Cardiopulmonary Cerebral Resuscitation: Techniques*

veterinary medicine. CPA is defined as sudden cessation of spontaneous and effective respiration and heartbeat. Veterinary staff should prepare for CPA by regularly reviewing techniques of cardiopulmonary cerebral resuscitation (CPCR; see box on page 781). Reported survival rates after CPCR in humans are 5% to 20%. In-hospital survival rates are usually higher than out-of-hospital rates. In veterinary medicine, most reports have been focused on in-hospital CPCR, in which survival rates are even lower (i.e., 5% to 10%). One of the confounding factors in comparing studies of CPCR is the definition of survival. In many experimental studies, successful CPCR is described as return of spontaneous circulation (ROSC). In general, these success rates are much higher than in clinical trials, in which the definition of success is return to normal neurologic function or survival to discharge. Because the re-arrest rate of resuscitated animals can be as high as 60% to 70% and neurologic dysfunction may be seen as a complication of resuscitation, successful CPCR should be defined as survival to discharge with intact neurologic function. Patient selection is one of the principal factors affecting the likelihood of successful resuscitation from CPA. Patients with end-stage disease, regardless of the organ system involved, are not good candidates for CPCR. Patient selection should be based on prior health of the animal and the reason for arrest (i.e., anesthesia versus multiorgan failure). In cases of critical illness, the possibility of arrest should be discussed with owners and advanced directives considered, such as “do not attempt resuscitation” (DNAR) orders. Cardiopulmonary arrest is a risk for any critically ill patient. Reported survival rates in humans and animals are poor. However, the veterinary team must understand the approach and techniques most likely to help patients survive. This article reviews the techniques of basic cardiopulmonary cerebral resuscitation. ABSTRACT: