CPR update recommendations article

Question 1

BLS and ALS stands for

Answer 1

BLS = Basic Life Support; ALS = Advanced Life Support

BLS is defined as the administration of external chest compressions and intermittent positive pressure ventilation (IPPV) with the intention to support the cardiorespiratory system in animals that are pulseless and apneic.

ALS is defined as the use of monitoring tools such as electrocardiography and capnography to guide cardiovascular support measures, electrical defibrillation when indicated, acquisition of vascular access and the administration of drugs, and other adjunctive therapies.

Unlike BLS, ALS can only be performed in a clinical setting due to the techniques and equipment used.

Question 2

CPA

Answer 2

cardiopulmonary arrest

Question 3

IPPV

Answer 3

intermittent positive pressure ventilation

Question 4

ROSC

Answer 4

return of spontaneous circulation

Question 5

CPR survival in dogs and cats undergoing CPR is

Answer 5

low and ranges from 5% to 7% in dogs and 1% to19% in cats.

Question 6

Perform chest compressions in cats and small dogs using any of 3 techniques:

Answer 6

In cats and small dogs, overlapping, 2-handed chest compressions could overcompress the heart. Thus, in these animals, we recommend that chest compressions be performed using 1 of 3 methods, based on a combination of compressor preference and real-time markers of perfusion when available.

◦ Circumferential
◦ One-handed palm
◦ One-handed thumb-to-fingers

Question 7

Perform chest compressions to what depth

Answer 7

25% depth (rather than 33%–50%) when patient is in dorsal recumbency

Question 8

For non-intubated cats and dogs, deliver breaths by

Answer 8

For non-intubated cats and dogs, deliver breaths with a tight-fitting face mask using supplemental O2 if available.

Question 9

For non-intubated cats and dogs, when no tight-fitting face mask is available:

Answer 9

◦ When risk to rescuer is low, give mouth-to-nose breaths

◦ When risk to rescuer is high or unknown, perform chest compression-only CPR

Question 10

High-dose epinephrine (0.1 mg/kg) is no longer recommended;

Answer 10

when epinephrine is used, dose(s) of 0.01 mg/kg are recommended.

Question 11

If atropine is used, administer…

Answer 11

once early in the CPR effort and do not repeat.

Question 12

For patients with a shockable rhythm, if a shockable rhythm persists after the first defibrillation attempt, starting with shock #2: (4)

Answer 12

◦ Double the initial defibrillation energy dose and remain at this dose for all subsequent shocks.

◦ Consider standard-dose epinephrine or vasopressin to support vasomotor tone every other 2-minute cycle.

◦ Consider esmolol loading dose followed by CRI.

◦ Consider giving antiarrhythmics (amiodarone in cats, lidocaine in dogs).

Question 13

A refractory shockable rhythm is either

Answer 13

ventricular fibrillation (VF) or pulseless ventricular tachycardia (PVT) that persists after the team has performed an electrical defibrillation, completed the next full 2-minute chest compression cycle, evaluated the ECG again, and confirmed that the animal remains pulseless with a shockable rhythm of either VF or PVT.

Question 14

During single-rescuer BLS, we recommend a compression-to-ventilation (C:V) ratio of

Answer 14

30 compressions:2 breaths (30:2).

The rescuer delivers 30 chest compressions at the recommended rate, then, during a chest compression pause of no more than a few seconds, delivers 2 breaths, and immediately begins another round of 30 chest compressions.

(So if 100-120 comp./min do 8 breathes/min)

But In intubated dogs and cats undergoing CPR, we recommend a respiratory rate of 10 breaths per minute.

Question 15

Rescue breaths should be delivered with

Answer 15

the animal’s neck and head in
alignment with the spine to avoid obstructing the airway.

Question 16

We recommend optimizing CPR to maximize ETCO2 to no less than

Answer 16

18 mm Hg in dogs and cats undergoing CPR.

Question 17

We recommend using a biphasic defibrillator over a

Answer 17

monophasic defibrillator in dogs and cats with shockable rhythms.

Question 18

We recommend that for dogs and cats with shockable arrest rhythms, if an initial
standard-dose (2 J/kg) electrical defibrillation is unsuccessful,…

Answer 18

the second and subsequent shocks be delivered at a dose of 2× the initial dose (4 J/kg).

Question 19

We recommend against the use of amiodarone formulations containing
polysorbate-80 in

Answer 19

dogs due to the adverse hemodynamic side effects of these formulations that have been documented.

Question 20

We recommend against the use of intravenous fluid boluses in

Answer 20

euvolemic dogs and cats during CPR.

Question 21

OCCPR

Answer 21

open-chest cardiopulmonary resuscitation

Question 22

We recommend the use of atropine (0.04 mg/kg IV or IO) in dogs and cats with

Answer 22

bradycardia causing hemodynamic compromise to attempt to prevent progression to CPA.

Question 23

Chest compressions are performed with most dogs and cats lying in

Answer 23

lateral recumbency (BLS-04, BLS-05, BLS-12).

Wide-chested dogs such as English Bulldogs that naturally fall into dorsal recumbency can undergo chest compressions in that position.

Question 24

Keel-chested dogs spot to compress on chest.

Answer 24

Note the “ski slope” shape of the
thorax when the dog lies in lateral recumbency (red dashed line). The
arrow indicates the recommended compression point over the heart
(cardiac pump).

Question 25

Round-chested dogs spot to compress on chest.

Answer 25

Round-chested dogs. Note the spherical shape of the thorax when the dog lies in lateral recumbency (red dashed lines). The
arrow indicates the recommended compression point at the widest
part of the thorax (thoracic pump).

Question 26

Chest compressions are performed at what rate?

Answer 26

at 100–120/min in dogs and cats.

In dogs and cats in lateral recumbency, we recommend providing chest compressions to a depth of one-third to one-half of the
width of the thorax at the compression point.

In dogs and cats positioned in dorsal recumbency, we recommend providing chest compressions to a depth of one-fourth of the thoracic depth at the compression point.

The compressor must allow full recoil of the thorax between compressions to allow the heart to refill with blood.

Question 27

Appropriate rescuer posture for performing chest compressions in medium- to giant-breed dogs in any recumbency.

Answer 27

Note that the rescuer’s shoulders, elbows, and wrists are in alignment with the shoulders vertically positioned over the compression point.

The compressor uses their core abdominal muscles to perform compressions while keeping the arms in rigid extension (ie, locked), which helps increase and sustain compression force.

High-quality chest compressions should be administered in uninterrupted 2-minute cycles.

Question 28

In what situations should we use epinephrine?

Answer 28

We recommend against the use of epinephrine in animals with shockable rhythms before the first defibrillation attempt; thus, epinephrine should only be considered during the first chest compression cycle in dogs and cats known to have a non-shockable rhythm at the time of arrest.

Question 29

what ETCO2 indicates proper ETT placement, and what ETCO2 should lead the rescuer to confirm ETT placement by other means

Answer 29

in dogs and cats with any CO2 detection device in place (such as a capnometer without waveform), ETCO2 ≥12 mm Hg
likely indicates proper ETT placement, while ETCO2 <12 mm Hg should lead the rescuer to confirm ETT placement by other means (e.g., direct visualization, cervical palpation, cervical ultrasound)

Question 30

PVT

Answer 30

Pulseless ventricular tachycardia

(regular ECG complexes at a rate >200/minute)

shockable rhythm