The ABC's of Cardiopulmonary Resuscitation

Introduction

Cardiopulmonary resuscitation (CPR) is a series of emergency procedures aimed at restoring and optimizing perfusion to the brain and heart during a period of cardiopulmonary arrest (CPA) in an effort to not only achieve return of spontaneous circulation (ROSC) but, more importantly, to promote a good neurologic outcome for the patient. Although the incidence of CPA in small animal patients is unknown, survival to discharge is poor with the best outcomes occurring in patients that arrest while under anesthesia (1). In contrast to humans, CPA in animals frequently involves hypoxia and poor tissue oxygenation which may complicate resuscitative measures and may explain the low incidence of survival to hospital discharge.

Until recently, veterinary CPR guidelines were mostly adopted from the human literature despite some notable differences in the physiology and pathophysiology of arrest. The first comprehensive, evidence-based consensus guidelines for CPR in small animals were recently published (2). This article reviews the central tenets of CPR, including basic and advanced life support, as well as post-resuscitative care, which may be utilized to help prevent unexpected death in small animal patients. [...]

Key Points

• Rapid recognition of cardiopulmonary arrest is essential and immediate basic life support, including securing a patent airway and provision of ventilation and chest compressions, is the foundation for successful cardiopulmonary resuscitation.

• Once basic life support measures have been instituted, advanced life support may be considered.

• Monitoring end-tidal carbon dioxide during CPR may be useful in evaluating efficacy of resuscitative measures.

• Re-arrest is common during the post-resuscitative period and survival to discharge following cardiopulmonary arrest is poor; therapy aimed at optimizing perfusion, oxygenation and ventilation will help to improve patient outcome.