Standardized veterinary CPR guidelines developed for dogs and cats

The survival rate of dogs and cats experiencing cardiopulmonary arrest while in the veterinary hospital is fairly bleak—only 6 percent to 7 percent survive to be discharged and returned to their families, according to the Veterinary Emergency and Critical Care Society (VECCS) and American College of Veterinary Emergency and Critical Care (ACVECC). In an effort to improve those outcomes, more than 100 board-certified veterinary specialists from around the world have collaborated to develop standardized CPR guidelines for companion animals, which were released in June.

The absence of standardized guidelines or training for cardiopulmonary resuscitation (CPR) in veterinary medicine has been cited as a major factor in the historically poor outcomes for dogs and cats in cardiac arrest. In fact, until the advent of evidence-based guidelines and standardized training in human medicine, survival rates in people were similar to animals, say VECCS and ACVECC spokespersons. Now human survival rates are at 20 percent.

In hopes of seeing similar improvement in veterinary patient outcomes, Daniel Fletcher, PhD, DVM, Dipl. ACVECC, assistant professor of emergency and critical care at Cornell University's College of Veterinary Medicine, and Manuel Boller, DVM, MTR (master of science in translational research), Dipl. ACVECC, senior research investigator at University of Pennsylvania's School of Veterinary Medicine and the Center for Resuscitation Science at Perelman School of Medicine, created the Reassessment Campaign on Veterinary Resuscitation (RECOVER), a collaborative project supported by VECCS and ACVECC.

The motivation for the initiative came about as the two colleagues were developing material for a CPR course. They soon discovered that there was considerable variation in CPR technique in the veterinary community and decided that needed to change.

"We wanted to formalize the process, do a more thorough review of existing evidence and develop true, evidence-based guidelines for CPR," Fletcher says. "We also wanted to establish consensus for the guidelines by involving more people in the veterinary community for the review process."

And that's just what they did. Veterinary specialists affiliated with the RECOVER initiative spent 18 months surveying more than 1,000 pieces of experimental and clinical CPR literature, critically appraising it and devising a series of evidence-based CPR guidelines for dogs and cats.

The process for developing the guidelines was similar to that used to develop the American Heart Association guidelines for CPR in human medicine. RECOVER identified five critical "domains," or subject areas, the guidelines needed to address: preparedness and prevention, basic life support, advanced life support, monitoring, and post-cardiac arrest care. In the end, 74 topics related to small animal CPR were evaluated, and from that analysis, 101 clinical guidelines were generated. The draft guidelines were made available to veterinary professionals for comment during an open feedback period and finalized by members of the RECOVER committee before publication.

The finished product includes detailed information about performing chest compressions, intubating and providing ventilation, monitoring the patient, gaining vascular access for drug administration and reversing the effects of sedatives and anesthetics, if those agents were used. Diagrams, step-by-step algorithms and drug dosing charts are also provided as quick-reference tools for practitioners.

Those closely involved with the project believe that the guidelines will have a substantial impact on the veterinary profession. "We finally have true, evidence-based guidelines that we can teach people and that will improve outcomes in patients," Fletcher says. "And on a greater scale, this is the first time in veterinary medicine that we've had a large initiative like this. This process is new for veterinary medicine and we hope that it will serve as a model to be applied to a lot of different questions in our profession."

The researchers state that while challenging, the methods used in this initiative—identifying and systematically evaluating specific key issues and questions using a collaborative approach and involving a variety of experts—are certainly feasible and could pave the way for further evidence-based efforts in veterinary medicine.

A free, downloadable version of the new CPR guidelines is currently available in a special issue of the Journal of Veterinary Emergency and Critical Care and online at www.veccs.org. In addition, RECOVER is working on developing a user-friendly, standardized training course to supplement the guidelines. Veterinary professionals who elect to take the course will become certified in CPR through ACVECC and VECCS.