8 things you didn’t know about CPR.

In this blog “the diary of a compulsive learner” is focussing on CPR. The current survival rates for patients undergoing cardio pulmonary arrest (CPA) in veterinary practice is 3 – 6 % in dogs and 2 – 10% in cats. For veterinary staff to optimise their success in CPR, prompt intervention, adequate CPR protocols, and efficient team work with frequent training is necessary.

1. We have veterinary specific CPR guidelines

After a review carried out by the American Veterinary Emergency and Critical Care Society (AVECC) in 2012 which reviewed CPR literature from both the human and veterinary fields, we now have veterinary specific guidelines to performing optimal CPR in both cats and dogs called the RECOVER guidelines (Reassessment Campaign on Veterinary Resuscitation).

2. Most veterinary professionals only learnt about CPR in university or college and have not had any refresher training

Recent studies have shown that even when performed by professionals. CPR is generally inadequately performed and one of the main problems was due to lack of training.

In the human field nurses, police officers, firefighters, and other professions require regular CPR training because studies show that we tend to forget CPR knowledge over time. Whilst this is surprisingly not compulsory in the veterinary industry CPR training and standardisation can help us to remember what do; enables the team and new members of the team to stay up-to-date on the latest CPR techniques and practices and team training helps us to work together.

3. The majority of your team won’t feel confident providing CPR

In human CPR it is reported that only one third of bystanders actually perform CPR on victims. This could be because they are fearful of getting involved or scared that they will perform CPR incorrectly. In the veterinary practice setting it is not uncommon for staff to feel “out of their depth” in the event of a crashing patient due to lack of training, lack of understanding and lack of regular simulations

Interested in booking an in house CPD session with your team? Click here

4. The ability to perform CPR is dependent on body strength

It is often thought that the stronger team member should perform chest compressions, in fact effectiveness of compressions are achieved through training to improve technique and using equipment to assess effectiveness of compressions

5. Every minute counts in CPR

CPR training allows individuals to jump into action in the event of a patient experiencing a cardiopulmonary arrest. Early and high quality CPR Is essential to create blood flow to the heart and brain and limit injury of these organs until spontaneous circulation resumes (ROSC). It is better to treat any unresponsive patient as a cardiac arrest, until proven otherwise.

6. Compressions should be started as soon as possible

The aetiology of the arrest should influence prioritisation of CPR technique:

• For cardiopulmonary arrest (CPA) the CAB protocol is advocated – compressions first, followed by Airway and Breathing.
• In the respiratory arrest ventilation is mandatory (more common in veterinary patients), but can be delayed for a few minutes

The new guidelines for CPR emphasise the importance of providing continuous uninterrupted chest compressions, if necessary interruptions should be minimised to <10 seconds to minimise the impact on coronary perfusion.

In human studies time taken to place catheters, ECG pads, defib etc resulted in interruptions for 40-50% of the time and have been shown to increase mortality.

7. It is possible to over ventilate our patients

Each time positive pressure ventilation is on board the intrathoracic pressure increases resulting in a reduction of venous return to the heart which reduces CO² and a reduction in cerebral and coronary perfusion.

Current recommendations include 1 second positive inspiration phase with an approximate tidal volume of 10ml/kg, followed by complete relaxation at a respiratory rate of 10–12bpm, these lower ventilation rates are an essential part of the guidelines.

8. Many crash boxes are poorly maintained

The effects of ready access to organised and consistently audited crash carts on outcomes for patients receiving CPR have been well studied in human medicine

When was the last time you audited your crash box?

Summary

In summary, the best crash is the one that is avoided, but the next best crash is the one that is managed by an educated and prepared team of people.