McIntyre Robin L, Hopper Kate, Epstein Steven E
William R. Pritchard Veterinary Medical Teaching Hospital, Departments of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California at Davis, Davis, CA, 95616.
J Vet Emerg Crit Care (San Antonio). 2014 Nov-Dec;24(6):693-704. doi: 10.1111/vec.12250.
To prospectively describe cardiopulmonary resuscitation (CPR) and evaluate factors associated with outcome in dogs and cats with cardiopulmonary arrest (CPA).
Prospective observational study.
University teaching hospital.
One hundred twenty-one dogs and 30 cats that underwent CPR.
None.
Supervising clinicians completed a data form immediately following completion of CPR. Eighty-seven (58%) animals attained return of spontaneous circulation (ROSC), 49 (32%) had ROSC >20 minutes, 15 (10%) were alive at 24 hours, and 8 (5%) were discharged alive. Cardiovascular abnormalities were the most common suspected precipitating cause of CPA (51/151, 34%). Presence of an IV catheter before CPA (P = 0.01) and the presence of palpable pulses during CPR (P = 0.007) were both associated with ROSC. Increased time from CPA to CPR (P = 0.04), longer duration of CPR (P < 0.0001), and neurologic cause of arrest (P = 0.02) were associated with not achieving ROSC. There was no association between ROSC and the initial arrest rhythm identified on ECG, animal weight, number of people present, and ventilation or compression rate. In patients achieving ROSC, those with a "survived event" were more likely to be euthanized and less likely to experience a second CPA than those with ROSC ≤ 20 minutes. Thirty-four percent of patients submitted for necropsy had gross and histological lesions considered secondary to CPR.
Early CPR interventions were associated with a greater likelihood of ROSC, emphasizing the importance of prompt recognition, and initiation of CPR efforts. Although ROSC rates in this study were comparable or higher than previous human and veterinary studies, the rate of "survived events" was lower than that reported in human patients. This may suggest that advances in post CPR care could have benefits to the veterinary CPR patient in the future.
前瞻性描述心肺复苏(CPR)情况,并评估与心肺骤停(CPA)的犬猫预后相关的因素。
前瞻性观察性研究。
大学教学医院。
121只犬和30只猫接受了心肺复苏。
无。
CPR结束后,指导临床医生立即填写一份数据表格。87只(58%)动物恢复自主循环(ROSC),49只(32%)ROSC持续时间>20分钟,15只(10%)在24小时存活,8只(5%)存活出院。心血管异常是CPA最常见的可疑促发原因(51/151,34%)。CPA前存在静脉导管(P = 0.01)以及CPR期间可触及脉搏(P = 0.007)均与ROSC相关。CPA至CPR的时间延长(P = 0.04)、CPR持续时间延长(P < 0.0001)以及神经源性骤停原因(P = 0.02)与未实现ROSC相关。ROSC与心电图识别的初始骤停心律、动物体重、在场人数以及通气或按压速率之间无关联。在实现ROSC的患者中,与ROSC≤20分钟的患者相比,“存活事件”患者更有可能实施安乐死,且再次发生CPA的可能性更小。接受尸检的患者中有34%存在被认为是CPR继发的大体和组织学病变。
早期CPR干预与更高的ROSC可能性相关,强调了迅速识别并开始CPR的重要性。尽管本研究中的ROSC率与之前的人类和兽医研究相当或更高,但“存活事件”率低于人类患者报告的水平。这可能表明CPR后护理的进展未来可能会给兽医CPR患者带来益处。