1
|
Burkitt-Creedon JM, Boller M, Fletcher DJ, Brainard BM, Buckley GJ, Epstein SE, Fausak ED, Hopper K, Lane SL, Rozanski EA, Wolf J. 2024 RECOVER Guidelines: Updated treatment recommendations for CPR in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2024; 34 Suppl 1:104-123. [PMID: 38924627 DOI: 10.1111/vec.13391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 04/25/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE After the 2012 Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR Guidelines, this is an update of evidence-based consensus guidelines for Basic Life Support (BLS), advanced life support (ALS), and periarrest monitoring. DESIGN These RECOVER CPR Guidelines were generated using a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for evidence evaluation and translation of this evidence into clear and actionable clinical instructions. Prioritized clinical questions in the Population, Intervention, Comparator, and Outcome (PICO) format were used as the basis to conduct systematic literature searches by information specialists, to extract information from relevant publications, to assess this evidence for quality, and finally to translate the findings into treatment recommendations. These recommendations were reviewed by the RECOVER writing group and opened for comment by veterinary professionals for 4 weeks. SETTING Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS A total of 40 worksheets were prepared to evaluate questions across the 3 domains of BLS, ALS and Monitoring, resulting in 90 individual treatment recommendations. High-dose epinephrine is no longer recommended, and atropine, if used, is only administered once. Bag-mask ventilation is prioritized over mouth-to-nose ventilation in nonintubated animals. In addition, an algorithm for initial assessment, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug dosing table are provided. CONCLUSIONS While the majority of the BLS and ALS recommendations remain unchanged, some noteworthy changes were made due to new evidence that emerged over the past 10 years. Indirectness of evidence remains the largest impediment to the certainty of guidelines formulation and underscores an urgent need for more studies in the target species of dogs and cats.
Collapse
Affiliation(s)
- Jamie M Burkitt-Creedon
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Manuel Boller
- VCA Canada Central Victoria Veterinary Hospital, Victoria, British Columbia, Canada
- Faculty of Veterinary Medicine, Department of Veterinary Clinical and Diagnostic Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Daniel J Fletcher
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | | | - Steven E Epstein
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Erik D Fausak
- University Library, University of California, Davis, Davis, California, USA
| | - Kate Hopper
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Selena L Lane
- Veterinary Emergency Group, Cary, North Carolina, USA
| | - Elizabeth A Rozanski
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Jacob Wolf
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
2
|
Hoehne SN, Balakrishnan A, Silverstein DC, Pigott AM, Tart KM, Rozanski EA, Powell LL, Boller M. Reassessment Campaign on Veterinary Resuscitation (RECOVER) Initiative small animal CPR registry report 2016-2021. J Vet Emerg Crit Care (San Antonio) 2023; 33:143-155. [PMID: 36573548 DOI: 10.1111/vec.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To introduce the Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR registry and report cardiopulmonary arrest (CPA) and CPR event data collected to date. DESIGN International, multi-institutional veterinary CPR registry data report. SETTING Veterinary private practice and university teaching hospitals. ANIMALS Data from 514 dogs and 195 cats undergoing CPR entered in the RECOVER CPR registry between February 2016 and November 2021. INTERVENTIONS The RECOVER CPR registry is an online medical database created for standardized collection of hospital, animal, arrest, and outcome information on dogs and cats undergoing CPR. Data were collected according to the veterinary Utstein-style guidelines for standardized reporting of in-hospital CPR in dogs and cats. Case records were downloaded, duplicate and incomplete cases were removed, and summary descriptive data were reported. MEASUREMENTS AND MAIN RESULTS Sixteen hospitals in the United States, Europe, and Australia contributed data on 709 CPR events to the registry. One hundred and forty-two (28%) dogs and 58 (30%) cats attained return of spontaneous circulation (ROSC), 62 (12%) dogs and 25 (13%) cats had ROSC >20 minutes, and 14 (3%) dogs and 4 (2%) cats survived to hospital discharge. The reason for CPR discontinuation was reported as owner choice in 321 cases (63%). The most common suspected causes for CPA were respiratory failure (n = 142, 20%), heart failure (n = 86, 12%), and hemorrhage (n = 76, 11%). CONCLUSION The RECOVER CPR registry contains the first multicenter data set on small animal CPR. It confirms poor outcomes associated with CPA, emphasizing the need for large-sized studies to gain adequate information on characteristics associated with favorable outcomes.
Collapse
Affiliation(s)
- Sabrina N Hoehne
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | | | - Deborah C Silverstein
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Armi M Pigott
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Kelly M Tart
- Veterinary Medical Center, University of Minnesota, St Paul, Minnesota, USA
| | - Elizabeth A Rozanski
- Cummings School of Veterinary Medicine, Tufts University, Grafton, Massachusetts, USA
| | - Lisa L Powell
- BluePearl Veterinary Partners, Eden Prairie, Minnesota, USA
| | - Manuel Boller
- VCA Canada Central Victoria Veterinary Hospital, Victoria, British Columbia, Canada
- School of Veterinary Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | | |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|