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Dazio VER, Gay JM, Hoehne SN. Cardiopulmonary resuscitation outcomes of dogs and cats at a veterinary teaching hospital before and after publication of the RECOVER guidelines. J Small Anim Pract 2022; 64:270-279. [PMID: 36562427 DOI: 10.1111/jsap.13582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/15/2022] [Accepted: 10/21/2022] [Indexed: 12/24/2022]
Abstract
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. Factors associated with return of spontaneous circulation were determined using multi-variable logistic regression, odds ratios (95% confidence interval) generated, and significance set at P < 0.05. 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 in the post-Reassessment Campaign on Veterinary Resuscitation period 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. More extensive cardiopulmonary resuscitation training protocols should be established, and the compliance with and outcome benefits of a Reassessment Campaign on Veterinary Resuscitation-based cardiopulmonary resuscitation approach re-evaluated prospectively.
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Affiliation(s)
- V E R Dazio
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - J M Gay
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, USA
| | - S N Hoehne
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Hagley SP, Kruppert A, Leal RO, Pizarro del Valle JC, Iannucci C, Hennink I, Boiron L, Hoehne SN. Self-Reported Clinical Practice of Small Animal Cardiopulmonary Resuscitation and Compliance With RECOVER Guidelines Among Veterinarians in Eight Western European Regions. Front Vet Sci 2022; 9:919206. [PMID: 35937302 PMCID: PMC9352391 DOI: 10.3389/fvets.2022.919206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe objective of this study was to assess whether small animal veterinarians across Western Europe are compliant with the 2012 cardiopulmonary resuscitation (CPR) guidelines by the Reassessment Campaign on Veterinary Resuscitation (RECOVER).MethodsA previously published online questionnaire from Switzerland was adapted and translated into 7 languages, corresponding to national languages in Austria, France, Germany, Ireland, Italy, Liechtenstein, Netherlands, Portugal, Spain, and the United Kingdom. The survey was distributed via respective national veterinary organizations and social media outlets. A subset of questions was analyzed to evaluate respondent demographics, RECOVER guideline awareness, and to allocate composite compliance scores for CPR preparedness, basic life support (BLS) and advanced life support (ALS). Percentages of group total (95% confidence interval) were calculated. Multivariable logistic regression was used to evaluate the effects of region of practice, gender, age, specialty training, and guideline awareness on compliance. Odds ratios (95% confidence interval) were generated and significance set at P < 0.05.ResultsNine-hundred and thirty respondents were included in analysis. Awareness of and compliance with RECOVER guidelines varied widely across regions. Compliance with all assessed RECOVER guideline recommendations was highest in Germany/Austria [14% (7- 27%)] and lowest in France and Portugal [0% (0–3%)]. CPR preparedness compliance was higher in participants aware of RECOVER guidelines [OR 10.1 (5.2-19.5)], those practicing in Germany/Austria [OR 4.1 (1.9–8.8)] or UK/Ireland [OR 2.2 (1.3–3.7)], and lower in those practicing in Portugal [OR 0.2 (0.1–0.9)]. Specialty training [OR 1.8 (1.1–2.9)], guideline awareness [OR 5.2 (3.2–8.6)], and practice in Germany/Austria [OR 3.1 (1.5–6.5)], UK/Ireland [OR 2.6 (1.7–4.1)], or the Netherlands [OR 5.3 (2.0–14.2)] were associated with increased BLS compliance. ALS compliance was higher in participants with guideline awareness [OR 7.0 (2.9–17.0)], specialty training [OR 6.8 (3.8–12.1)], those practicing in Germany/Austria [OR 3.5 (1.3–9.6)], UK/Ireland [OR 4.0 (1.9–8.3)], or Spain [OR 3.2 (1.2–8.3)] and in younger survey participants [OR 0.9 (0.9–1.0)].ConclusionsAwareness and compliance with RECOVER guidelines varied widely among countries surveyed, however overall compliance scores in all countries were considered low. Further research may highlight factors surrounding poor guideline awareness and compliance so targeted efforts can be made to improve veterinary CPR in Europe.
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Affiliation(s)
- Simon P. Hagley
- Emergency and Critical Care Department, Vets Now Referrals, Manchester, United Kingdom
| | - Anne Kruppert
- Division of Anaesthesia and Analgesia, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Rodolfo Oliveira Leal
- CIISA Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal; Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS)
| | - José Carlos Pizarro del Valle
- , Small Animal Hospital, School of Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Claudia Iannucci
- Division of Small Animal Emergency and Critical Care, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Imke Hennink
- Division of Small Animal Emergency and Critical Care, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Ludivine Boiron
- Department of Emergency and Critical Care, Clinique Vétérinaire Languedocia, Montpellier, France
| | - Sabrina N. Hoehne
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States
- *Correspondence: Sabrina N. Hoehne
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Development and implementation of veterinary anesthesia medical quality standards for primary care. Vet Anaesth Analg 2022; 49:233-242. [DOI: 10.1016/j.vaa.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 01/07/2022] [Accepted: 01/28/2022] [Indexed: 11/22/2022]
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Ward MJ, Blong AE, Walton RA. Feline cardiopulmonary resuscitation: Getting the most out of all nine lives. J Feline Med Surg 2021; 23:447-461. [PMID: 33719693 PMCID: PMC10741280 DOI: 10.1177/1098612x211004811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PRACTICAL RELEVANCE Cardiopulmonary arrest (CPA) can occur in any veterinary or animal care setting and is a particular risk in scenarios involving ill, injured or anesthetized patients. Education of all staff on the prevention and recognition of CPA, as well as the performance of cardiopulmonary resuscitation (CPR), is vital to influencing outcome. EVIDENCE BASE While there is a plethora of information regarding CPA and CPR in human medicine, there are comparably few studies in the veterinary literature. Many of the current veterinary guidelines are extrapolated from human medicine or studies based on animal models. Ongoing work is needed to tailor guidelines and recommendations to our domestic feline (and canine) patients in a clinical setting. AIM The aim of this article, which is intended for veterinarians in all areas of small animal practice, is to provide an evidence-based review of CPA and CPR in feline patients. The authors have drawn heavily on detailed recommendations published by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) initiative - one of the few resources specific to the veterinary clinical setting - as well as reviewing the available peer-reviewed literature studies, in constructing this article. Among the topics discussed are recognizing and preventing CPA, staff training and clinic preparedness, basic life support and advanced life support interventions, and appropriate post-cardiac arrest care.
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Affiliation(s)
- Melody J Ward
- College of Veterinary Medicine, Iowa State
University, Ames, Iowa, USA
| | | | - Rebecca A Walton
- Department of Veterinary Clinical Sciences,
Iowa State University, Ames, Iowa, USA
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Donaldson L, Stevenson MA, Fletcher DJ, Gillespie Í, Kellett-Gregory L, Boller M. Differences in the clinical practice of small animal CPR before and after the release of the RECOVER guidelines: Results from two electronic surveys (2008 and 2017) in the United States and Canada. J Vet Emerg Crit Care (San Antonio) 2020; 30:615-631. [PMID: 32975359 DOI: 10.1111/vec.13010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/24/2019] [Accepted: 03/29/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess whether the clinical approach to CPR has changed following the publication of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) guidelines in 2012. DESIGN Internet-based survey. SETTING Academia and referral practice. SUBJECTS Four hundred and ninety-one small animal veterinarians in clinical practice in the United States and Canada. INTERVENTIONS An internet-based survey assessing the clinical approach to small animal CPR was circulated with the assistance of veterinary professional organizations on 2 separate occasions: prior to (2008) and following (2017) publication of the 2012 (RECOVER) guidelines. Survey questions identical to both surveys solicited details of clinician approaches to CPR preparedness, basic life support (BLS), and advanced life support (ALS). Respondents were grouped into level of expertise (board-certified specialists [BCS, n = 202] and general practitioners in emergency clinics [GPE, n = 289]), and year of response to the survey (2008, n = 171; 2017, n = 320). MEASUREMENTS AND MAIN RESULTS Compliance with the RECOVER guidelines pertaining to CPR preparedness (P < 0.01), BLS (P < 0.01), and ALS P < 0.01) was consistently higher in respondents to the 2017 survey compared to those of the 2008 survey. Being a BCS was associated with significantly higher compliance with the RECOVER recommendations than GPE in the domains of preparedness (P = 0.02), BLS (P < 0.01), and ALS (P < 0.01). Increases in age of the respondent had a negative effect on compliance with the BLS guidelines (P < 0.01), while gender had no effect. CONCLUSIONS Compared to 2008, current practices in small animal CPR in the North American emergency and critical care community shifted toward those recommended in the RECOVER guidelines across all CPR domains. This supports the notion that uptake of the RECOVER guidelines among veterinary emergency or critical care clinicians was sufficient to lead to a change in the practice of CPR.
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Affiliation(s)
- Liam Donaldson
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia
| | - Mark A Stevenson
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia
| | - Daniel J Fletcher
- College of Veterinary Medicine, Department of Clinical Sciences, Cornell University, Ithaca, New York
| | - Íde Gillespie
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia
| | | | - Manuel Boller
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia.,Translational Research and Clinical Trials (TRACTs), Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Melbourne, Australia
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Boller M, Fletcher DJ. Update on Cardiopulmonary Resuscitation in Small Animals. Vet Clin North Am Small Anim Pract 2020; 50:1183-1202. [PMID: 32798056 DOI: 10.1016/j.cvsm.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cardiopulmonary arrest (CPA), the acute cessation of ventilation and systemic perfusion, leads to discontinuation of tissue oxygen delivery and death if not quickly reversed. Reported resuscitation rates suggest that the heart can be restarted in 40% to 50% of dogs and cats treated with cardiopulmonary resuscitation (CPR). However, approximately 80% of these animals do not survive to hospital discharge. To minimize mortality due to CPA a broad strategy is required including preparedness and prevention measures, basic and advanced life support as well as post-cardiac arrest care. This article summarizes the current guidelines on the treatment of small animals with CPA..
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Affiliation(s)
- Manuel Boller
- Melbourne Veterinary School, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Daniel J Fletcher
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, DCS Box 31, Ithaca, NY 14853, USA
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Mathis A. Preparing and training for CPR in small animal practice. Vet Rec 2020; 184:412-413. [PMID: 30926701 DOI: 10.1136/vr.l1467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Alessandra Mathis
- Willows Veterinary Centre & Referral Service, Highlands Road, Shirley, Solihull, West Midlands B90 4NH
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Hoehne SN, Epstein SE, Hopper K. Prospective Evaluation of Cardiopulmonary Resuscitation Performed in Dogs and Cats According to the RECOVER Guidelines. Part 1: Prognostic Factors According to Utstein-Style Reporting. Front Vet Sci 2019; 6:384. [PMID: 31788482 PMCID: PMC6854014 DOI: 10.3389/fvets.2019.00384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/21/2019] [Indexed: 11/13/2022] Open
Abstract
Factors associated with positive cardiopulmonary resuscitation (CPR) outcomes defined according to the veterinary Utstein-style CPR reporting guidelines have not been described since implementation of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR clinical guidelines in 2012. The aims of this study were to assess factors associated with positive CPR outcomes at a U.S. veterinary teaching hospital, to re-evaluate these factors since implementation of the RECOVER guidelines compared to reported factors prior to their publication, and to identify potential additional factors since guideline publication. One-hundred and seventy-two dogs and 47 cats that experienced cardiopulmonary arrest (CPA) and had CPR performed were prospectively included in this observational study. Supervising clinicians were asked to complete a data form on CPR events immediately following completion of CPR efforts. Multivariable logistic regression was used to evaluate the effect of twenty hospital, animal, and arrest variables on the three patient outcomes “any return of spontaneous circulation (ROSC),” “sustained ROSC,” and survival to hospital discharge. Cats had significantly higher odds to achieve any ROSC [OR (95%CI) 2.72 (1.12–6.61), p = 0.028] and survive to hospital discharge than dogs [OR (95%CI) 4.87 (1.52–15.58), p = 0.008]. Patients had significantly lower odds of achieving any ROSC if CPA occurred during nighttime hours [OR (95%CI) nighttime = 0.52 (0.27–0.98), p = 0.043], and higher odds if CPA was witnessed [OR (95%CI) 3.45 (1.57–7.55), p = 0.002], if less people were involved in CPR efforts [OR (95%CI) 0.8 (0.66–0.96), p = 0.016], if pulses were palpable during CPR [OR (95%CI) 9.27 (4.16–20.63), p < 0.0005], and if an IV catheter was already in place at the time of CPA [OR (95%CI) 5.07 (2.12–12.07), p = 0.0003]. Odds for survival to hospital discharge were significantly higher if less people were involved in CPR efforts [OR (95%CI) 0.65 (0.46–0.91), p = 0.013] and for patients of the anesthesia service [OR (95%CI) 14.82 (3.91–56.17), p = 0.00007]. Overall, factors associated with improved CPR outcomes have remained similar since incorporation of RECOVER guidelines into daily practice. Witnessed CPA events and high-quality CPR interventions were associated with positive patient outcomes, emphasizing the importance of timely recognition and initiation of CPR efforts. An optimal CPR team size has yet to be determined.
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Affiliation(s)
- Sabrina N Hoehne
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Steven E Epstein
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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Mathis A. Preparing and training for CPR. IN PRACTICE 2019. [DOI: 10.1136/inp.k5125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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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 (San Antonio) 2014; 24:693-704. [DOI: 10.1111/vec.12250] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 05/17/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Robin L. McIntyre
- William R. Pritchard Veterinary Medical Teaching Hospital; Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
| | - Kate Hopper
- William R. Pritchard Veterinary Medical Teaching Hospital; Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
| | - Steven E. Epstein
- William R. Pritchard Veterinary Medical Teaching Hospital; Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
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Fletcher DJ, Boller M. Updates in small animal cardiopulmonary resuscitation. Vet Clin North Am Small Anim Pract 2013; 43:971-87. [PMID: 23747269 DOI: 10.1016/j.cvsm.2013.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
For dogs and cats that experience cardiopulmonary arrest, rates of survival to discharge are 6% to 7%, as compared with survival rates of 20% for people. The introduction of standardized cardiopulmonary resuscitation guidelines and training in human medicine has led to substantial improvements in outcome. The Reassessment Campaign on Veterinary Resuscitation initiative recently completed an exhaustive literature review and generated a set of evidence-based, consensus cardiopulmonary resuscitation guidelines in 5 domains: preparedness and prevention, basic life support, advanced life support, monitoring, and postcardiac arrest care. This article reviews some of the most important of these new guidelines.
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Affiliation(s)
- Daniel J Fletcher
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, DCS Box 31, Ithaca, NY 14853, USA.
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Boller M, Fletcher DJ. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 1: Evidence analysis and consensus process: collaborative path toward small animal CPR guidelines. J Vet Emerg Crit Care (San Antonio) 2012; 22 Suppl 1:S4-12. [DOI: 10.1111/j.1476-4431.2012.00758.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Manuel Boller
- Department of Emergency Medicine; School of Medicine; Center for Resuscitation Science; and the Department of Clinical Studies; School of Veterinary Medicine; University of Pennsylvania; Philadelphia; PA
| | - Daniel J. Fletcher
- College of Veterinary Medicine; Department of Clinical Sciences; Cornell University; Ithaca; NY
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