L&J Chi 5 Anesthetic Emergencies and Resuscitation

Question 1

At the time of publication, what are the most recent measures of anesthetic-associated mortality in veterinary medicine?

Answer 1

Canine: 0.17%
Feline: 0.24%
Rabbits: 1.39%

Question 2

What is the most common cause of anesthetic complications?

Answer 2

70% involved human error

Question 3

Cardiopulmonary arrest

Answer 3

CPA
Dynamic, time-dependent process occurring secondary to failed cardiac contractility –> results in either ventricular asystole, PEA, pulseless VT, ventricular fibrillation

Question 4

Aims of CPR?

Answer 4

Provide blood flow to the heart and brain until restoration of spontaneous circulation

Question 5

Use of the term “cardiopulmonary resuscitation”

Answer 5

-Not used as a medical term until 1958 when tx of CPA shifted from open chest cardiac massage to closed chest compressions, defibrillation

Question 6

At time of publication: initial CPR success/return of spontaneous circulation

Answer 6

Dogs: 28-35%
Cats: 42-44%

Question 7

At time of publication: what are the survival to discharge rates following CPR?

Answer 7

Dogs: 4.1-6.0%
Cats: 7-9%
Every minute spent performing CPR adds significant morbidity and risk and the success rate decreases rapidly

Question 8

Outcome of CPR

Answer 8

• Depends on timely intervention of effective interventions
• Regardless of initial training, there is always time-related decay of skills
• Recommend refresher courses/simulation practice Q6 mo

Question 9

CPR Equipment

Answer 9

• Necessary emergency drugs, equipment should be organized in one place (ie crash cart)
• Cart should be adequately stocked, regularly audited, placed in readily accessible area
• Include supplies for venous access, airway management, initial pharmacological therapy
• Surgery kit: emergency thoracotomy, tracheostomy, venous dissection

Question 10

History Human CPR Guidelines:

Answer 10

• 1992: International Liaison Committee on Resuscitation (ILCOR) was created to develop an internationally accepted CPR protocol
• Composed of American Heart Association (AHA), European Resuscitation Council, and Heart and Stroke Foundation of Canada

Question 11

What were the ILCOR protocols designed on?

Answer 11

Protocols based on research discussed at the International Consensus Conference for CPR and Emergency CV Science and Treatment

Question 12

Publication of the ILCOR guidelines

Answer 12

-Published first international CPR guidelines in in 2000, revised protocol in 2005 and 2010

Question 13

Veterinary CPR guidelines

Answer 13

• 2012: Reassessment Campaign on Veterinary Resuscitation
• Goal: provide evidence-based CPR guidelines for veterinary medicine, combo of ACVAA and ACVECC diplomates
• Collaborative initiative that systematically evaluated published evidence regarding 75 topics relevant to SA CPR and generated CPR guidelines

Question 14

BLS

Answer 14

Basic Life Support

Question 15

Basic Life Support (BLS)

Answer 15

• Recognition of CPA
• Initiation of chest compressions
• Airway management
• Assisted ventilation

Quality of BLS performed directly related to ROSC and survival rate

Question 16

Change to human guidelines in 2010 with BLS

Answer 16

• Order of intervention for all age groups except newborns was: airway - breathing - circulation/chest compressions
• Change: circulation/chest compressions - airway - breathing
• Change was made partially due to fact securing an airway in humans is challenging; prolonged intubation time causes a delay in initiation of chest compression, which negative impacts ROSC
• Large percentage of CPA in human DT primary cardiac disease

Question 17

Veterinary BLS Order Guidelines

Answer 17

• ABC resuscitation still preferred
• Many veterinary CPA cases due to ventilatory/pulmonary failure and not myocardial ischemia
• In most small animals, fairly easy to intubate and secure airway
• If CPA unwitnessed or not due to primary cardiac disease, traditional ventilation first or ABC resuscitation acceptable
• If witnessed CPA due to primary cardiac disease, CAB recommended