Cardiopulmonary Resuscitation of Small Animals

Prognosis for recovery from cardiopulmonary arrest (CPA) is 35%–44%, but survival to discharge is < 10%.

Prevention and Preparedness

Equipment: Standardize and regularly audit crash carts and "ready areas".
Cognitive Aids: Use checklists and descriptive dose charts/algorithms.
Team Training: Leadership training, closed-loop communication, and simulation training every 6 months.
Patient Status: Assign a "CPR code status" to every patient admitted.

Basic Life Support (BLS):

Immediate Action: Start efforts upon recognition; do not delay to palpate pulses.
Airway: Intubate early but do not stop chest compressions to do so. Confirm placement via ETCO2, visualization, and auscultation.
Breathing: 10 breaths/minute (1 breath every 6 seconds); 10 mL/kg volume; 1-second inspiration time.
Circulation (Chest Compressions):
- Position: Lateral recumbency (dorsal for barrel-chested dogs).
- Rate: 100–120 compressions/minute.
- Depth: 1/3 to 1/2 of the thoracic wall width with full recoil.
- Technique: Thoracic pump (for wide/round chests) vs. Cardiac pump (for tall/narrow chests).
- Cycles: Uninterrupted 2-minute cycles; rotate compressors between cycles to prevent fatigue.

Advanced Life Support (ALS):

Access: Priority is Central IV > Peripheral IV > Intraosseous (IO) > Intratracheal (IT).
Drugs (NAVEL for IT route): Naloxone, Atropine, Vasopressin, Epinephrine, Lidocaine.
Arrhythmia Management:
- Asystole/PEA: Epinephrine or Vasopressin every other cycle; consider Atropine.
- VF/Pulseless VT: Electrical defibrillation (2–4 J/kg external biphasic); resume BLS immediately after the shock.
Reversal Agents: Administer agents to reverse opioids, benzodiazepines, or alpha-2 agonists if they contributed to arrest.

Open-Chest CPR:

Indications: Failure of closed-chest CPR (after 5–10 mins), large dogs, trauma, diaphragmatic hernia, or pleural/pericardial disease.
Procedure: Left 4th or 5th intercostal incision; incise pericardium; compress heart from apex to base.
Advanced Maneuver: Aortic cross-clamping to direct blood flow to the brain (max 10 minutes).

Monitoring & Endpoints:

ETCO2 (Primary Monitor):
- < 10 mmHg: Ineffective CPR or esophageal intubation.
- 12–18 mmHg: Adequate CPR efforts.
- Sharp increase to > 20–45 mmHg: Indicator of Return of Spontaneous Circulation (ROSC).
ECG: Evaluate only at the end of 2-minute BLS cycles.

Postresuscitation Care:

Common Issues: Rearrest is frequent; acidosis and hyperkalemia are common.
Support: Blood pressure support (Dopamine, Norepinephrine); address cerebral edema (Mannitol).
Lactate: Expect a dramatic rise with ROSC followed by resolution with treatment.

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Cardiopulmonary Resuscitation of Small Animals

Prognosis for recovery from cardiopulmonary arrest (CPA) is 35%–44%, but survival to discharge is < 10%.

Prevention and Preparedness

Equipment: Standardize and regularly audit crash carts and "ready areas".

Cognitive Aids: Use checklists and descriptive dose charts/algorithms.

Team Training: Leadership training, closed-loop communication, and simulation training every 6 months.

Patient Status: Assign a "CPR code status" to every patient admitted.

Basic Life Support (BLS):

Immediate Action: Start efforts upon recognition; do not delay to palpate pulses.

Airway: Intubate early but do not stop chest compressions to do so. Confirm placement via ETCO2, visualization, and auscultation.

Breathing: 10 breaths/minute (1 breath every 6 seconds); 10 mL/kg volume; 1-second inspiration time.

Circulation (Chest Compressions):

Position: Lateral recumbency (dorsal for barrel-chested dogs).

Rate: 100–120 compressions/minute.

Depth: 1/3 to 1/2 of the thoracic wall width with full recoil.

Technique: Thoracic pump (for wide/round chests) vs. Cardiac pump (for tall/narrow chests).

Cycles: Uninterrupted 2-minute cycles; rotate compressors between cycles to prevent fatigue.

Advanced Life Support (ALS):

Access: Priority is Central IV > Peripheral IV > Intraosseous (IO) > Intratracheal (IT).

Drugs (NAVEL for IT route): Naloxone, Atropine, Vasopressin, Epinephrine, Lidocaine.

Arrhythmia Management:

Asystole/PEA: Epinephrine or Vasopressin every other cycle; consider Atropine.

VF/Pulseless VT: Electrical defibrillation (2–4 J/kg external biphasic); resume BLS immediately after the shock.

Reversal Agents: Administer agents to reverse opioids, benzodiazepines, or alpha-2 agonists if they contributed to arrest.

Open-Chest CPR:

Indications: Failure of closed-chest CPR (after 5–10 mins), large dogs, trauma, diaphragmatic hernia, or pleural/pericardial disease.

Procedure: Left 4th or 5th intercostal incision; incise pericardium; compress heart from apex to base.

Advanced Maneuver: Aortic cross-clamping to direct blood flow to the brain (max 10 minutes).

Monitoring & Endpoints:

ETCO2 (Primary Monitor):

< 10 mmHg: Ineffective CPR or esophageal intubation.

12–18 mmHg: Adequate CPR efforts.

Sharp increase to > 20–45 mmHg: Indicator of Return of Spontaneous Circulation (ROSC).

ECG: Evaluate only at the end of 2-minute BLS cycles.

Postresuscitation Care:

Common Issues: Rearrest is frequent; acidosis and hyperkalemia are common.

Support: Blood pressure support (Dopamine, Norepinephrine); address cerebral edema (Mannitol).

Lactate: Expect a dramatic rise with ROSC followed by resolution with treatment.