CPCR 2010: techniques and updates (Proceedings)
Nov 01, 2010
CVC IN SAN DIEGO PROCEEDINGS
CPCR is the restoration of spontaneous circulation AND the preservation of neurologic function. CPCR techniques are constantly evolving through laboratory and clinical research. The most comprehensive review of currently accepted American Heart Association (AHA) Guidelines can be found in the 2005 AHA Guidelines for CPR and Emergency Cardiac Care.
CPCR should be instituted in any dog or cat that lacks a patent airway, spontaneous respiration, or spontaneous circulation. The decision to initiate CPCR ultimately lies with the appropriately informed owner of the pet. A "code" status is an important piece of information to require from owners whether the problem that their pet is presenting with is likely to result in a situation requiring CPCR or not. The code status will direct the team whether to resuscitate or not (DNR). In this system, the veterinarian would make appropriate decisions as to what techniques should be employed to optimize the likelyhood of successful resuscitation.
Current Recommendations for Basic CPCR:
One of the keys to a successful "code" is for the team leader to rapidly assess the patient and delegate tasks to various members of the team. The leader must endotracheally intubate the patient (AIRWAY), as this step is THE MOST COMMON source of error in an arrest situation. One individual should be assigned to administering 10-24 breaths per minute (100% oxygen) (BREATHING) and maintaining endotracheal intubation by securing the endotracheal tube. A lower respiratory rate is most often utilized. This same individual should serve as a record keeper / timekeeper. One individual should institute chest compressions (CIRCULATION) at 100-120/minute. Chest compressions are most easily performed with the patient in right lateral recumbency with the hands placed atop one another over the base of the heart. The heart can be grasped and compressed between the hands in very small dogs and cats. In the situation in which a single rescuer is present, priority should be given to thoracic compressions over positive pressure ventilations. At this point in the "code", the team leader should assess whether compressions are generating a palpable pulse or improvement in mucous membrane color. If the compressions are not generating adequate pulses, the position of the hands should be altered slightly or other technical alterations made, and compressions resumed.
The decision to utilize open chest CPCR is based on the underlying pathology triggering the cardiac arrest, the size of the patient, and a lack of success of closed-chest CPCR. Absolute indicutions for immediate open-chest CPCR include pleural space (pneumothorax, pleural effusion, diaphragmatic hernia), pericardial space disease (pericardial effusion), and penetrating thoracic trauma that triggered the cardiac arrest. Open-chest CPCR should be considered in any animal in which closed chest CPCR is not successful.
Vascular Access and CPCR:
Vascular access has many purposes in the CPCR setting. Vascular access will allow for the administration of drug therapy in all patients and for IV fluids if the arrest occurred due to hypovolemia. The route of vascular access that can be acquired most rapidly is the best one for the situation. In a neonate, the intraosseous route is probably the most practical. In the event that vascular access cannot be rapidly established, drug therapy (epinephrine and atropine) can be administered at double the recommended dose down the endotracheal tube.