Cardiopulmonary cerebral resuscitation: basic life support
Abstract
Cardiopulmonary arrest (CPA) is the cessation of spontaneous ventilation and systemic perfusion, which, if not rapidly detected and treated, leads to hypoxia and death. Cardiopulmonary cerebral resuscitation (CPCR) is a technique employed to reverse CPA. A review of veterinary and human literature revealed that producing evidence-based guidelines for veterinary CPCR is difficult due to the limited number of clinical veterinary studies. Many studies have been performed in human medicine and healthy animal models, however induced ventricular fibrillation does not represent clinically relevant situations. Despite this, evidence-based chest compression and ventilation rates for small animals can be recommended. Over-ventilation and inadequate chest compressions commonly occur during CPCR. Education of staff likely to be involved in CPCR and monitoring efficacy of CPCR during CPA is important to optimize the likelihood of success.
Cardiopulmonary arrest (CPA) is the cessation of spontaneous ventilation and systemic perfusion leading to inadequate tissue oxygen delivery and death. Cardiopulmonary cerebral resuscitation (CPCR) is a technique utilized to reverse CPA. Effective chest compressions can restore circulation, maintaining cerebral and myocardial perfusion, and ventilation aims to maintain adequate oxygenation until return of spontaneous circulation (ROSC). Nurses play an important role in CPCR as they are often the first on the scene. CPCR can be divided into three stages: basic life support; advanced life support; and post-resuscitation care. This article provides a review of how to perform effective basic life support. Recent veterinary and human literature is examined to provide some suggested guidelines for CPCR in small animal patients. Advanced life support will be discussed in a future article.
Studies have examined the survival rates of cats and dogs after CPCR and the survival to discharge rates are very low. Wingfield and Van Pelt (1992) report survival rates of 4.1% for dogs and 9.6% for cats after CPCR, which is similar to those reported by Kass and Haskins (1992) following full CPA. It is important to note that the reason for and the type of arrest profoundly affects survival. Wingfield and Van Pelt (1992) demonstrated that in patients with respiratory arrest alone, the success rate of resuscitation was much higher (28% of dogs and 58% of cats survived until discharge). All animals that survived had CPA due to drug overdose or general anaesthesia (Kass and Haskins, 1992). This demonstrates the importance of early intervention in respiratory arrest before full CPA occurs, and that the decision of whether to attempt resuscitation should take into account the reason for CPA as well as the owner's wishes. Cole et al (2002) suggest that if CPA is due to a reversible underlying disease, is vagally mediated or due to a drug overdose, then CPCR may lead to long-term survival and aggressive resuscitation attempts are warranted.
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