teresa m. rieser, vmd, dacvecc veterinary...

1

Teresa M. Rieser, VMD, DACVECC

Veterinary Specialist

Emergency/Critical Care

VCA West Los Angeles Animal Hospital

1900 S. Sepulveda Boulevard

Los Angeles, CA 90025

P 310-473-2951 | F 310-979-5400

VCAWLAspecialty.com

Cardiopulmonary resuscitation (CPR)

in veterinary medicine has largely

been modeled on human CPR

practices. Until recently, no evidence

based guidelines for the performance

of CPR have existed in veterinary

medicine. The Reassessment

Campaign on Veterinary

Resuscitation (RECOVER) had the

goal of creating evidence based

guidelines for CPR in cats and dogs.

In 2012 the RECOVER guidelines were published in the Journal of Veterinary Emergency

and Critical Care. The new CPR guidelines for dogs and cats are available by visiting here

to access the free special issue of the Journal of Veterinary Emergency and Critical Care.

RECOVER puts forth the following recommendations for CPR in small animals:

Preparedness

Be Prepared. Make sure that your crash cart is appropriately stocked and that all

staff members are aware of the location of the crash cart and their role in the

event of a cardiopulmonary arrest (CPA).

Checklists, algorithm charts (fig 1, fig 2) and drug dosing charts (fig 3) have all

been shown to be beneficial in adhering to CPR guidelines. Formal training in the

use of these aids also improves compliance. Finally, these charts should be

prominently placed in locations where CPA may occur.

continued

http://onlinelibrary.wiley.com/doi/10.1111/vec.2012.22.issue-s1/issuetoc

2





P 310-473-2951 | F 310-979-5400

CPR training is important! This involves not only didactic training but also hands-

on training and high quality feedback.

Immediately following an arrest is an excellent time to review how the team

performed during the resuscitation, what was done well and what could be

improved.

Basic Life Support (BLS)

BLS refers to the recognition of CPA, administration of chest compressions

(fig 4, fig 5), air management and delivery of ventilations.

For the purpose of organization BLS, Advanced Life Support (ALS) and

monitoring are divided in the RECOVER guidelines but it should be understood

that in the clinical setting they occur simultaneously.

High quality chest compressions with minimal interruption are essential.

Chest compressions should be performed in lateral recumbancy in both dogs and

cats. Either left or right lateral recumbancy is acceptable.

High quality chest compressions should be started immediately upon recognition

of CPA.

The rate of compressions should be 100-120 compressions/minute with a

compression depth of 1/3-1/2 the width of the chest. Full elastic recoil of the

chest should be allowed between each compression.

Chest compressions should be performed for a full two minutes before

re-assessing the patient’s response to resuscitative efforts.

Fatigue can very negatively impact CPR efforts. Compressors should rotate in

delivery of compressions to avoid fatigue.

Early intubation and ventilations are also valuable.

Animals should be intubated in lateral recumbancy so as to not interrupt chest

compressions. Ventilations should be delivered at the same time as chest

compressions are performed.

A tidal volume or 10ml/kg should be used with a ventilation rate of 10 breaths/

minute. The inspiratory time should be 1 second. Higher rates of ventilations

have been associated with worsening outcomes in humans.

continued

continued

3





P 310-473-2951 | F 310-979-5400

In the event that intubation supplies are not available, mouth to snout ventilations

(fig 6) can be performed at a rate of 2 rapid breaths for every 30 chest

compressions.

Advanced Life Support (ALS)

ALS refers to the interventions that are started in veterinary CPR after BLS is

begun and until the return of spontaneous circulation (ROSC) occurs.

The relatively small cardiac output that is generated in CPR necessitates a high

peripheral vascular resistance in order to provide adequate cerebral and

coronary perfusion pressures. For this reason, vasopressor therapy is valuable in

CPR.

Epinephrine has been shown to be of benefit in CPR. Both high dose (0.1 mg/kg

IV) and low-dose (0.01mg/kg) have been advocated over the years. The current

recommendation is to use low-dose initially. If CPR is prolonged, high-dose may

be considered.

In order to avoid overdosage, epinephrine should only be given during every

other 2 minute cycle of CPR.

Vasopressin can also be considered for its vasopressor effect which occurs by

stimulation of different receptors than are targeted by epinephrine. The

recommended dose is 0.8U/kg IV every 3-5 minutes.

Atropine is a parasympatholytic that has been widely used in CPR. Studies have

not shown a clear cut benefit to its use for different types of CPA. It does appear

to be of benefit in resuscitating patients who are identified as having pulseless

electrical activity (PEA) or asystole. Because if has not been shown to be

detrimental, it is still reasonable to use it routinely in CPA at a dose of 0.04mg/kg

IV. Higher doses are NOT appropriate and have been associated with worse

outcomes.

Electrical defibrillation (fig 7) is indicated for ventricular fibrillation of pulseless

ventricular tachycardia. If an electrical defibrillator is not available, a precordial

thump can be attempted.

Part 7 of the RECOVER guidelines discusses these interventions in depth as well as

additional drug therapies and monitoring.

continued

continued

▪

4





P 310-473-2951 | F 310-979-5400

Figures

Figure 1

continued

continued

5





P 310-473-2951 | F 310-979-5400

continued

continued

Figure 2

6





P 310-473-2951 | F 310-979-5400

continued

continued

Figure 3

7





P 310-473-2951 | F 310-979-5400

continued

continued

Figure 4

8





P 310-473-2951 | F 310-979-5400

continued

continued

Figure 5

9





P 310-473-2951 | F 310-979-5400

continued

continued

Figure 6

10





P 310-473-2951 | F 310-979-5400

continued

Figure 7

11





P 310-473-2951 | F 310-979-5400

Dr. Rieser earned her veterinary degree from the University of

Pennsylvania in 1995. She completed an internship at the University of

Georgia in 1996 and then returned to the University of Pennsylvania for a

residency is Small Animal Emergency and Critical Care. She became

board certified in Small Animal Emergency and Critical Care in 1999. She

remained at the University of Pennsylvania as a lecturer in Emergency

Medicine and Critical Care for one year and then joined VCA. She worked

at the VCA Newark Animal Hospital from 2000 until 2012. Dr. Rieser is

delighted to join the team at VCA West LA Animal Hospital. Her areas of

interest include renal hemodynamics and electrolyte disturbances.

Teresa M. Rieser, DVM, DACVECC

Veterinary Specialist


teresa m. rieser, vmd, dacvecc veterinary...

Documents