The Reassessment Campaign on Veterinary Resuscitation (RECOVER) has produced the first set of evidence-based recommendations to resuscitate dogs and cats in cardiac arrest.

The Reassessment Campaign on Veterinary Resuscitation (RECOVER) has developed the first set of evidence-based recommendations to resuscitate dogs and cats in cardiac arrest.

Dog CPR illustrationAccording to RECOVER, no such evidence-based guidelines have previously existed in the veterinary world, which could explain why more than 20% of human patients who suffer cardiac arrests in the hospital survive, while the equivalent figure for dogs and cats is less than 6%.

The RECOVER initiative was spearheaded by senior research investigator Manuel Boller from the University of Pennsylvania School of Veterinary Medicine and the Center for Resuscitation Science of Penn’s Perelman School of Medicine, and Daniel Fletcher, an assistant professor in veterinary emergency and critical care at Cornell University’s College of Veterinary Medicine.

Manuel BollerThe need for pet-CPR guidelines became obvious to Dr Boller and colleagues when they surveyed vets on how they treated dogs and cats in cardiac arrest.

The results, compiled from more than 600 practitioners, showed a large amount of variation.

Dr Boller explained: “What we found was that there was really no consensus on how to do that best. There may have been a cohort, for example, that recommended 60-80 compressions per minute and another that thought 120-150 compressions per minute was the right thing.”

Drs Boller and Fletcher recruited more than 100 board-certified veterinary specialists from around the world who systematically reviewed more than 1,000 scientific papers related to CPR.

Weighting the studies by their rigor and relevance to dogs and cats, the committee ended up with 101 specific clinical guidelines. Each has a rating based on the strength of the evidence backing it.

Cat CPR illustrationThe recommended practices include:

  • Perform 100-120 chest compressions per minute of one-third to one-half of the chest width, with the animal lying on its side.
  • Ventilate intubated dogs and cats at a rate of 10 breaths per minute, or at a compression to ventilation ratio of 30 to 2 for mouth-to-snout ventilation.
  • Perform CPR in 2-minute cycles, switching the “compressor” each cycle.
  • Administer vasopressors every 3-5 minutes during CPR.

Other guidelines pertain to how clinicians should be trained, how to perform CPR on dogs of different breeds and sizes, what drugs to give when and what follow-up care to provide.

Dr Fletcher said: “We identified two overarching goals for our research: first to devise clinical guidelines establishing how to best treat cardiopulmonary arrest in dogs and cats, and second to identify important knowledge gaps in veterinary CPR that need to be filled in order to improve the quality of recommendations, and thus the quality of patient care in the future.

“With this knowledge we can construct and implement educational initiatives that are evidence-based.”

A series of articles that outline the new guidelines and the method by which they were identified have been published in a special issue of the “Journal of Veterinary Emergency and Critical Care” (June 2012). These articles also include algorithms and drug-dose charts for practitioners to follow.

Illustrations courtesy Journal of Veterinary Emergency and Critical Care.
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