliniques suisses pour petits animaux et à évaluer leur conformité aux directives RECOVER. Méthodes: Une enquête nationale sur Internet a été menée et des invitations ont été envoyées via les listes de diffusion de la Société des Vétérinaire Suisses (SVS). Les questions portaient sur les données démographiques des répondants, la préparation à la RCP, les techniques de Basic Life Support (BLS) et Advanced Life Support (ALS) et la connaissance des directives RECOVER. Les pourcentages du total du groupe (intervalle de confiance à 95%) ont été calculés. Résultats: Cent cinquante répondants ont été regroupés par niveau d'expertise en spécialistes certifiés (BCS, n = 19), vétérinaires ayant une formation post-universitaire supplémentaire (PGT, n = 27) et généralistes avec (GPE, n = 30) et sans service d'urgence (GPG, n = 74). Parmi les répondants BCS, 58% (36­77%) connaissaient les directives RECOVER, contre 8% (4­17%) des GPG. De grandes disparités dans les techniques de préparation, BLS et ALS sont apparues entre les niveaux d'expertise. Le non-respect des mesures de préparation variait de 89% (69­98%) chez les BCS à 100% (95­100%) chez les GPG et était principalement dû au fait de ne pas suivre une formation régulière en RCP. L'observance du BLS variait de 26% (12­49%) chez les BCS à 5% (2­13%) chez les GPG et la non-conformité était principalement caractérisée par des taux de compression thoracique inférieurs aux recommandations. L'observance de la SLA variait de 21% (9­43%) chez les BCS à 0% (0­5%) chez les GPG et était compromise par des limitations dans l'environnement de réanimation telles que le manque d'accès à un défibrillateur, à l'équipement de surveillance et aux médicaments d'urgence. Conclusion: La connaissance des directives RECOVER en Suisse est acceptable chez les spécialistes, mais insuffisante parmi les vétérinaires généralistes et les pratiques de RCP ne sont en grande partie pas en accord avec les directives RECOVER. Une stratégie pédagogique est nécessaire pour améliorer les connaissances et les performances de la RCP chez les petits animaux en Suisse.

Identification of Mucosa-Invading and Intravascular Bacteria in Feline Small Intestinal Lymphoma.

Persistent bacterial infections of the gastrointestinal mucosa are causally linked to gastric carcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma in people and laboratory animals. We examined the relationship of mucosa-associated bacteria to alimentary lymphoma in cats. Intestinal biopsies from 50 cats with alimentary lymphoma (small cell, n = 33; large cell, n = 17) and 38 controls without lymphoma (normal to minimal change on histopathology, n = 18; lymphocytic-plasmacytic enteritis, n = 20) were evaluated. The number and spatial distribution of bacteria (ie, in luminal cellular debris, villus-associated mucus, adherent to epithelium, mucosal invasion, intravascular, or serosal) were determined by fluorescence in situ hybridization with the eubacterial probe EUB-338. Mucosa-invasive bacteria were more frequently observed in cats with large cell lymphoma (82%, P ≤ .001) than in cats with small cell lymphoma (18%), normal to minimal change on histopathology, and lymphocytic-plasmacytic enteritis (3%). Intravascular bacteria were observed solely in large cell lymphoma (29%), and serosal colonization was more common in cats with large cell lymphoma (57%) than with small cell lymphoma (11%, P ≤ .01), normal to minimal change (8%, P ≤ .01), and lymphocytic-plasmacytic enteritis (6%, P ≤ .001). The high frequency of invasive bacteria within blood vessels and serosa of cats with large cell lymphoma may account for the sepsis-related complications associated with large cell lymphoma and inform clinical management. Further studies are required to determine the role of intramucosal bacteria in the etiopathogenesis of feline alimentary lymphoma.

Accuracy of potassium supplementation of fluids administered intravenously.

BACKGROUND: Potassium (K+) supplementation of isotonic crystalloid fluids in daily fluid therapy is commonly performed, yet its accuracy in veterinary medicine is undetermined. OBJECTIVE: To investigate the accuracy of K+ supplementation in isotonic crystalloid fluids. ANIMALS: None. METHODS: Observational study. 210 bags of fluid supplemented with KCl being administered to hospitalized dogs and cats intravenously (IV) were sampled over a 3-month period. Measured K+ concentration ([K+]) was compared to the intended [K+] of the bag. In a second experiment, 60 stock fluid bags were supplemented to achieve a concentration of 20 mmol/L K+, mixed well and [K+] was measured. In another 12 bags of 0.9% NaCl, K+ was added without mixing the bag, and [K+ ] of the delivered fluid was measured at regular time points during constant rate infusion. RESULTS: The measured [K+] was significantly higher than intended [K+] (mean difference 9.0 mmol/L, range 6.5 to >280 mmol/L, P < .0001). In 28% of clinical samples measured [K+] was ≥5 mmol/L different than intended [K+]. With adequate mixing, K+ supplementation of fluids can be accurate with the mean difference between measured and intended [K+] of 0.7 (95% CI -0.32 to 1.7) mmol/L. When not mixed, K(+) supplementation of 20 mmol/L can lead to very high [K+] of delivered fluid (up to 1410 mmol/L). CONCLUSIONS AND CLINICAL IMPORTANCE: Inadequate mixing following K+ supplementation of fluid bags can lead to potentially life threatening IV infused [K+]. Standard protocols for K+ supplementation should be established to ensure adequate mixing.