Publications by authors named "Daniel J Fletcher"

44 Publications

Fluid Therapy During Cardiopulmonary Resuscitation.

Front Vet Sci 2020 28;7:625361. Epub 2021 Jan 28.

Faculty of Veterinary and Agricultural Sciences, Melbourne Veterinary School, University of Melbourne, Werribee, VIC, Australia.

Cardiopulmonary arrest (CPA), the acute cessation of blood flow and ventilation, is fatal if left untreated. Cardiopulmonary resuscitation (CPR) is targeted at restoring oxygen delivery to tissues to mitigate ischemic injury and to provide energy substrate to the tissues in order to achieve return of spontaneous circulation (ROSC). In addition to basic life support (BLS), targeted at replacing the mechanical aspects of circulation and ventilation, adjunctive advanced life support (ALS) interventions, such as intravenous fluid therapy, can improve the likelihood of ROSC depending on the specific characteristics of the patient. In hypovolemic patients with CPA, intravenous fluid boluses to improve preload and cardiac output are likely beneficial, and the use of hypertonic saline may confer additional neuroprotective effects. However, in euvolemic patients, isotonic or hypertonic crystalloid boluses may be detrimental due to decreased tissue blood flow caused by compromised tissue perfusion pressures. Synthetic colloids have not been shown to be beneficial in patients in CPA, and given their documented potential for harm, they are not recommended. Patients with documented electrolyte abnormalities such as hypokalemia or hyperkalemia benefit from therapy targeted at those disturbances, and patients with CPA induced by lipid soluble toxins may benefit from intravenous lipid emulsion therapy. Patients with prolonged CPA that have developed significant acidemia may benefit from intravenous buffer therapy, but patients with acute CPA may be harmed by buffers. In general, ALS fluid therapies should be used only if specific indications are present in the individual patient.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fvets.2020.625361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876065PMC
January 2021

Differences in the clinical practice of small animal CPR before and after the release of the RECOVER guidelines: Results from two electronic surveys (2008 and 2017) in the United States and Canada.

J Vet Emerg Crit Care (San Antonio) 2020 Nov 25;30(6):615-631. Epub 2020 Sep 25.

Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia.

Objective: To assess whether the clinical approach to CPR has changed following the publication of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) guidelines in 2012.

Design: Internet-based survey.

Setting: Academia and referral practice.

Subjects: Four hundred and ninety-one small animal veterinarians in clinical practice in the United States and Canada.

Interventions: An internet-based survey assessing the clinical approach to small animal CPR was circulated with the assistance of veterinary professional organizations on 2 separate occasions: prior to (2008) and following (2017) publication of the 2012 (RECOVER) guidelines. Survey questions identical to both surveys solicited details of clinician approaches to CPR preparedness, basic life support (BLS), and advanced life support (ALS). Respondents were grouped into level of expertise (board-certified specialists [BCS, n = 202] and general practitioners in emergency clinics [GPE, n = 289]), and year of response to the survey (2008, n = 171; 2017, n = 320).

Measurements And Main Results: Compliance with the RECOVER guidelines pertaining to CPR preparedness (P < 0.01), BLS (P < 0.01), and ALS P < 0.01) was consistently higher in respondents to the 2017 survey compared to those of the 2008 survey. Being a BCS was associated with significantly higher compliance with the RECOVER recommendations than GPE in the domains of preparedness (P = 0.02), BLS (P < 0.01), and ALS (P < 0.01). Increases in age of the respondent had a negative effect on compliance with the BLS guidelines (P < 0.01), while gender had no effect.

Conclusions: Compared to 2008, current practices in small animal CPR in the North American emergency and critical care community shifted toward those recommended in the RECOVER guidelines across all CPR domains. This supports the notion that uptake of the RECOVER guidelines among veterinary emergency or critical care clinicians was sufficient to lead to a change in the practice of CPR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vec.13010DOI Listing
November 2020

Update on Cardiopulmonary Resuscitation in Small Animals.

Vet Clin North Am Small Anim Pract 2020 Nov 12;50(6):1183-1202. Epub 2020 Aug 12.

Department of Clinical Sciences, Cornell University College of Veterinary Medicine, DCS Box 31, Ithaca, NY 14853, USA.

Cardiopulmonary arrest (CPA), the acute cessation of ventilation and systemic perfusion, leads to discontinuation of tissue oxygen delivery and death if not quickly reversed. Reported resuscitation rates suggest that the heart can be restarted in 40% to 50% of dogs and cats treated with cardiopulmonary resuscitation (CPR). However, approximately 80% of these animals do not survive to hospital discharge. To minimize mortality due to CPA a broad strategy is required including preparedness and prevention measures, basic and advanced life support as well as post-cardiac arrest care. This article summarizes the current guidelines on the treatment of small animals with CPA..
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cvsm.2020.06.010DOI Listing
November 2020

Severity of Ionized Hypercalcemia and Hypocalcemia Is Associated With Etiology in Dogs and Cats.

Front Vet Sci 2019 22;6:276. Epub 2019 Aug 22.

Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States.

Calcium disorders are common in small animals, but few studies have investigated the etiology of ionized hypercalcemia and hypocalcemia in large populations. This study aimed to determine the incidence of ionized calcium disorders in dogs and cats treated at a tertiary referral clinic and to describe the associated diseases. An electronic database of electrolyte analyses conducted at the Cornell University Hospital for Animals from 2007 to 2017 was searched. Dogs and cats with ionized hypercalcemia or hypocalcemia were identified based on institution reference intervals. Duplicate case entries were removed. Medical records were reviewed to identify the cause of the calcium abnormality. Chi-squared analysis with Bonferroni adjustment was performed to compare frequencies of disease processes between mild and moderate-severe disturbances. The database included 15,277 dogs and 3,715 cats. Hypercalcemia was identified in 1,641 dogs and 119 cats. The incidence of canine and feline hypercalcemia was 10.7 and 3.2%, respectively. Hypocalcemia was identified in 1,467 dogs and 450 cats. The incidence of canine and feline hypocalcemia was 9.6% and 12.1%, respectively. The most common pathologic causes of hypercalcemia in dogs were malignancy-associated (12.9%), parathyroid-dependent (4.6%) and hypoadrenocorticism (1.7%). In cats, malignancy-associated hypercalcemia (22.7%), kidney injury (13.4%) and idiopathic hypercalcemia (12.6%) were most common. Dogs presenting with moderate-severe hypercalcemia vs. mild hypercalcemia were significantly more likely to have hyperparathyroidism, malignancy-associated hypercalcemia or hypervitaminosis D, whereas cats were significantly more likely to have malignancy-associated hypercalcemia or idiopathic hypercalcemia. The most common pathologic causes of hypocalcemia in dogs were critical illness (17.4%), kidney injury (10.4%) and toxicity (7.5%). In cats, kidney injury (21.6%), urethral obstruction (15.1%), and critical illness (14.7%) were most frequent. Dogs presenting with moderate-severe hypocalcemia were significantly more likely to have hypoparathyroidism, kidney injury, eclampsia or critical illness, whereas cats were significantly more likely to have kidney injury, soft tissue trauma or urethral obstruction. Mild calcium disturbances are most commonly associated with non-pathologic or transient conditions. Malignancy-associated hypercalcemia is the most common cause of ionized hypercalcemia in dogs and cats. Critical illness and kidney injury are frequent causes of ionized hypocalcemia in both species.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fvets.2019.00276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6714612PMC
August 2019

Assessment of the percutaneous dilatational tracheostomy technique in experimental manikins and canine cadavers.

J Vet Emerg Crit Care (San Antonio) 2019 Sep 30;29(5):484-494. Epub 2019 Jun 30.

Clinical Programs Center, Cornell University College of Veterinary Medicine, Ithaca, NY.

Objective: To evaluate procedure time, ease of placement, and complication rates of percutaneous dilatational tracheostomy (PDT) compared to surgical tracheostomy (ST) in canine cadavers.

Design: Randomized crossover experimental manikin and cadaver study involving 6 novice veterinary students.

Setting: University teaching hospital.

Animals: Canine tracheostomy training manikin, 24 canine cadavers.

Interventions: None.

Measurements And Main Results: For training, each student performed 10 PDT and 10 ST procedures on a training manikin, followed by 2 PDT and 2 ST procedures on a canine cadaver. After each training procedure, feedback from bronchoscopy and observers was provided. Final PDT and ST tube placements using new equipment were performed in unused cadavers. Placements were timed, ease of placement was scored using visual analog scales (VAS, 0-10 cm), and complications were assessed by two independent observers using ordinal scales (0-3). Cadaver tracheas were explanted postprocedure to evaluate anatomical damage scores (0-3). Procedure time and VAS scores for PDT and ST procedures were analyzed using mixed-effects linear models, accounting for student, technique, and procedure number with post hoc pairwise comparisons. Data are presented as median (range). For the final cadaver placement, there were no significant differences in placement time (300 seconds [230-1020] vs 188 seconds [116-414], P = 0.210), ease of placement (3.8 cm [2.1-5.7] vs 1.9 cm [0-4.7], P = 0.132), anatomical damage score (1 [0-2] vs 0 [0-1], P = 0.063), or equipment complications score (0 [0-1] vs 0 [0-0], P = 1.000) between PDT and ST, respectively.

Conclusions: These data suggest that PDT can be performed as quickly, as easily, and as safely as ST in a canine cadaver by novice veterinary students following manikin training. Additional studies will be required to determine if these findings can be translated into veterinary clinical practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vec.12869DOI Listing
September 2019

The Compliance of Current Small Animal CPR Practice With RECOVER Guidelines: An Internet-Based Survey.

Front Vet Sci 2019 11;6:181. Epub 2019 Jun 11.

Faculty of Veterinary and Agricultural Sciences, Melbourne Veterinary School, University of Melbourne, Werribee, VIC, Australia.

In 2012 the Reassessment Campaign on Veterinary Resuscitation (RECOVER) published evidence-based treatment recommendations for dogs and cats with cardiopulmonary arrest (CPA), to optimize the clinical practice of small animal CPR and positively impact outcomes. Six years after the release of these guidelines, we aimed to determine the compliance of small animal veterinary CPR practices with these RECOVER guidelines. To identify current CPR practices in clinically active small animal veterinarians and their awareness of the RECOVER guidelines, we conducted an internet-based survey. Survey invitations were disseminated internationally via veterinary professional organizations and their social media outlets. Questions explored respondent demographics, CPR preparedness, BLS and ALS techniques and awareness of RECOVER guidelines. Responding small animal veterinarians ( = 770) in clinical practice were grouped by level of expertise: board-certified specialists (BCS, = 216) and residents (RES, = 69) in anesthesia or emergency and critical care, practitioners in emergency (GPE, = 299) or general practice (GPG, = 186). Large disparities in preparedness measures, BLS and ALS techniques emerged among levels of expertise. Only 32% (95% CI: 29-36%) of respondents complied with BLS practice guidelines, varying from 49% (95% CI: 42-55%) of BCS to 15% (95% CI: 10-20%) of GPG. While incompliances in BCS, RES, and GPE were predominantly due to knowledge gaps, GPG compliance was further compromised by limitations in the resuscitation environment (e.g., defibrillator availability, team size). Those aware of RECOVER guidelines (100% of BCS and RES; 77% of GPE; 35% of GPG) were more likely to comply with recommended preparedness (OR = 2.4; 95% CI: 1.2-4.8), BLS (OR = 4.5; 95% CI: 2.4-9.1), and ALS techniques (OR = 7.8; 95% CI: 2.4-9.1) independent of age, gender, region of practice or level of expertise. We conclude that awareness of RECOVER guidelines is high in specialists and residents, but incomplete among general practitioners. This awareness positively influenced compliance with CPR guidelines, but CPR practices continue to be variable and largely not in agreement with guidelines. A widely accessible educational strategy is required to broadly improve compliance with best practices in small animal CPR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fvets.2019.00181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6581025PMC
June 2019

Evaluation of the association between strong ion acid-base disturbances and mortality in dogs: a retrospective study.

Vet Med Sci 2018 Apr 10. Epub 2018 Apr 10.

Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA.

Acid-base abnormalities are frequently encountered in veterinary emergency and critical care, but information regarding the prognostic value of these findings is limited. Several systems for analysing acid-base disturbances have been reported, but the prognostic abilities of these systems have not been compared in dogs. The objectives of this retrospective study were to determine if the commonly used acid-base interpretation methods (Henderson-Hasselbalch, Stewart and semi-quantitative) have prognostic value, and to compare the performance of the three methods. Electronic medical records were searched to create a database containing point-of-care blood-gas, electrolyte and serum chemistry values for 1024 dogs assessed at a university teaching hospital. Dogs with contemporaneous blood-gas analysis, blood lactate and serum biochemistry samples were eligible for study, and only the first recorded analyses for each patient visit were included. Components of the Henderson-Hasselbalch, Stewart and semi-quantitative methods were calculated. To assess prognostic ability and to compare analysis system performance, receiver-operating characteristic (ROC) curves for survival to hospital discharge were created. Of the 1024 dogs identified, case fatality rate was 23.8%. Area under the ROC curve did not exceed 0.63 for any calculated variable. Performance of all three analysis systems was similar. While some acid-base abnormalities identified were associated with mortality, no individual abnormality or system output yielded sensitive and specific cut-off values for mortality prediction, and no interpretation method outperformed the others. This study suggests that initial acid-base abnormalities have limited prognostic utility and that various analysis systems can be used to assess acid-base disturbances in critically ill dogs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/vms3.101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090410PMC
April 2018

Multivariable analysis of the association between electrolyte disturbances and mortality in cats.

J Feline Med Surg 2018 12 5;20(12):1072-1081. Epub 2017 Dec 5.

1 Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.

Objectives: Electrolyte disorders have been individually associated with mortality in small populations of cats with specific conditions, but the associations and interactions between electrolyte disturbances and outcome have not been evaluated in a large, heterogeneous population. It was hypothesized that abnormalities of sodium, chloride, potassium and calcium concentrations would be independently and proportionately associated with death from natural causes and with all-cause mortality in cats.

Methods: An electronic database containing 7064 electrolyte profiles was constructed to assess the association between disorders of sodium, potassium, corrected-chloride and ionized calcium concentrations with non-survival by multivariable modelling. A second database containing 2388 records was used to validate the models constructed from the first database.

Results: All four electrolytes assessed had non-linear U-shaped associations with case fatality rates, wherein concentrations clustered around the reference interval had the lowest case fatality rates, while progressively abnormal concentrations were associated with proportionately increased risk of non-survival (area under the receiver operator characteristic curve [AUROC] 0.689) or death (AUROC 0.750).

Conclusions And Relevance: Multivariable modelling suggested that these electrolyte disturbances were associated with non-survival and with death from natural causes independent of each other. The present study suggests that measurement of electrolyte concentrations is an important component of the assessment of cats in emergency rooms or intensive care units. Future studies should focus on confirming these associations in a prospective manner accounting for disease severity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1098612X17743564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259255PMC
December 2018

Transpalpebral ultrasonographic measurement of the optic nerve sheath diameter in healthy dogs.

J Vet Emerg Crit Care (San Antonio) 2018 Jan 24;28(1):31-38. Epub 2017 Nov 24.

Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853.

Objective: To develop a reference range for ultrasonographically measured optic nerve sheath diameter (ONSD-US) in dogs. We hypothesized that ONSD-US can be measured reliably and is associated with weight but not age, sex, or body condition score (BCS), and that the relationship between weight and ONSD-US in dogs is allometric due to canine size variations.

Design: Prospective, observational study.

Setting: University teaching hospital.

Animals: Seventy-eight healthy adult dogs.

Interventions: The ONSD was measured by a standardized transpalpebral approach.

Measurements And Main Results: Regression analysis showed the relationship between weight and ONSD was better fit with a linear model (R = 0.8510) than an allometric model (R = 0.7917). Multiple regression analysis showed ONSD is associated with weight (P < 0.0001), age (P = 0.0021), and BCS (P = 0.0007), but not with sex. Dominance analysis showed 94.6% of the variance explained by the model was due to weight. Intraclass correlation coefficient (ICC) analysis showed excellent interobserver (ICC = 0.9338-0.9608) and intraobserver (ICC = 0.9893) reliability.

Conclusions: These results suggest that ONSD-US may be reliably measured in dogs using our described transpalpebral approach, and we have calculated prediction intervals based on body weight. Future studies are needed to determine if ONSD-US measurements are associated with intracranial hypertension as shown in human medicine.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vec.12677DOI Listing
January 2018

Plasmatic coagulation and fibrinolysis in healthy and Otostrongylus-affected Northern elephant seals (Mirounga angustirostris).

Vet Clin Pathol 2017 Dec 13;46(4):589-596. Epub 2017 Sep 13.

Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, USA.

Background: Prepatent Otostrongylus arteritis results in hemorrhagic diathesis in free-ranging Northern elephant seals (Mirounga angustirostris) attributed to aberrant larval migration of the lungworm, Otostrongylus circumlitus. Clinical signs are often nonspecific, including lethargy, anorexia, and blepharospasm, but can progress to spontaneous frank hemorrhage and death within 72 hours of onset. Previously published case reports describe coagulopathy with prolonged PT and APTT, normal to elevated platelet counts, normal antithrombin concentrations, and low concentrations of fibrinogen degradation products. Disseminated intravascular coagulation was proposed as the cause of hemorrhage, but is inconsistent with some of the reported clinicopathologic changes.

Objective: The purpose of this study was to compare plasmatic coagulation and fibrinolysis in healthy and Otostrongylus-affected elephant seals, in order to identify potential therapy. We hypothesized that hyperfibrinolysis contributed to hemorrhage in these cases.

Methods: Citrated plasma samples were collected from 3- to 4-month-old Northern elephant seals in a wildlife rehabilitation hospital. The sampled population included 25 healthy, prerelease seals and 32 clinically ill seals diagnosed with presumptive Otostrongylus arteritis. Twenty-one of the included seals had Otostrongylus infestation confirmed at necropsy. Standard coagulation tests and plasma thromboelastography were performed for a complete assessment of coagulation and fibrinolysis.

Results: Northern elephant seals with definitive Otostrongylus infestation were hypocoagulable and hypofibrinolytic compared to healthy controls.

Conclusions: Results were most consistent with disseminated intravascular coagulation. Treatment with antifibrinolytic drugs to control hemorrhage may be unrewarding; alternative therapies such as plasma transfusions or coagulation factor concentrates should be investigated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vcp.12540DOI Listing
December 2017

Electrolyte Disturbances Are Associated with Non-Survival in Dogs-A Multivariable Analysis.

Front Vet Sci 2017 18;4:135. Epub 2017 Aug 18.

Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States.

Electrolyte disorders have been individually associated with mortality in small populations of dogs and cats with specific conditions, but the associations and interactions between electrolyte disturbances and outcome have not been evaluated in a large, heterogeneous population. It was hypothesized that abnormalities of sodium, chloride, potassium, and calcium concentrations would be independently and proportionately associated with death from natural causes and with all-cause mortality in dogs. An electronic database containing 33,117 electrolyte profiles was constructed to retrospectively assess the association between disorders of sodium, potassium, corrected chloride, and ionized calcium concentrations with non-survival and with death excluding euthanasia by multivariable modeling. A second database containing 11,249 records was used to validate the models constructed from the first database. All four electrolytes assessed had non-linear U-shaped associations with case fatality rates, wherein concentrations clustered around the reference interval had the lowest case fatality rates, while progressively abnormal concentrations were associated with proportionately increased risk of non-survival (AUROC 0.624) or death (AUROC 0.678). Multivariable modeling suggested that these electrolyte disturbances were associated with non-survival and with death from natural causes independent of each other. This study suggests that measurement of electrolyte concentrations is an important component of the assessment of dogs in emergency rooms or intensive care units. Future studies should focus on confirming these associations in a prospective manner accounting for disease severity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fvets.2017.00135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563317PMC
August 2017

Chloride:Sodium Ratio May Accurately Predict Corrected Chloride Disorders and the Presence of Unmeasured Anions in Dogs and Cats.

Front Vet Sci 2017 2;4:122. Epub 2017 Aug 2.

Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States.

Disorders of chloride and mixed acid-base disturbances are common in veterinary emergency medicine. Rapid identification of these alterations and the presence of unmeasured anions aid prompt patient assessment and management. This study aimed to determine in dogs and cats if site-specific reference values for [Cl]:[Na] ratio and [Na] - [Cl] difference accurately identify corrected chloride abnormalities and to evaluate the predictive ability of the [Cl]:[Na] ratio for the identification of unmeasured anions. A database containing 33,117 canine, and 7,604 feline blood gas and electrolyte profiles was generated. Institution reference intervals were used to calculate site-specific reference values for the [Cl]:[Na] ratio and the [Na] - [Cl] difference. Contingency tables were used to assess the ability of these values to correctly identify corrected chloride disorders. Unmeasured anions were estimated by calculating strong ion gap (SIG). Continuous variables were compared using the Mann-Whitney test. Correlations between continuous variables were assessed using Spearman's rho (). In dogs, site-specific reference values for the [Cl]:[Na] ratio correctly identified 94.6% of profiles as hyper-, normo-, or hypochloremic. For dogs with normal sodium concentrations, site-specific reference values for the [Na] - [Cl] difference correctly identified 97.0% of profiles. In dogs with metabolic acidosis (base deficit > 4.0), [Cl]:[Na] ratio and SIG were moderately but significantly negatively correlated ( -0.592,  < 0.0001). SIG was significantly greater in dogs with metabolic acidosis and hypochloremia compared to those without hypochloremia ( < 0.0001). In cats, site-specific reference values for the [Cl]:[Na] ratio correctly identified 93.3% of profiles as hyper-, normo-, or hypochloremic, while site-specific reference values for [Na] - [Cl] difference correctly identified 95.1% of profiles. In cats with metabolic acidosis [Cl]:[Na] ratio and SIG were moderately significantly negatively correlated ( -0.730,  < 0.0001). SIG was significantly greater in cats with metabolic acidosis and hypochloremia compared to those without hypochloremia ( < 0.0001). Site-specific values for [Cl]:[Na] ratio and [Na] - [Cl] difference accurately identify corrected chloride disorders in both dogs and cats and may aid identification of the presence of unmeasured anions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fvets.2017.00122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539434PMC
August 2017

Effect of aminocaproic acid on clot strength and clot lysis of canine blood determined by use of an in vitro model of hyperfibrinolysis.

Am J Vet Res 2016 Nov;77(11):1258-1265

OBJECTIVE To determine pharmacodynamic and pharmacokinetic profiles of aminocaproic acid (ACA) by use of a thromboelastography (TEG)-based in vitro model of hyperfibrinolysis and high-performance liquid chromatography-mass spectrometry. ANIMALS 5 healthy adult dogs. PROCEDURES A single dose of injectable ACA (20, 50, or 100 mg/kg) or an ACA tablet (approximately 100 mg/kg) was administered orally. Blood samples were collected at 0, 15, 30, 45, 60, 90, 120, and 240 minutes after ACA administration for pharmacokinetic analysis. Samples were obtained at 0, 60, and 240 minutes for pharmacodynamic analysis by use of a TEG model of hyperfibrinolysis. RESULTS No adverse effects were detected. In the hyperfibrinolysis model, after all doses, a significantly higher TEG maximum amplitude (clot strength), compared with baseline, was detected at 60 and 240 minutes. Additionally, the percentage of fibrinolysis was reduced from the baseline value at 60 and 240 minutes, with the greatest reduction at 60 minutes. At 240 minutes, there was significantly less fibrinolysis for the 100 mg/kg dose than the 20 mg/kg dose. Maximum plasma ACA concentration was dose dependent. There was no significant difference in pharmacokinetic parameters between 100 mg/kg formulations. CONCLUSIONS AND CLINICAL RELEVANCE In an in vitro model of hyperfibrinolysis, ACA inhibited fibrinolysis at all doses tested. At 240 minutes after administration, the 100 mg/kg dose inhibited fibrinolysis more effectively than did the 20 mg/kg dose. Thus, ACA may be useful for in vivo prevention of fibrinolysis in dogs. IMPACT FOR HUMAN MEDICINE These data may improve research models of hyperfibrinolytic diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2460/ajvr.77.11.1258DOI Listing
November 2016

The Effects of Varying Concentrations of Dietary Protein and Fat on Blood Gas, Hematologic Serum Chemistry, and Body Temperature Before and After Exercise in Labrador Retrievers.

Front Vet Sci 2016 2;3:59. Epub 2016 Aug 2.

Department of Clinical Sciences, Cornell University College of Veterinary Medicine , Ithaca, NY , USA.

Optimal dietary protocols for the athletic canine are often defined by requirements for endurance athletes that do not always translate into optimal dietary interventions for all canine athletes. Prior research studying detection dogs suggests that dietary fat sources can influence olfaction; however, as fat is added to the diet the protein calories can be diminished potentially resulting in decreased red blood cell counts or albumin status. Optimal macronutrient profile for detection dogs may be different considering the unique work they engage in. To study a calorically low protein: high fat (18:57% ME), high protein: high fat (27:57% ME), and high protein: low fat (27:32% ME) approach to feeding, 17 dogs were provided various diets in a 3 × 3 cross over design. Dogs were exercised on a treadmill and blood was taken pre-exercise, immediately post-exercise, 10- and 20-min post-exercise to assess complete blood count, serum chemistry, blood gases, and cortisol; as well as rectal and core body temperature. Exercise induced a decrease in serum phosphorus, potassium, and increases in non-esterified fatty acids and cortisol typical of moderate exercise bouts. A complete and balanced high protein: high-fat diet (27:57% ME) induced decreases in serum cortisol and alkaline phosphatase. Corn oil top dressed low protein: high-fat diet (18:57% ME) induced a slightly better thermal recovery than a complete and balanced high protein: high fat diet and a high protein: low fat (27%:32% ME) diet suggesting some mild advantages when using the low protein: high fat diet that warrant further investigation regarding optimal protein and fat calories and thermal recovery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fvets.2016.00059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4969627PMC
August 2016

PHARMACOKINETIC STUDY OF ORAL ε-AMINOCAPROIC ACID IN THE NORTHERN ELEPHANT SEAL (MIROUNGA ANGUSTIROSTRIS).

J Zoo Wildl Med 2016 Jun;47(2):438-46

ε-Aminocaproic acid (EACA) is a lysine analogue antifibrinolytic drug used to treat bleeding disorders in humans and domestic animals. Its use in zoological medicine is rare, and dosage is anecdotal. One possible application of EACA is to treat bleeding associated with prepatent Otostrongylus arteritis in Northern elephant seals ( Mirounga angustirostris ) presenting to wildlife rehabilitation centers. This study used an in vitro model of hyperfibrinolysis and a thromboelastograph-based assay to estimate the therapeutic plasma concentration of EACA in elephant seals (85 μg/ml, 95% confidence interval = 73.8-96.8 μg/ml). A concurrent pharmacokinetic study of orally administered, single-dose EACA found that doses of 75 and 100 mg/kg achieved therapeutic plasma concentrations (>85 μg/ml), but the drug was rapidly eliminated and remained in the therapeutic range for only 0.4 and 1.5 hr, respectively. Models of repeated oral dosing at 100 mg/kg every 6 hr predict that therapeutic plasma concentration will be maintained for 31.7% (7.6 hr) of a 24-hr period. More frequent dosing would be required to maintain continuous therapeutic concentrations but would be impractical in a wildlife rehabilitation setting. Further pharmacodynamic studies to evaluate the duration of action of EACA in elephant seals and a prospective, placebo-controlled study are needed to determine if EACA is effective in decreasing bleeding associated with prepatent Otostrongylus arteritis and other bleeding disorders in this species.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1638/2015-0138.1DOI Listing
June 2016

EFFECT OF ε-AMINOCAPROIC ACID ON FIBRINOLYSIS IN PLASMA OF ASIAN ELEPHANTS (ELEPHAS MAXIMUS).

J Zoo Wildl Med 2016 Jun;47(2):397-404

ε-Aminocaproic acid (EACA) is a lysine analogue antifibrinolytic drug used to treat bleeding disorders in humans and domestic animals. Use in zoological medicine is rare and dose recommendations are anecdotal, but EACA may be a valuable therapeutic option for bleeding disorders in exotic species, including Asian elephants ( Elephas maximus ). This study used an in vitro model of hyperfibrinolysis and a thromboelastograph-based assay to estimate the therapeutic plasma concentration of EACA in Asian elephants (61.5 μg/ml, 95% CI = 34.6-88.5 μg/ml). Substantial but incomplete inhibition of lysis was seen at relatively low concentrations of EACA (40 μg/ml). Asian elephants appear sensitive to EACA-mediated inhibition of hyperfibrinolysis. Doses published for domestic animals, targeting higher plasma concentrations, may be inappropriate in this species.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1638/2015-0255.1DOI Listing
June 2016

Retrospective comparison of early- versus late-insulin therapy regarding effect on time to resolution of diabetic ketosis and ketoacidosis in dogs and cats: 60 cases (2003-2013).

J Vet Emerg Crit Care (San Antonio) 2016 Jan-Feb;26(1):108-15. Epub 2015 Nov 9.

Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853.

Objective: To determine whether early insulin administration (≤6 h after admission) results in more rapid resolution of diabetic ketosis (DK) and ketoacidosis (DKA), shorter duration of hospitalization, and higher incidence of complications, and whether more severe ketonuria is associated with longer time to resolution of DK/DKA.

Design: Retrospective study (January 1, 2003-March 1, 2013).

Setting: University teaching hospital.

Animals: Sixty dogs and cats with DK or DKA receiving short-acting insulin therapy.

Interventions: None.

Measurements And Main Results: Medical records were reviewed and data recorded including signalment; previous history of diabetes; intake temperature, blood pressure, blood glucose, pH, base excess, and degree of ketonuria; time to short-acting insulin therapy and resolution of DK/DKA; length of hospitalization; and complications. Insulin was initiated ≤6 hours in the early group and >6 hours in the late group after hospital admission. Early group patients had more rapid resolution of DK/DKA after starting short-acting insulin therapy (36.4 ± 22.6 vs. 55.4 ± 26.6 h, P = 0.014). There was no difference in duration of hospitalization or complications. More severe ketonuria resulted in longer time to resolution of DK/DKA after initiation of short-acting insulin (severe: 50.9 ± 24.2; moderate: 29.6 ± 19; mild: 23.4 ± 21.9 h, P = 0.005, all individual pairwise comparisons P < 0.05).

Conclusions: Early insulin administration is associated with more rapid resolution of DK/DKA without an associated increase in complication rates. DK/DKA took longer to resolve with more severe ketonuria. Prospective studies are warranted to identify specific time targets for insulin administration in DK/DKA patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vec.12415DOI Listing
September 2016

The authors' response.

J Vet Emerg Crit Care (San Antonio) 2015 Sep-Oct;25(5):595-6. Epub 2015 Sep 22.

Department of Veterinary Surgical and Radiological Sciences, University of California at Davis, Davis, CA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vec.12373DOI Listing
January 2016

Compression screw fixation without bone grafting for scaphoid fibrous nonunion.

Hand (N Y) 2015 Sep;10(3):450-3

The Hand Center of San Antonio, 21 Spurs Lane, San Antonio, TX 78240 USA.

Purpose: Bone graft is often recommended as an adjuvant for treatment of scaphoid nonunions. However, recent literature has suggested that fibrous nonunion may be suited to treatment with rigid fixation without bone grafting. This work reported on outcomes of compression screw fixation for established scaphoid fibrous nonunions without bone graft.

Methods: Fourteen patients underwent surgical compression screw fixation without bone grafting of scaphoid fibrous nonunion between January 1, 2000, and December 31, 2012, with minimum follow-up until the time of clinical and radiographic healing. Fibrous nonunion of the scaphoid was defined as a scaphoid fracture with all of the following features: (1) persistent tenderness, (2) incomplete trabecular bridging on three X-ray views, (3) injury that had occurred at a minimum of 6 months prior to surgery, and (4) identification of fibrous union at the time of surgery. Outcomes were assessed with range of motion assessment, Disability of the Arm, Shoulder and Hand (DASH) scores, and plain radiographs.

Results: Twelve of the 14 patients healed successfully, while two patients required secondary vascularized bone grafting. Both unhealed patients sustained proximal pole fractures and had a duration of ≥1 year from injury to surgery. Average time to healing was 4.4 ± 2.0 months. Average flexion was 73 ± 22° and average extension was 66 ± 22° postoperatively. Average grip strength was 90 ± 25 lbs on the operative side. Mean postoperative pain score was 1.4 (range, 0 to 7). Mean postoperative DASH score was 10.2 (range, 0 to 52). Increasing age and an interval from injury to surgery of >1 year correlated with worse DASH and pain scores.

Conclusions: Patients with fibrous scaphoid nonunion demonstrated good results with rigid fixation without bone grafting. Increasing age and >1-year interval between injury and surgery resulted in lower self-assessed outcomes.

Level Of Evidence: Therapeutic Level IV, retrospective case series.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11552-015-9741-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4551641PMC
September 2015

Assessment of the relationships among coagulopathy, hyperfibrinolysis, plasma lactate, and protein C in dogs with spontaneous hemoperitoneum.

J Vet Emerg Crit Care (San Antonio) 2016 Jan-Feb;26(1):41-51. Epub 2015 Jul 28.

Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853-6007.

Objective: To relate coagulation and fibrinolysis derangements to shock severity as reflected by plasma lactate concentrations in dogs with spontaneous hemoperitoneum (SHP) and determine the impact on transfusions.

Design: Prospective, observational, case-control study.

Setting: Three veterinary teaching hospitals.

Animals: Twenty-eight client-owned dogs with SHP and 28 breed- and age-matched control dogs.

Interventions: None.

Measurements And Main Results: Blood samples for platelet counts, coagulation, and anticoagulant assays (prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin, and protein C, thromboelastography [TEG]), fibrinolysis testing (d-dimer and TEG lysis parameters with and without the addition of 50 U/mL of tissue plasminogen activator [TEG LY30 measured with the addition of 50 U/mL of tPA to the blood sample, LY3050 and TEG LY60 measured with the addition of 50 U/mL of tPA to the blood sample, LY6050 ; LY30 and LY60]), and plasma lactate as an indicator of severity of shock were collected from SHP dogs at the time of diagnosis. SHP dogs were hypocoagulable (prolonged prothrombin time and activated partial thromboplastin time, decreased TEG maximum amplitude) and hyperfibrinolytic (increased LY3050 and TEG LY6050 ) compared to controls. The severity of hypocoagulability was related to protein C activity, while the severity of hyperfibrinolysis was related to plasma lactate concentration. Among the 18 dogs discharged from the hospital, LY3050 was significantly associated with the dose of fresh frozen plasma administered, but none of the parameters were associated with the dose of red blood cells administered.

Conclusions: Dogs with SHP have evidence of hypocoagulability, protein C deficiency, and hyperfibrinolysis. Parameters of hyperfibrinolysis were related to plasma lactate concentrations and volume of plasma transfused during hospitalization. These derangements resemble those found in people with acute coagulopathy of trauma and shock, and activation of protein C may be a common feature to both syndromes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vec.12346DOI Listing
September 2016

Evaluation of tranexamic acid and ε-aminocaproic acid concentrations required to inhibit fibrinolysis in plasma of dogs and humans.

Am J Vet Res 2014 Aug;75(8):731-8

Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853.

Objective: To determine minimum plasma concentrations of the antifibrinolytic agents tranexamic acid (TEA) and ε-aminocaproic acid (EACA) needed to completely inhibit fibrinolysis in canine and human plasma after induction of hyperfibrinolysis.

Samples: Pooled citrated plasma from 7 dogs and commercial pooled citrated human plasma.

Procedures: Concentrations of EACA from 0 μg/mL to 500 μg/mL and of TEA from 0 μg/mL to 160 μg/mL were added to pooled citrated canine and human plasma. Hyperfibrinolysis was induced with 1,000 units of tissue plasminogen activator/mL, and kaolin-activated thromboelastography was performed in duplicate. The minimum concentrations required to completely inhibit fibrinolysis 30 minutes after maximum amplitude of the thromboelastography tracing occurred were determined.

Results: Minimum plasma concentrations necessary for complete inhibition of fibrinolysis by EACA and TEA in pooled canine plasma were estimated as 511.7 μg/mL (95% confidence interval [CI], 433.2 to 590.3 μg/mL) and 144.7 μg/mL (95% CI, 125.2 to 164.2 μg/mL), respectively. Concentrations of EACA and TEA necessary for complete inhibition of fibrinolysis in pooled human plasma were estimated as 122.0 μg/mL (95% CI, 106.2 to 137.8 μg/mL) and 14.7 μg/mL (95% CI, 13.7 to 15.6 μg/mL), respectively.

Conclusions And Clinical Relevance: Results supported the concept that dogs are hyperfibrinolytic, compared with humans. Higher doses of EACA and TEA may be required to fully inhibit fibrinolysis in dogs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2460/ajvr.75.8.731DOI Listing
August 2014

Influence of cross-match on posttransfusion packed cell volume in feline packed red blood cell transfusion.

J Vet Emerg Crit Care (San Antonio) 2014 Jul-Aug;24(4):429-36. Epub 2014 Jul 15.

Department of Clinical Sciences, Cornell University, College of Veterinary Medicine, Ithaca, NY, 14853.

Objective: To evaluate the influence of major cross-match on transfusion efficacy based on the change in PCV following packed red blood cell (pRBC) administration in cats.

Design: Retrospective study from January 2000 to December 2010.

Setting: University Teaching Hospital.

Animals: Two hundred nine cats received 233 type-specific pRBC transfusions as treatment for anemia. Forty-three transfusions were cross-match compatible and 190 were not screened with cross-match.

Interventions: Pretransfusion major cross-match.

Measurements And Main Results: Signalment, body weight, dosage of pRBC transfusion, pretransfusion PCV, posttransfusion PCV, IV fluid volumes administered between the measurement of the pretransfusion PCV and posttransfusion PCV, time delay between pretransfusion PCV measurement and transfusion administration, time between administration of transfusion and posttransfusion PCV measurement, and major cross-match testing data were extracted from the medical records of cats receiving pRBC transfusions and were evaluated for their influence on posttransfusion PCV scaled to dose of pRBC administered. The mean pretransfusion PCV was significantly lower for cross-match compatible transfusions (13.7 ± 4.2%) compared to noncross-matched transfusions (16.1 ± 4.5%; independent samples t-test, P < 0.0001). The PCV increase posttransfusion scaled by dose was significantly greater for cross-match compatible transfusions (1.02 ± 0.51%/mL/kg) than for noncross-matched transfusions (0.74 ± 0.65%/mL/kg; independent samples t-test, P = 0.0093). Of age, dose of pRBCs, cross-match status, reason for transfusion, pretransfusion PCV, and dose of IV fluids administered between the pretransfusion and posttransfusion PCV, only pRBC dose, cross-match status, and pretransfusion PCV were independent predictors of change in PCV with transfusion on multiple regression analysis (coefficient = 0.507, P < 0.0001; coefficient = 1.64, P = 0.041; coefficient = -0.235, P = 0.0009, respectively).

Conclusions: In this retrospective study, administration of type-specific, cross-match compatible pRBC transfusions resulted in significantly greater increases in the posttransfusion PCV when compared to administration of typed, noncross-matched pRBCs. Future prospective studies evaluating the effect of cross-match on transfusion efficacy in cats are warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vec.12204DOI Listing
April 2015

Updates in small animal cardiopulmonary resuscitation.

Vet Clin North Am Small Anim Pract 2013 Jul 12;43(4):971-87. Epub 2013 Apr 12.

Department of Clinical Sciences, Cornell University College of Veterinary Medicine, DCS Box 31, Ithaca, NY 14853, USA.

For dogs and cats that experience cardiopulmonary arrest, rates of survival to discharge are 6% to 7%, as compared with survival rates of 20% for people. The introduction of standardized cardiopulmonary resuscitation guidelines and training in human medicine has led to substantial improvements in outcome. The Reassessment Campaign on Veterinary Resuscitation initiative recently completed an exhaustive literature review and generated a set of evidence-based, consensus cardiopulmonary resuscitation guidelines in 5 domains: preparedness and prevention, basic life support, advanced life support, monitoring, and postcardiac arrest care. This article reviews some of the most important of these new guidelines.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cvsm.2013.03.006DOI Listing
July 2013

Updates in the management of the small animal patient with neurologic trauma.

Vet Clin North Am Small Anim Pract 2013 Jul 13;43(4):915-40. Epub 2013 Apr 13.

Section of Emergency and Critical Care, Cornell University Hospital for Animals, Upper Tower Road, Ithaca, NY 14853, USA.

Neurologic trauma, encompassing traumatic brain injury (TBI) and acute spinal cord injury (SCI), is a cause of significant morbidity and mortality in veterinary patients. Acute SCIs occurring secondary to trauma are also common. Essential to the management of TBI and SCI is a thorough understanding of the pathophysiology of the primary and secondary injury that occurs following trauma. This article reviews the pathophysiology of this primary and secondary injury, as well as recommendations regarding clinical assessment, diagnostics, pharmacologic and nonpharmacologic therapy, and prognosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cvsm.2013.03.002DOI Listing
July 2013

T2-weighted magnetic resonance imaging measurements of optic nerve sheath diameter in dogs with and without presumed intracranial hypertension.

Vet Radiol Ultrasound 2013 May-Jun;54(3):263-70. Epub 2013 Mar 7.

Department of Clinical Sciences, Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA.

Intracranial hypertension is a cause of cerebral ischemia and neurologic deficits in dogs. Goals of this retrospective study were to test interobserver agreement for MRI measurements of optic nerve sheath diameter and associations between optic nerve sheath diameter, signalment data, and presumed intracranial hypertension status in a cohort of dogs. A veterinary radiologist interpreted scans of 100 dogs and dogs were assigned to groups based on presence or absence of at least two MRI characteristics of presumed intracranial hypertension. Two observers who were unaware of group status independently measured optic nerve diameter from transverse T2-weighted sequences. Mean optic nerve sheath diameter for all dogs was 3 mm (1-4 mm). The mean difference between observers was 0.3 mm (limits of agreement, -0.4 and 1.0 mm). There was no correlation between optic nerve sheath diameter and age for either observer (r = -0.06 to 0.00) but a moderate positive correlation was observed between optic nerve sheath diameter and body weight for both observers (r = 0.70-0.76). The 22 dogs with presumed intracranial hypertension weighed less than the 78 dogs without (P = 0.02) and were more often female (P = 0.04). Dogs with presumed intracranial hypertension had a larger ratio of optic nerve sheath diameter to body weight for each observer-side pair (P = 0.01-0.04) than dogs without. Findings indicated that the ratio of MRI optic nerve sheath diameter relative to body weight may be a repeatable predictor of intracranial hypertension in dogs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vru.12023DOI Listing
February 2014

Admission base excess as a predictor of transfusion requirement and mortality in dogs with blunt trauma: 52 cases (2007-2009).

J Vet Emerg Crit Care (San Antonio) 2012 Oct;22(5):588-94

Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.

Objective: To evaluate the ability of admission base excess (ABE) to predict blood transfusion requirement and mortality in dogs following blunt trauma.

Design: Retrospective study 2007-2009.

Setting: University Veterinary Teaching Hospital.

Animals: Fifty-two dogs admitted to the intensive care unit for treatment following blunt trauma.

Measurements And Main Results: Animals requiring red blood cell transfusion (N = 8) had significantly lower ABE than those not requiring transfusion (N = 44; median base excess [BE] = -8.4 versus -4.7, P = .0034), while there was no difference in admission packed cell volume (PCV) or age. Animals that died or were euthanized due to progression of signs (N = 5) had lower median ABE than those that survived (N = 47; median BE = -7.3 versus -4.9, P = 0.018). Admission PCV and age were not significantly different between survivors and nonsurvivors. Receiver operator characteristic curve analysis showed an ABE cutoff of -6.6 was 88% sensitive and 73% specific for transfusion requirement (P < 0.001), and a cutoff of -7.3 was 81% sensitive and 80% specific for survival (P < 0.001). Multivariate logistic regression analysis demonstrated that ABE was a predictor of transfusion requirement that was independent of overall severity of injury as measured by the Animal Triage Trauma (ATT) score, but a similar analysis showed that only ATT was an independent predictor of survival.

Conclusions: The ABE in dogs with blunt trauma was a predictor of mortality and blood transfusion requirement within 24 hours.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1476-4431.2012.00798.xDOI Listing
October 2012

RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 6: Post-cardiac arrest care.

J Vet Emerg Crit Care (San Antonio) 2012 Jun;22 Suppl 1:S85-101

AVETS, Monroeville, PA 15146, USA.

Objective: To systematically examine the evidence for interventions after the return of spontaneous circulation (ROSC) on outcomes from veterinary cardiopulmonary resuscitation and to determine important knowledge gaps.

Design: Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical post-cardiac arrest care.

Setting: Academia, referral practice, and general practice.

Results: Fifteen standardized clinical questions important for post-cardiac arrest care were asked and research articles relevant to answering these questions were identified through structured, explicit literature database searches. The majority of these articles report research in species other than dogs or cats or consisted of experimental work in canine cardiac arrest models. Outcome metrics reported in these studies widely varied and ranged from quantification of mechanistic endpoints, such as elaboration of reactive oxygen species, to survival, and functional neurologic outcome.

Conclusions: Despite the near complete absence of clinical veterinary studies, the process allowed the formulation of statements for several postcardiac arrest treatments that were either supportive, such as mild therapeutic hypothermia or controlled reoxygenation, or neutral, such as for mannitol administration or seizure prophylaxis. Evidence grading allowed transparency in regards to the strength of these recommendations. Moreover, numerous knowledge gaps emerged that will allow generation of a road map for progress in veterinary post-cardiac arrest care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1476-4431.2012.00754.xDOI Listing
June 2012

RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 5: Monitoring.

J Vet Emerg Crit Care (San Antonio) 2012 Jun;22 Suppl 1:S65-84

Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602-7371, USA.

Objective: To systematically examine the evidence on patient monitoring before, during, and following veterinary CPR and to identify scientific knowledge gaps.

Design: Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. Relevant questions were answered on a worksheet template and reviewed by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) monitoring domain members, by the RECOVER committee and opened for comments by veterinary professionals for 3 months.

Setting: Academia, referral practice, and general practice.

Results: Eighteen worksheets evaluated monitoring practices relevant for diagnosing cardiopulmonary arrest (CPA), monitoring CPR efforts, identifying return of spontaneous circulation (ROSC), and post-ROSC monitoring.

Conclusions: Although veterinary clinical trials are lacking, experimental literature using canine models and human clinical trials provided relevant data. The major conclusions from this analysis of the literature highlight the utility of end-tidal carbon dioxide (EtCO(2)) monitoring to identify ROSC and possibly to evaluate quality of CPR. In addition, recommendations for ECG analysis during CPR were addressed. Unless the patient is instrumented at the time of CPA, other monitoring devices (eg, Doppler flow probe) are likely not useful for diagnosis of CPA, and the possibility of pulseless electrical activity makes ECG inappropriate as a sole diagnostic tool. Optimal monitoring of the intra- and postcardiac arrest patient remains to be determined in clinical veterinary medicine, and further evaluation of the prognostic and prescriptive utility of EtCO(2) monitoring will provide material for future studies in veterinary CPR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1476-4431.2012.00751.xDOI Listing
June 2012

RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 4: Advanced life support.

J Vet Emerg Crit Care (San Antonio) 2012 Jun;22 Suppl 1:S44-64

Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA.

Objective: To systematically evaluate the evidence of the effect of advanced life support techniques on outcome in veterinary cardiopulmonary resuscitation (CPR) and to outline knowledge gaps.

Design: Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice.

Setting: Academia, referral practice, and general practice

Results: Sixteen population, intervention, control group, outcome questions were evaluated to determine if recommendations could be made concerning drug therapy, including vasopressors, vagolytics, corticosteroids, reversal agents, buffer therapy, and correction of electrolyte disturbances. Electrical defibrillation strategies as well as other advanced interventions such as open-chest CPR, impedance threshold devices, and special considerations regarding anesthesia-related cardiopulmonary arrest (CPA) were also investigated.

Conclusions: There is strong evidence supporting the use of standard-dose (0.01 mg/kg) epinephrine in CPR, as well as early electrical defibrillation for animals experiencing CPA due to ventricular fibrillation or pulseless ventricular tachycardia, preferentially using a biphasic defibrillator. For CPA due to certain causes and with the availability of advanced postcardiac arrest support, open chest CPR is preferred. Many knowledge gaps regarding other pharmacologic and advanced therapies were identified, and further studies are recommended to better systematically address these questions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1476-4431.2012.00755.xDOI Listing
June 2012
-->