Survey of academic veterinarians' clinical practice in cardiopulmonary–cerebral resuscitation

Objective: To document the clinical practice of cardiopulmonary–cerebral resuscitation (CPCR) among academic veterinarians. Design: Survey. Setting: Eight colleges of veterinary medicine in the United States. Subjects: Two hundred and one academic veterinarians. Interventions: The survey was distributed by hand by the authors into the mailboxes of small animal faculty, residents, and interns. Demographic variables, questions regarding number of cardiopulmonary arrests (CPA) supervised and number successful, do not attempt resuscitation discussions, and Likert‐style questions about client presence during CPCR, appropriateness of CPCR, and CPCR decision‐making were included. Multiple linear regression models were constructed to determine the effect of multiple questions on different target variables of interest. Measurements and main results: Numerous differences were noted based on institution, gender, specialty, and position. Most institutions did not have a standard resuscitation consent form. Most respondents believed the client, house officer, and senior clinician should determine whether to perform resuscitation or not. Quality of life was the most significant determinant of whether to resuscitate or not, followed by long‐term prognosis, then short‐term prognosis. Conclusions: Veterinarians differ in many aspects of their approach to CPA and resuscitation. Creating consensus within the veterinary profession would benefit client service and patient care.     

Survival Following Cardiopulmonary Resuscitation in Dogs and Cats

Dogs and cats receiving cardiopulmonary resuscitation (CPR) were evaluated for factors leading to cardiac arrest and for survival following the procedure. One-hundred-thirty-five canine and forty-three feline patients seen at the University of California, Davis Veterinary Medical Teaching Hospital that received CPR between August 1987 and December 1991 were studied. Initial resuscitation attempts were unsuccessful in 72% of dogs and 58% of cats. Five dogs and one cat were still alive 3 days after CPR. Ultimately only four dogs and one cat were discharged from the hospital alive. These five patients with uniquely longer survival all had cardiac arrests associated with drug and/or anesthetic reactions.     

Cardiopulmonary resuscitation in small animal medicine: an update

In December 2005, the American Heart Association published new guidelines for cardiopulmonary cerebral resuscitation (CPCR) in humans for the 1st time in 5 years. Many of the recommendations are based on research conducted in animal species and may be applicable to small animal veterinary patients. One important change that may impact how CPCR is performed in veterinary medicine is the recommendation to avoid administration of excessive ventilatory rates because this maneuver severely decreases myocardial and cerebral perfusion, decreasing the chance of survival. The new guidelines also emphasize the importance of providing well-executed, continuous, uninterrupted chest compressions. Interruption of chest compressions should be avoided and, if necessary, should be minimized to <10 seconds. During defibrillation, immediate resumption of chest compressions for 2 minutes after a single shock, before reassessment of the rhythm by ECG, is recommended. This recommendation replaces previous recommendations for the delivery of 3 defibrillatory shocks in rapid succession. Allowing permissive hypothermia postresuscitation has been found to be beneficial and may increase success rate. Medications utilized in cardiopulmonary resuscitation, including amiodarone, atropine, epinephrine, lidocaine, and vasopressin, along with the indications, effects, routes of administration, and dosages, are discussed. The application of the new guidelines to veterinary medicine as well as a review of cardiopulmonary resuscitation in small animals is provided.     

The clinical practice of CPCR in small animals: an internet‐based survey

Objective – To characterize the provision of CPCR by small animal veterinarians in clinical practice and to assess how this practice varies among different levels of expertise. Design – Internet‐based survey. Setting – Academia, referral practice, and general practice. Subjects – Six hundred and two small animal veterinarians in clinical practice. Respondents were grouped a priori according to level of expertise: board‐certified (ACVECC, ACVA, ECVAA) specialists; general practitioners in emergency clinics; general practitioners in general practice (GPG). Interventions – Email invitations to the online questionnaire were disseminated via a veterinary internet platform and mailing list server discussion groups. Questions explored respondent characteristics, CPCR preparedness, infrastructural and personnel resources, and techniques of basic and advanced life support. Main Results – In this group of practitioners, the majority (65%) were in general practice. GPG were more likely to perform CPCR <5 times per year and to have 3 or fewer members on their resuscitation team. Most practitioners have a crash cart and drug‐dosing chart available. GPG were less likely to obtain resuscitation codes on their patients, and less likely to use end‐tidal carbon dioxide monitoring or defibrillation. Intubation, oxygen supplementation, vascular access, and external thoracic compressions were widely used, however, GPG were more likely to use lower chest compression rates. Drugs used for CPCR differed among the groups with GPG more likely to use doxapram and glucocorticoids. Conclusions – CPCR is heterogeneously performed in small animal veterinary medicine; differences exist, both among and within different types of veterinarians with varying levels of expertise, in respect to available infrastructure, personnel and CPCR techniques used.     

Cardiopulmonary resuscitation with vasopressin in a dog

That endogenous vasopressin levels in successfully resuscitated human patients were significantly higher than in patients who died pointed to the possible benefit of administering vasopressin during cardiopulmonary resuscitation (CPR). Several CPR studies in pigs showed that vasopressin improved blood flow to vital organs, cerebral oxygen delivery, resuscitability and neurological outcome when compared with epinephrine. In a small clinical study, vasopressin significantly improved short-term survival when compared with epinephrine indicating its potential as an alternative pressor to epinephrine during CPR in human beings. As there was little clinical data available at that time, its recommended use was limited to adult human beings with shock-refractory ventricular fibrillation. In this report, we present the case of a dog in which the successful management of intraoperative asystolic cardiac arrest involved vasopressin. Unexpected cardiac arrest occurred during anaesthesia for the surgical removal of multiple mammary adenocarcinomata in a 11-year-old Yorkshire terrier. Despite an ASA physical status assignation of III, the dog was successfully resuscitated with external chest compressions, intermittent positive pressure ventilation and vasopressin (2 doses of 0.8 IU kg(-1)) and was discharged 3 days later without signs of neurological injury. We believe vasopressin contributed to restoring spontaneous circulation. It may prove increasingly useful in perioperative resuscitation in dogs.     

Heatstroke in small animal medicine: a clinical practice review

Objective: To review the pathophysiology, diagnosis, current treatment, and prognosis of heatstroke. Etiology: Heatstroke can be a life‐threatening condition occurring because of an imbalance of heat dissipation and production. Certain factors may predispose some animals to heatstroke. The pathophysiology and sequelae of heatstroke share similarities with that of sepsis; thus, multiple organ dysfunction often ensues. The pathophysiological derangements that occur with heatstroke result from a complex series of events associated with direct cytotoxicity of heat and initiation of the acute‐phase response by endotoxin, inflammatory cytokines, and chemokines. Activation of endothelial cells, coagulation factors, and fibrinolysis (with ensuing microvascular thrombosis) leads to hypoxia and organ dysfunction. Heat shock proteins produced secondary to sudden heating act as protein chaperones or molecular guardians to provide protection against future heatstroke and may be implicated as a possible genetic component of heatstroke. Diagnosis: A history of recent exercise or being confined in a hot and/or humid environment, combined with clinical signs such as body temperature above 40°C (104°F), panting, tachycardia, hyperemia, dry mucous membranes, and depression to prostration is consistent with a diagnosis of heatstroke. A complete blood count performed during the initial examination of dogs with suspected heatstroke often includes nucleated red blood cells. Therapy: The mainstays for treating heatstroke include rapid evaporative cooling, volume replacement to provide cardiovascular support, and management of secondary complications. Prognosis: The prognosis is multifactorial. There is a significant negative correlation between comatose mental status, decreased temperature, and hypoglycemia with mortality.     

Gastroprotectants in small animal veterinary practice – a review of the evidence. Part 1: cyto‐protective drugs

Diverse drugs with presumed cytoprotective effect have been used therapeutically in small animal veterinary practice for various gastro‐intestinal conditions such as oesophagitis, gastric ulceration, gastritis or chronic gastro‐enteropathies. Their efficacy has been doubted in human medicine, raising similar questions in the veterinary field. The aim of this review was to assess the current evidence on the efficacy and safety of these drugs in dogs and cats. Through a systematic review of the literature, we identified 37 articles on the use of misoprostol, sucralfate and other gastroprotectants in dogs and cats. There was evidence to support use of misoprostol in the prevention of aspirin‐induced gastroduodenal mucosal injury in dogs, and for use of sucralfate in the prevention of acid‐induced oesophagitis in cats. However, the overall quality of evidence supporting the use of these drugs in small animal patients was poor. In contrast, there was evidence of important adverse effects, especially drug interaction and gastro‐intestinal signs. We therefore recommend prescribing these drugs with caution until further well‐conducted studies reveal a useful gastroprotectant effect.     

Successful cardiopulmonary cerebral resuscitation incorporating defibrillation in a filly with neonatal maladjustment syndrome following a routine anaesthetic procedure

A 10-h-old 56-kg Thoroughbred filly was presented for treatment of partial failure of passive transfer of immunity and presumed neonatal maladjustment syndrome (NMS). The filly was hospitalised, and supportive care initiated. On Day 5 of hospitalisation, seizures were observed and were controlled with IV administration of diazepam. Due to progression of clinical signs of NMS, magnetic resonance imaging of the filly's brain was performed. During the early anaesthetic recovery period, the filly exhibited cardiopulmonary arrest (CPA) at which point cardiopulmonary cerebral resuscitation (CPCR) was performed for a total of 48 min. During this time, ventricular fibrillation (VF) was observed on ECG and the filly was defibrillated three times at 1–2-min intervals using 2–4 J/kg of monophasic electrical defibrillation. The filly successfully recovered from CPCR, was discharged 5 days later and was reported healthy 12 months post-discharge.     

Feline entropion: a case series of 50 affected animals (2003–2008)

Aim  To evaluate the signalment, clinical signs, and etiopathogenesis of entropion in 50 cats.
Methods  Signalment and history of 50 cases of entropion in cats presented to a referral ophthalmology clinic. Animals were examined with direct and indirect ophthalmoscopy and slit-lamp biomicroscopy. Animals were treated surgically with a Hotz-Celsus procedure and results of surgery were evaluated between 4 and 22 weeks.
Results  Sixteen cats were young (mean age 4.1 ± 3.6 years) with pre-existing irritative ocular surface conditions such as conjunctivitis, corneal ulceration or sequestrum. Twenty-six cats were relatively older (mean age 11.3 ± 2.2 years) with involutional entropion with or without enophthalmos, presumed to result from a reduction in orbital tissue. Five cats were Persians with entropion associated with brachycephalic facial anatomy, whereas three were entire young adult male Maine Coones with in-turning associated with excessive facial 'jowl' tissue. Surgical treatment was curative in the majority of cases after one surgery although an increased amount of eyelid tissue was required to be removed for correction compared with similar surgery in the dog.
Discussion  This study has shown that entropion in cats may be caused in young animals as a result of continued blepharospasm related to irritative causes such as conjunctivitis or corneal ulceration or in older animals with lid laxity or globe enophthalmos. Lid in-turning was also seen in Persian and Maine Coone breeds.     

Brown recluse spider (Loxosceles reclusa) envenomation in small animals

Objective – To provide a comprehensive review of relevant literature regarding the brown recluse spider (BRS) and to define those criteria that must be satisfied before making a diagnosis of brown recluse envenomation.
Etiology – The complex venom of the BRS contains sphingomyelinase D, which is capable of producing all the clinical signs in the human and some animal models.
Diagnosis – There is no current commercially available test. In humans there are many proposed guidelines to achieve a definitive diagnosis; however, there are no established guidelines for veterinary patients.
Therapy – Currently, no consensus exists for treatment of BRS envenomation other than supportive care, which includes rest, thorough cleaning of the site, ice, compression, and elevation.
Prognosis – Prognosis varies based on severity of clinical signs and response to supportive care.     

Pneumothorax in cats with a clinical diagnosis of feline asthma: 5 cases (1990–2000)

Objective: This paper characterizes the clinical findings in 5 cats with feline asthma complicated by concurrent pneumothorax. Design: Retrospective study. Medical records of cats with concurrent diagnoses of asthma and pneumothorax that were presented to the Veterinary Hospital of the University of Pennsylvania from 1990 to 2000 were reviewed. Results: Of 421 cases of feline asthma, 5 cats fulfilled the inclusion criteria (1.2%). All 5 had respiratory distress at presentation. One cat was panting, and the other 4 cats had respiratory rates of 28, 52, 58 and 120 breaths per minute (bpm), respectively (mean RR 65±39 bpm). Historical findings included untreated chronic cough (n=3), previously treated asthma (n=1), and no previous illness (n=1). Thoracocentesis was performed in 4/5 cats, and 3 of those cats required thoracostomy tubes. Four cats required immediate oxygen supplementation, and 1 of those cats required ventilation. All 5 cats had evidence of pneumothorax on initial radiographs. Follow‐up radiographs revealed partial or complete resolution of pneumothorax in 4 cats which were discharged alive with total hospitalization of 2–7 days, but were then lost to follow‐up. One cat was euthanized because it could not be weaned off mechanical ventilation, and necropsy confirmed end‐stage feline asthma and emphysema. Conclusion: Small airway obstruction can predispose asthma patients to increased alveolar pressure, emphysema, and spontaneous pneumothorax, which can lead to dyspnea in affected cats. The short‐term outcome in these cats was good despite the severity of dyspnea at presentation.     

The use of amniotic membrane transplantation for ocular surface reconstruction: a review and series of 58 equine clinical cases (2002–2008)

Amniotic membrane transplantation (AMT) is an effective clinical therapy for reconstruction of the ocular surface in human and veterinary patients. Amnion is avascular and strong, contains antiangiogenic and antiinflammatory properties and growth factors, and has properties that prevent or decrease fibrosis in healing tissue. Indications for its use are steadily growing and include grafting to replace diseased, missing or excised tissue, patching to support diseased tissue during the healing process and as a substrate for the expansion of epithelial cells for transplantation to the cornea. AMT through a combination of mechanical and biologic factors can preserve the integrity of the globe, optimize the visual outcome, and minimize scarring in severely diseased corneas.