Prospective Evaluation of Cardiopulmonary Resuscitation Performed in Dogs and Cats According to the RECOVER Guidelines. Part 1: Prognostic Factors According to Utstein-Style Reporting.

Sabrina N Hoehne,Steven E Epstein,Kate Hopper

doi:10.3389/fvets.2019.00384

Abstract

Factors associated with positive cardiopulmonary resuscitation (CPR) outcomes defined according to the veterinary Utstein-style CPR reporting guidelines have not been described since implementation of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR clinical guidelines in 2012. The aims of this study were to assess factors associated with positive CPR outcomes at a U.S. veterinary teaching hospital, to re-evaluate these factors since implementation of the RECOVER guidelines compared to reported factors prior to their publication, and to identify potential additional factors since guideline publication. One-hundred and seventy-two dogs and 47 cats that experienced cardiopulmonary arrest (CPA) and had CPR performed were prospectively included in this observational study. Supervising clinicians were asked to complete a data form on CPR events immediately following completion of CPR efforts. Multivariable logistic regression was used to evaluate the effect of twenty hospital, animal, and arrest variables on the three patient outcomes “any return of spontaneous circulation (ROSC),” “sustained ROSC,” and survival to hospital discharge. Cats had significantly higher odds to achieve any ROSC [OR (95%CI) 2.72 (1.12–6.61), p = 0.028] and survive to hospital discharge than dogs [OR (95%CI) 4.87 (1.52–15.58), p = 0.008]. Patients had significantly lower odds of achieving any ROSC if CPA occurred during nighttime hours [OR (95%CI) nighttime = 0.52 (0.27–0.98), p = 0.043], and higher odds if CPA was witnessed [OR (95%CI) 3.45 (1.57–7.55), p = 0.002], if less people were involved in CPR efforts [OR (95%CI) 0.8 (0.66–0.96), p = 0.016], if pulses were palpable during CPR [OR (95%CI) 9.27 (4.16–20.63), p < 0.0005], and if an IV catheter was already in place at the time of CPA [OR (95%CI) 5.07 (2.12–12.07), p = 0.0003]. Odds for survival to hospital discharge were significantly higher if less people were involved in CPR efforts [OR (95%CI) 0.65 (0.46–0.91), p = 0.013] and for patients of the anesthesia service [OR (95%CI) 14.82 (3.91–56.17), p = 0.00007]. Overall, factors associated with improved CPR outcomes have remained similar since incorporation of RECOVER guidelines into daily practice. Witnessed CPA events and high-quality CPR interventions were associated with positive patient outcomes, emphasizing the importance of timely recognition and initiation of CPR efforts. An optimal CPR team size has yet to be determined.

Highlights

There has been growing awareness of the importance of veterinary cardiopulmonary resuscitation (CPR) in recent years and the Reassessment Campaign on Veterinary Resuscitation (RECOVER) clinical guidelines on veterinary CPR were published in 2012
Several factors associated with increased rates of return of spontaneous circulation (ROSC) and survival rates in veterinary CPR have previously been identified and include hospital, patient, and arrest variables such as the number of people involved in CPR efforts, arrest due to absolute or relative drug overdose, shorter time to CPR initiation, shorter CPR duration, palpable pulses during CPR, and presence of an intravenous catheter (IVC) at the time of cardiopulmonary arrest (CPA) [2,3,4]
46% of patients undergoing CPR achieved ROSC, which is comparable to previous veterinary studies reporting ROSC in 28–60% of dogs and 42–44% of cats, and to reports of ROSC rates of up to 53% for in-hospital cardiac arrest of human patients [3, 4, 16,17,18]

Summary

Introduction

There has been growing awareness of the importance of veterinary cardiopulmonary resuscitation (CPR) in recent years and the Reassessment Campaign on Veterinary Resuscitation (RECOVER) clinical guidelines on veterinary CPR were published in 2012. These formed the first evidence-based performance of CPR guidelines in dogs and cats, and the basis for more uniform CPR training amongst veterinary professionals [1]. In human medicine, reporting guidelines for CPR event data were first published in 1991 as the “Utstein Style guidelines for uniform reporting of data from out-ofhospital cardiac arrest” [5]. Only one prospective veterinary study investigating a single monitoring variable as a predictor of improved CPR outcome employed veterinary Utstein-style definitions of ROSC [13]

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