Apparently the main reason cats and dogs that experience cardiopulmonary arrest (CPA) have poor survival outcomes relative to their human counterparts, is because there has been a lack of training and standardised, evidence-based guidelines in cardiopulmonary resuscitation (CPR) in the veterinary profession [1]. The RECOVER initiative was developed in an attempt to address this problem. Now we have a scientific basis for standardised guidelines, and formal training for CPR in small animals is available, any resultant improvement in survival outcomes now depends on the extent this knowledge is disseminated and whether training is widely undertaken by veterinary staff. In an arrest situation, there is no time for research or training, which means the best time to learn the fundamentals of veterinary CPR, is now.

CPR Training in Small Animals: Where to Begin?

1. Watch this video, featuring ECC specialist Dr Erin Mooney, demonstrating the technique required to successfully perform chest compressions and ventilation in dogs and cats in a cardiopulmonary arrest (CPA) situation
2. Read the RECOVER evidence based guidelines, published in a special, freely accessible issue of the Journal of Veterinary Emergency and Critical Care [2]
3. Undergo formal training and certification in veterinary CPR – available via the RECOVER initiative and formally recognized by the Veterinary Emergency and Critical Care Society (VECCS)
4. Undergo veterinary team training in clinic. Contact your local ECC specialist to enquire if they run courses on site.  Dr Erin Mooney offers this service to clinics in Sydney (details below).

What about CPR in other species?

CPR is an area in which veterinary studies are generally lacking [2, 3, 4,8] and current veterinary guidelines rely heavily on first principles and extrapolation from other species (especially human literature).

No doubt as a result, many of the fundamentals for basic CPR remain consistent across species. Key recommendations include:

1. Early recognition of CPA and rapid intervention [2, 3, 5, 6,8]
2. Chest compressions: 2 minute cycles of uninterrupted chest compressions before checking rhythm [2, 3, 4, 5, 6] and avoiding rescuer fatigue by alternating rescuers performing compressions if possible [2, 3, 7]. Rescuers should ensure adequate depth of chest compressions to approximately 1/3 of the width of the chest [2, 3, 4, 5, 6], taking care with small patients with highly compliant chests [4]. The recommended rate is 100-120bpm in most species [3, 4, 5, 7,8], with the main exception being birds, in which chest compressions are utilised primarily to pump air through the air sacs, and the recommended rate is therefore around 60-80/minute [4].
3. Ventilation: Establishing control of the airway and providing positive pressure ventilation [2, 3, 4] is a key component of basic CPR in all species but is the area in which there appears to be most variation in species guidelines. In most species the recommended rate is 10bpm[3, 5,8]; however in small birds and mammals (with higher metabolic rates,) 20-40bpm is the recommendation [4]; while in reptiles (who can survive long periods using anaerobic metabolism), rates from 1-6bpm are suggested [4]. In humans, the current protocol is to give 30 chest compressions followed by 2 breaths [6].

Before undertaking CPR in veterinary species, part of the hazard assessment must include the possibility of transmission of zoonotic disease, particularly if mouth to mouth or mouth to nose procedures are used (8]. The clinician should also establish if an animal is a suitable candidate for resuscitation on welfare or viability grounds [3,8].

About the Presenter

Dr Erin Mooney BVSc DACVECC, an Emergency and Critical Care Specialist and lecturer at the University of Sydney, presents this video. Erin has a passion for both teaching and research, and has a particular interest in pulmonary disease, mechanical ventilation, trauma, transfusion medicine and peri-operative care. I first met Erin at vet school at the University of Sydney, and she was as delightful to work with in filming this video as I remember her in those days.

Erin can be contacted for personalised veterinary team training in CPR in Sydney veterinary hospitals.  Hands-on training for all veterinary staff in these key skills, and defining their roles in an emergency and within the context of your individual facilities, could prove invaluable.

Email:  erin.mooney@sydney.edu.au 

Need to know more?

Many of the references below give a good understanding of the considerations for CPR in various species, and include both Basic Life Support and Advanced Life Support recommendations and emergency drug doses. The species differences (particularly birds and exotics) that are relevant to this field are fascinating – I suggest reading them for interest’s sake, even if you do not treat these species in practice.

Don’t forget to update your first aid training with an accredited centre (in Australia find one at https://resus.org.au/courses/accredited-course-centres/). You never know when it might be a human life you need to save.

References

[1] RECOVER, Recover Guidelines [Website], accessed 8 July 2019, <https://www.recoverinitiative.org/cpr-guidelines/current-recover-guideline/>

[2] Hopper, K., Epstein, S.E., Fletcher, D.J., Boller, M., and the RECOVER Basic Life Support Domain Worksheet Authors. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 3: Basic life support, J Vet Emerg Crit Car, vol. 22 (SI), pp S26-S43, 2012

[3] Jokisalo, J.M. and Corley, K.T.T. CPR in the Neonatal Foal Has RECOVER Changed Our Approach? Vet Clin Equine, vol 30, pp301-316, 2014

[4] Pollock, C., and Lichtenberger, M. (2017), Cardiopulmonary Resuscitation in Exotic Animals, [Website], LafeberVet, accessed 10 July 2019, https://lafeber.com/vet/cardiopulmonary-resuscitation-in-exotic-animals/

[5] Fletcher, D.J., Boller, M., Brainard, B.M., Haskins, S.C. Hopper, K., McMichael, M.A., Rozanski, E.A., Rush, J.E. and Smarick, S.D., RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 7: Clinical guidelines, J Vet Emerg Crit Car, vol. 22 (S1), ppS102-S131, 2012

[6] Australian and New Zealand Committee on Resuscitation (ANZCOR), ANZCOR Guideline 8 – Cardiopulmonary Resuscitation (CPR) [Website], Australian Resuscitation Council and New Zealand Resuscitation Council, accessed 10 July 2019, https://resus.org.au/guidelines

[7] Australian and New Zealand Committee on Resuscitation (ANZCOR), ANZCOR Guideline 6 – Compressions [Website], Australian Resuscitation Council and New Zealand Resuscitation Council, accessed 10 July 2019, https://resus.org.au/guidelines

[8] Nagy, D.W. Resuscitation and Critical Care of Neonatal Calves. Vet Clin North Am Food Anim Pract, vol 25 (1), pp 1-9, 2009