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space is restricted, some practices may adopt a crash box. When the latter is used, it should contain only drugs and equipment that are not quickly reachable in the ready area. Staff must be familiar with the crash trolley or box and must be trained in using the related equipment (such as the defibrillator). Equipment and supply must be prestocked, readily accessible and regularly audited.

Drug dosing charts and checklists are also very useful timesavers during CPR and should be provided in the ready area. Unfortunately, checklists are still rarely used in CPA situations.3

Personnel trainingHigh-quality basic life support requires both cognitive and psychomotor skills. The team performing CPR should be structured and a leader identified.

Leadership trainingIn human medicine, there is compelling evidence, at least in simulation scenarios, that specific leadership training will improve CPR performance. The skills of a good leader are to be

Introduction With an increasing number of sick cats and dogs being presented to veterinary practices, witnessing cardiopulmonary arrest (CPA) is not uncommon. Veterinary practitioners and their support staff should be ready to perform cardiopulmonary resuscitation (CPR) when these events occur.

In 2012, the RECOVER (REassessment Campaign On VEterinary Resuscitation) initiative1 presented a series of evidence-based consensus guidelines for veterinary CPR in cats and dogs.2 These guidelines, along with evidence from human medical literature, also highlight the importance of preparing and training for CPR.

Preparation for CPR is not only related to the process of having a ‘ready area’ where life support will be enacted, but also relates to personnel training and debriefing after any CPA or CPR effort (real or drill) has occurred. Optimising CPR outcome demands a coordinated team with in-depth knowledge of the CPR guidelines, as well as tidy, organised and functional equipment.

Preparing the ‘ready area’ Having an area of the practice that is always ready, organised and functional for CPR will facilitate the initiation of such activity, minimising the delays which have been associated with worse outcome for the patients.

In most practices, this area will be the prep room, where equipment necessary for CPR is often kept. An easily accessible, organised crash trolley is the preferred option but, if

Preparing and training for CPR in small animal practice Alessandra Mathis

A. Mathis, Willows Veterinary Centre & Referral Service, Highlands Road, Shirley, Solihull, West Midlands B90 4NH email for correspondence: alessandra.mathis@willows.uk.net

This is a summary of a paper that was published in the March 2019 issue of In Practice. It can be read in full at https://inpractice.bmj.com/content/41/2/50

able to adapt to and coordinate tasks that can change rapidly during the resuscitation process while maintaining a global perspective of the situation. The leader should ensure that the CPR guidelines are properly followed, prompting cooperation among the team members and minimising interruptions. These skills are better performed if the leader adopts an observing and coordinating role rather than a hands-on role during CPR.

Team trainingStandardising team training for CPR will improve success rates.4 This

30 March 2019 | VET RECORD412

In this series, Vet Record publishes advice from expert veterinary professionals on how to treat common conditions. All are summaries of articles that first appeared in our sister journal In Practice. The aim is to give readers concise, up to date practical information to optimise their care of patients.

Cardiopulmonary resuscitation practice session with a high-fidelity manikin

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training should include non-cognitive skills, such as clear closed-loop communication and psychomotor skills. The latter is improved by the use of high-fidelity manikins and other feedback devices.

Refresher training at least every six months is recommended to avoid deterioration of learned skills.5 It is also useful to test the skills learnt after every CPR training or refresher session by undertaking a structured drill scenario.6

DebriefingEarly debriefing after each real resuscitation attempt will improve individuals’ cognitive skills and their CPR performance.7 Debriefing can also help to identify factors that, if improved, may facilitate quicker, more effective and organised CPR in the future.

SummaryAny delay in initiating CPR can have serious deleterious effects on the likelihood of return of spontaneous circulation in an animal. A prompt and effective response to CPA events can be achieved by having organised, prestocked arrest stations, training staff using a standardised programme that uses high-fidelity manikins and includes leadership

and communication training, and having debriefing sessions following an event to identify areas for improvement.

References1 Reassessment Campaign on Veterinary

Resuscitation (RECOVER) 2012. https://recoverini-tiative.org/ (accessed 27 March 2019)

2 Fletcher DJ, Boller M, Brainard BM, et al. RECOVER

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A readily accessible crash trolley with all the required equipment organised in separate compartments helps to ensure CPR can begin without delay

evidence and knowledge gap analysis on veteri-nary CPR. Part 7: clinical guidelines. J Vet Emerg Crit Care 2012;22:S102–31

3 Bould MD, Hayter MA, Campbell DM, et al. Cognitive aid for neonatal resuscitation: a pro-spective single-blinded randomized controlled trial. Br J Anaesth 2009;103:570–5

4 McMichael M, Herring J, Fletcher DJ, et al. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 2: preparedness and pre-vention. J Vet Emerg Crit Care 2012;22:S13–25

5 Wik L, Myklebust H, Auestad BH, Steen PA. Retention of basic life support skills 6 months after training with an automated voice advisory manikin system without instructor involvement. Resuscitation 2002;52:273–9

6 Kromann CB, Jensen ML, Ringsted C. The effect of testing on skills learning. Med Educ 2009;43: 21–7

7 Edelson DP, Litzinger B, Arora V, et al. Improving in-hospital cardiac arrest process and outcomes with performance debriefing. Arch Intern Med 2008;168:1063–9

Further reading American Heart Association. CPR & First Aid 2018.

www.cpr.heart.org/AHAECC/CPRAndECC/General/UCM_477263_CardiacArrest-Statistics.jsp (accessed 27 March 2019)

Graham R, McCoy MA, Schultz AM. In-hospital car-diac arrest and post-arrest care. In: Strategies to Improve Cardiac Arrest Survival: A Time to Act. National Academies Press, Washington: 2015:243–314.

McIntyre RL, Hopper K, Epstein SE. Assessment of cardiopulmonary resuscitation in 121 dogs and 30 cats at a university teaching hospital (2009-2012). J Vet Emerg Crit Care 2014;24:693–704

Tschan F, Semmer NK, Hunziker S, et al. Leadership in different resuscitation situations. Trends Anaesth Crit Care 2014;4:32–6

Ward P, Johnson LA, Mulligan NW, et al. Improving cardiopulmonary resuscitation skills reten-tion: effect of two checklists designed to prompt correct performance. Resuscitation 1997;34:221–5

Looking for ways to promote your practice for free?Download the BVA media guide for vets for simple tips and advice to help you achieve local press coverage. www.bva.co.uk/guides

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