Abstract
In 2012 the Reassessment Campaign on Veterinary Resuscitation (RECOVER) published evidence-based treatment recommendations for dogs and cats with cardiopulmonary arrest (CPA), to optimize the clinical practice of small animal CPR and positively impact outcomes. Six years after the release of these guidelines, we aimed to determine the compliance of small animal veterinary CPR practices with these RECOVER guidelines. To identify current CPR practices in clinically active small animal veterinarians and their awareness of the RECOVER guidelines, we conducted an internet-based survey. Survey invitations were disseminated internationally via veterinary professional organizations and their social media outlets. Questions explored respondent demographics, CPR preparedness, BLS and ALS techniques and awareness of RECOVER guidelines. Responding small animal veterinarians (n = 770) in clinical practice were grouped by level of expertise: board-certified specialists (BCS, n = 216) and residents (RES, n = 69) in anesthesia or emergency and critical care, practitioners in emergency (GPE, n = 299) or general practice (GPG, n = 186). Large disparities in preparedness measures, BLS and ALS techniques emerged among levels of expertise. Only 32% (95% CI: 29–36%) of respondents complied with BLS practice guidelines, varying from 49% (95% CI: 42–55%) of BCS to 15% (95% CI: 10–20%) of GPG. While incompliances in BCS, RES, and GPE were predominantly due to knowledge gaps, GPG compliance was further compromised by limitations in the resuscitation environment (e.g., defibrillator availability, team size). Those aware of RECOVER guidelines (100% of BCS and RES; 77% of GPE; 35% of GPG) were more likely to comply with recommended preparedness (OR = 2.4; 95% CI: 1.2–4.8), BLS (OR = 4.5; 95% CI: 2.4–9.1), and ALS techniques (OR = 7.8; 95% CI: 2.4–9.1) independent of age, gender, region of practice or level of expertise. We conclude that awareness of RECOVER guidelines is high in specialists and residents, but incomplete among general practitioners. This awareness positively influenced compliance with CPR guidelines, but CPR practices continue to be variable and largely not in agreement with guidelines. A widely accessible educational strategy is required to broadly improve compliance with best practices in small animal CPR.
Highlights
Mortality is extremely high in small animals experiencing inhospital cardiopulmonary arrest (CPA)
Forty-eight percent of RES, 38% of board-certified specialists (BCS), and 34% of general practitioners working as emergency veterinarians (GPE) indicated that they were directly involved in cardiopulmonary resuscitation (CPR) more than 20 times per year, while general practitioners working in non-emergency positions (GPG) performed CPR predominantly once (31%; 95% CI: 25–38%) or 2–5 times (41%; 95% CI: 35–49%) per year
Survival from CPA is not possible without CPR and evidence suggests that survival rates from cardiac arrest, while very low, are not static, but can be improved by high-quality CPR delivery (18, 19)
Summary
Mortality is extremely high in small animals experiencing inhospital cardiopulmonary arrest (CPA). Survival to discharge rates range from 1.6–6% in dogs, and 2.3–9.6% in cats (1–5), whereas in humans, approximately 12% and 24% of adults survive out-of-hospital and in-hospital cardiac arrest, respectively (6). Implementation of a comprehensive CPR strategy, starting with recognition of CPA risk factors and extending far into the post-resuscitative phase, is imperative to improve survival rates associated with CPA (6, 7)
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