Publications by authors named "Manuel Boller"

34 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

The Effect of Pet Insurance on Presurgical Euthanasia of Dogs With Gastric Dilatation-Volvulus: A Novel Approach to Quantifying Economic Euthanasia in Veterinary Emergency Medicine.

Front Vet Sci 2020 8;7:590615. Epub 2020 Dec 8.

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

Euthanasia of companion animals in veterinary emergency medicine is a common cause of death. Euthanasia is economic when it is the consequence of the pet owner's inability to afford essential treatment while a viable medical alternative to euthanasia exists. Gastric dilatation-volvulus (GDV) is an acute life-threatening emergency condition of dogs; if left untreated, rapid death is highly likely. Surgical treatment leads to survival of around 80-90% of dogs; however, such treatment is costly. Therefore, pre-surgical euthanasia may be largely economically motivated. Having pet insurance, a financial instrument to reduce the burden of unforeseen veterinary medical costs on pet owners, would be expected to abolish the risk for pre-surgical economic euthanasia. We therefore aimed to determine whether pet insurance attenuates the risk of pre-surgical economic euthanasia in dogs with GDV. Non-referred dogs ( = 260) with GDV and known insurance status seen at 24 emergency clinics over a 2-year period were included. Relevant data (e.g., insurance status, age, comorbidities, outcome) were retrospectively extracted from a pet insurer's claim records (insured animals) or from electronic medical records of participating hospitals (non-insured animals). Forty-one percent of dogs (106 of 260 dogs) did not survive to hospital discharge; 82 (77%) of non-survivors died before surgery, all through euthanasia. The pre-surgical euthanasia rate was 10% in insured and 37% in non-insured dogs ( < 0.001). When adjusted for the effect of age, deposit size, comorbidities, and blood lactate concentration, the absence of insurance increased the odds of pre-surgical euthanasia by a factor of 7.4 (95% CI 2.0 to 37; = 0.002). Of dogs undergoing surgery, 86% survived to hospital discharge. Overall, 80% of insured animals and 53% of non-insured animals survived to hospital discharge ( < 0.001). Thus, insurance was associated with a marked decrease in risk of pre-surgical euthanasia indicating that the cause of pre-surgical euthanasia of dogs with GDV is predominantly economic in nature. The rate of pre-surgical euthanasia in dogs with GDV may emerge as a suitable marker to quantify economic decision making of pet owners and to measure the impact of financial interventions aimed at mitigating economic duress associated with cost of veterinary emergency care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fvets.2020.590615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752994PMC
December 2020

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

Coagulation factor activity patterns of venom-induced consumption coagulopathy in naturally occurring tiger snake (Notechis scutatus) envenomed dogs treated with antivenom.

Toxicon 2020 Jul 21;181:36-44. Epub 2020 Apr 21.

Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, 250 Princes Highway, Werribee, VIC, 3030, Australia; Translational Research and Animal Clinical Trial Study Group (TRACTS), Faculty of Veterinary and Agricultural Sciences, University of Melbourne, 250 Princes Highway, Werribee, VIC, 3030, Australia. Electronic address:

Background: Venom-induced consumption coagulopathy (VICC) from tiger snake (Notechis scutatus) envenomation results in a dose-dependent coagulopathy that is detectable on coagulometry. However, individual coagulation factor activities in dogs with tiger snake envenomation have not been determined. This study aimed to characterise VICC and the time course of recovery in tiger snake envenomed dogs and to investigate an association between tiger snake venom (TSV) concentrations and factor activity.

Methods: This was a prospective, observational, cohort study. The study cohort was 11 dogs of any age, breed, sex, body weight >10 kg, confirmed serum TSV on ELISA and treated with antivenom. Blood was collected at enrolment before antivenom administration, then at 3, 12 and 24 h after antivenom administration. Tiger snake venom concentrations were detected with a sandwich ELISA. Fibrinogen was measured using a modified Clauss method, and coagulation factors (F) II, V, VII, VIII and X were measured with factor-deficient human plasma using a modified prothrombin (PT) and activated partial thromboplastin (aPTT) method. Linear mixed models, with multiple imputations of censored observations, were used to determine the effect of time and TSV concentration on the coagulation times and factor activity. This cohort was compared to 20 healthy controls.

Results: At enrolment, there were severe deficiencies in fibrinogen, FV and FVIII, with predicted recovery by 10.86, 11.75 and 13.14 h after antivenom, respectively. There were modest deficiencies in FX and FII, with predicted recovery by 20.57 and 32.49 h after antivenom, respectively. No changes were detected in FVII. Prothrombin time and aPTT were markedly prolonged with predicted recovery of aPTT by 12.58 h. Higher serum TSV concentrations were associated with greater deficiencies in FII, FV and FVIII, and greater prolongations in coagulation times. The median (range) serum TSV concentration was 57 (6-2295) ng/mL.

Conclusions: In tiger snake envenomed dogs, we detected a profound, TSV-concentration-related consumption of select coagulation factors, that rapidly recovered toward normal. These findings allowed further insight into tiger snake VICC in dogs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.toxicon.2020.03.010DOI Listing
July 2020

In vitro effects of lactated Ringer's solution, hypertonic saline, hydroxyethyl starch, hypertonic saline/hydroxyethyl starch, and mannitol on thromboelastographic variables of canine whole blood.

J Vet Emerg Crit Care (San Antonio) 2020 May 19;30(3):255-263. Epub 2020 Feb 19.

U-Vet Animal Hospital, Melbourne Veterinary School, University of Melbourne, Werribee, Victoria, Australia.

Objective: To assess the in vitro effects of crystalloid and colloid IV fluids on the thromboelastographic (TEG) variables of canine whole blood.

Design: In vitro experimental study.

Setting: Veterinary teaching hospital.

Animals: Twenty-two healthy dogs.

Intervention: Citrated whole blood samples collected from healthy dogs were diluted with 3.4% hypertonic saline (HTS 3.4), 7% hypertonic saline (HTS 7), and 20% mannitol at 8% and 16% dilutions; hydroxyethyl starch 130/0.4 (HES 130/0.4) at 16% dilution; lactated Ringer's solution (LRS) at 16%, 33%, and 66% dilutions; and HTS 7-HES 130/0.4 at 25% and 50% dilutions. Kaolin-activated TEG analysis was concurrently performed on diluted and control (undiluted) samples.

Measurements And Main Results: Dilution of canine whole blood with LRS compared to control reduced α angle and MA at both 33% (P = 0.009 and P = 0.011, respectively) and 66% dilution (P < 0.001 and P < 0.001, respectively), and prolonged K time at 66% dilution (P = 0.003). At 16% dilution, HTS 3.4, prolonged R time (P = 0.007), while mannitol, a fluid iso osmolar to HTS 3.4, prolonged K time (P = 0.006), reduced α angle (P < 0.001), MA (P = 0.046), and LY60 (P = 0.015). At 8% dilution, HTS 7, a fluid of high osmolarity and tonicity, prolonged R time (P = 0.009) and reduced MA (P = 0.015), while all measured TEG variables were altered at the 16% dilution (P < 0.01 for all variables). HES 130/0.4 reduced α angle (P = 0.031) and MA (P = 0.001) and increased LY60 (P < 0.001) at 16% dilution. Comparing different fluid types, HES 130/0.4 and HTS 3.4 had no to minor, mannitol intermediate, and HTS 7 profound effects on TEG variables (P < 0.05) when compared to LRS at the same dilution.

Conclusions: In vitro dilution of canine whole blood with commonly used IV fluids leads to thromboelastographic changes consistent with hypocoagulability in a dose dependent manner for all fluid types tested. Viscoelastic changes are also influenced by fluid characteristics, specifically tonicity and osmolarity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vec.12929DOI Listing
May 2020

The endothelial glycocalyx: Structure and function in health and critical illness.

J Vet Emerg Crit Care (San Antonio) 2020 Mar 18;30(2):117-134. Epub 2020 Feb 18.

U-Vet Animal Hospital, Melbourne Veterinary School, University of Melbourne, Werribee, Victoria, 3030, Australia.

Objective: To conduct a narrative review of the current literature in reference to the structure and function of the endothelial glycocalyx (EG) and its contribution to the pathophysiology of conditions relevant to the veterinary emergency and critical care clinician. Novel therapies for restoring or preserving the EG will also be discussed.

Data Sources: Online databases (PubMed, CAB abstracts, Scopus) were searched between January 1st 2017 and May 1st 2017 for English language articles without publication date restriction. Keywords included EG, endothelial surface layer, degradation, syndecan-1, heparan sulfate, critical illness, sepsis, trauma, and therapeutics.

Data Synthesis: The EG is a complex and important structure located on the luminal surface of all blood vessels throughout the body. It plays an important role in normal vascular homeostasis including control of fluid exchange across the vascular barrier. Loss or degradation of the EG has an impact on inflammation, coagulation, and vascular permeability and tone. These changes are essential components in the pathophysiology of many conditions including sepsis and trauma. A substantial body of experimental animal and human clinical research over the last decade has demonstrated increased circulating concentrations of EG degradation products in these conditions. However, veterinary-specific research into the EG and critical illness is currently lacking. The utility of EG degradation products as diagnostic and prognostic tools continues to be investigated and new therapies to preserve or improve EG structure and function are under development.

Conclusions: The recognition of the presence of the EG has changed our understanding of transvascular fluid flux and the pathophysiology of many conditions of critical illness. The EG is an exciting target for novel therapeutics to improve morbidity and mortality in conditions such as sepsis and trauma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vec.12925DOI Listing
March 2020

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

Acute barium poisoning in a dog after ingestion of handheld fireworks (party sparklers).

J Vet Emerg Crit Care (San Antonio) 2019 Mar 12;29(2):201-207. Epub 2019 Mar 12.

U-Vet Animal Hospital, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Australia.

Objective: To report a case of acute barium poisoning in a dog subsequent to ingestion of a common handheld pyrotechnic (sparkler).

Case Summary: A 5-year-old female neutered German Shorthaired Pointer presented with acute onset of generalized flaccid muscle paralysis and fasciculations, ptyalism, and an irregular heart rhythm. Marked hypokalemia (1.9 mmol/L [mEq/L]; reference range [3.5-5.8 mmol/L [mEq/L]), acidemia (pH 7.20; reference range 7.38-7.44), and hypoventilation (PvCO 55 mm Hg; reference range 40-50 mm Hg) were present on admission. Treatment consisted of fluid therapy, aggressive IV potassium chloride supplementation, gastric lavage, and oral magnesium sulfate administration. Based on history and clinical presentation, barium intoxication after ingestion of handheld firework (sparklers) was suspected and a serum sample was submitted for barium analysis. The serum barium concentration determined by inductively coupled plasma/mass spectrometry was 2,000 μg/L, a 3 orders of magnitude elevation above previously reported normal values in dogs. Within 18 hours of admission, the clinical signs resolved and the blood potassium concentration normalized. The animal was discharged home 36 hours after admission. On follow-up performed after 1 and 5 years, no health issues were apparent.

New Information Provided: To the authors' knowledge, this is the first report of acute, life-threatening barium toxicosis characterized by flaccid paralysis, acidemia, and severe hypokalemia occurring in a dog after ingestion of a popular pyrotechnic (sparkler) containing barium nitrate. Clinical signs may resolve within 24 hours with appropriate supportive care including aggressive potassium supplementation and chelation therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vec.12820DOI Listing
March 2019

ACVECC-Veterinary Committee on Trauma Registry Report 2013-2017.

J Vet Emerg Crit Care (San Antonio) 2018 Nov 7;28(6):497-502. Epub 2018 Oct 7.

American College of Veterinary and Emergency Critical Care Veterinary Committee on Trauma (ACVECC-VetCOT) (Chair), Stillwater, MN, 55082.

Objective: To report summative data from the American College of Veterinary Emergency and Critical Care Veterinary Committee on Trauma (VetCOT) registry.

Design: Multi-institutional veterinary trauma registry data report.

Setting: VetCOT identified veterinary trauma centers (VTCs).

Animals: Dogs and cats with evidence of trauma presented to VTCs with data entered in the VetCOT registry September 1, 2013-March 31, 2017.

Interventions: VetCOT created a standardized data collection methodology for dog and cat trauma. Data were input to a web-based data capture system (REDCap) by data entry personnel trained in data software use and operational definitions of data variables. Data on demographics, trauma type (blunt vs penetrating), preadmission care, hospitalization and intensive care requirement, trauma severity assessment at presentation (eg, modified Glasgow coma scale and animal trauma triage score), key laboratory parameters, necessity for surgical intervention, and case outcome were collected. Summary descriptive data for each species are reported.

Measurements And Main Results: Twenty-nine VTCs in North America, Europe, and Australia contributed information from 17,335 dog and 3,425 cat trauma cases during the 42-month reporting period. A large majority of cases presented directly to the VTC after injury (80.4% dogs and 78.1% cats). Blunt trauma was the most common source for injury in cats (56.7%); penetrating trauma was the most common source for injury in dogs (52.3%). Note that 43.8% of dogs and 36.2% of cats were reported to have surgery performed. The proportion surviving to discharge was 92.0% (dogs) and 82.5% (cats).

Conclusions: The VetCOT registry proved to be a powerful resource for collection of a large dataset on trauma in dogs and cats seen at VTCs. While overall survival to discharge was quite high, further evaluation of data on subsets of injury types, patient assessment parameters, interventions, and associated outcome are warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vec.12766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226341PMC
November 2018

Retrospective evaluation of cats with elapid snake envenomation associated neurotoxicity requiring mechanical ventilation: 12 cases (2005-2014).

J Vet Emerg Crit Care (San Antonio) 2017 Sep 11;27(5):579-585. Epub 2017 Aug 11.

U-Vet Animal Hospital, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, VIC 3030, Australia.

Objective: To retrospectively determine the population and outcome characteristics of a cohort of Australian elapid snake envenomed cats requiring mechanical ventilation (MV).

Design: Retrospective observational study (2005-2014).

Setting: Academic veterinary emergency and critical care service.

Animals: Twelve cats undergoing MV for elapid snake envenomation.

Interventions: None.

Measurements And Main Results: The medical records were searched to identify cats requiring MV as part of treatment for elapid snake envenomation. Signalment, the indication for, duration of and complications associated with MV, duration of hospitalization, and survival to hospital discharge were recorded for each of the enrolled cases. Seven cats (58.3%) underwent MV because of presumed unsustainable respiratory effort and 5 cats (41.7%) for respiratory arrest. Eleven cats (91.7%) were successfully weaned from MV and survived to hospital discharge. No cats developed ventilator associated pneumonia or pneumothorax. The median duration of MV was 19.5 hours for the survivors (range 7.0-37.0 hours) and median duration of hospitalization was 3.5 days (range 2.4-14.9 days).

Conclusions: Cats requiring MV for elapid snake envenomation have a favorable outcome and require a relatively short period of MV. Complications encountered are unlikely to influence outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vec.12632DOI Listing
September 2017

Utstein-style guidelines on uniform reporting of in-hospital cardiopulmonary resuscitation in dogs and cats. A RECOVER statement.

J Vet Emerg Crit Care (San Antonio) 2016 Jan-Feb;26(1):11-34. Epub 2016 Jan 6.

Banfield Pet Hospital, Portland, OR.

Objective: To provide recommendations for reviewing and reporting clinical in-hospital cardiopulmonary resuscitation (CPR) events in dogs and cats and to establish nonambiguous operational definitions for CPR terminology.

Design: Consensus guidelines.

Setting: International, academia, referral practice, general practice, and human medicine.

Methods: An international veterinary Utstein task force was convened in April 2013 in San Francisco to determine the scope of the project, the variables to be reported, their definitions, and a reporting template. Factors that were essential for meaningful data reporting and were amenable to accurate collection (ie, core variables) and additional variables useful for research projects and hypothesis generation (ie, supplemental variables) were defined. Consensus on each item was either achieved during that meeting or during the subsequent online modified Delphi process and dialogue between task force members.

Results: Variables were defined and categorized as hospital, animal, event (arrest), and outcome variables. This report recommends a template for standardized reporting of veterinary in-hospital CPR studies involving dogs or cats. Core elements include the suspected cause(s) and location of arrest, first rhythm identified, the occurrence of return of spontaneous circulation (ROSC) of more than 30 seconds (any ROSC) or more than 20 minutes (sustained ROSC), survival to discharge, and functional capacity at discharge. If CPR is discontinued or the patient is euthanized by owner request, a reason is reported. The task force suggests a case report form to be used for individual resuscitation events.

Conclusions: The availability of these veterinary small animal CPR reporting guidelines will encourage and facilitate high-quality veterinary CPR research, improve data comparison between studies and across study sites, and serve as the foundation for veterinary CPR registries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vec.12436DOI 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

Assessment of Fluid Balance and the Approach to Fluid Therapy in the Perioperative Patient.

Vet Clin North Am Small Anim Pract 2015 Sep 29;45(5):895-915. Epub 2015 May 29.

Emergency and Critical Care, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, 250 Princes Highway, Werribee, Melbourne, Victoria 3030, Australia.

Perioperative patients can be highly dynamic and have various metabolic, physiologic, and organ system derangements that necessitate smart monitoring strategies and careful fluid therapy. The interplay between changing patient status, therapeutic interventions, and patient response makes effective monitoring crucial to successful treatment. Monitoring the perioperative patient and an approach to fluid therapy are discussed in this text.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cvsm.2015.04.011DOI Listing
September 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

Prelude to RECOVER: time is up for veterinary CPR guidelines.

J Vet Emerg Crit Care (San Antonio) 2012 Apr;22(2):143-4

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1476-4431.2012.00732.xDOI Listing
April 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

RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 3: Basic life support.

J Vet Emerg Crit Care (San Antonio) 2012 Jun;22 Suppl 1:S26-43

School of Veterinary Medicine, Department of Veterinary Surgical and Radiological Sciences, University of California at Davis, Davis, CA 95616, USA.

Objective: To systematically examine the evidence on basic life support (BLS) in veterinary CPR and to determine 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) BLS domain members, by the RECOVER committee and opened for comments by veterinary professionals for 30 days.

Setting: Academia, referral practice, and general practice.

Results: Sixteen worksheets were prepared to evaluate techniques for chest compression and ventilation strategies as well as identification of cardiopulmonary arrest (CPA). Major recommendations arising from this evidence review include performing chest compressions at a rate of at least 100/min at a compression depth of one-third to half the width of the chest with minimal pauses, and early instigation of ventilation at a rate of 8-10 breaths/min in intubated patients, or using a 30:2 compression/ventilation ratio in nonintubated patients.

Conclusions: Although veterinary clinical trials are lacking, much of the experimental literature on BLS utilized canine models. The major conclusions from this analysis of the literature are the importance of early identification of CPA, and immediate initiation of BLS in these patients. Many knowledge gaps exist, most importantly in our understanding of the optimal hand placement and technique for chest compressions, warranting coordinated future studies targeted at questions of relevance to differences between veterinary species and humans.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1476-4431.2012.00753.xDOI Listing
June 2012

RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 2: Preparedness and prevention.

J Vet Emerg Crit Care (San Antonio) 2012 Jun;22 Suppl 1:S13-25

College of Veterinary Medicine, University of Illinois, Urbana, IL 61802, USA.

Objective: To systematically examine the evidence on the effect of prevention and preparedness measures on outcomes in veterinary cardiopulmonary resuscitation and to determine 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) prevention and preparedness domain members, by the RECOVER committee, and opened for comments by veterinary professionals for 3 months.

Setting: Academia, referral practice, and general practice.

Results: Nine worksheets were prepared to determine the extent to which preparation of the environment (charts, visual aids, etc) and personnel (training, debriefing, etc) are beneficial in improving return of spontaneous circulation.

Conclusions: Of the questions evaluated, only the association between anesthesia-related cardiopulmonary arrest and better outcomes was supported by strong evidence. There is some evidence from the human literature that the use of cognitive aids, standardized didactic, and hands-on training with high-fidelity simulators, team and leadership training, and post-cardiac arrest debriefing improve adherence to cardiopulmonary resuscitation guidelines and, in some cases, patient outcomes. Veterinary studies investigating these issues are lacking, and development of initial guidelines is a crucial first step.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1476-4431.2012.00752.xDOI Listing
June 2012

RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 1: Evidence analysis and consensus process: collaborative path toward small animal CPR guidelines.

J Vet Emerg Crit Care (San Antonio) 2012 Jun;22 Suppl 1:S4-12

Department of Emergency Medicine, School of Medicine, Center for Resuscitation Science, University of Pennsylvania, Philadelphia, PA 19104, USA.

Objective: To describe the methodology used by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) to evaluate the scientific evidence relevant to small animal CPR and to compose consensus-based clinical CPR guidelines for dogs and cats.

Design: This report is part of a series of 7 articles on the RECOVER evidence and knowledge gap analysis and consensus-based small animal CPR guidelines. It describes the organizational structure of RECOVER, the evaluation process employed, consisting of standardized literature searches, the analysis of relevant articles according to study design, species and predefined quality markers, and the drafting of clinical CPR guidelines based on these data. Therefore, this article serves as the methodology section for the subsequent 6 RECOVER articles.

Setting: Academia, referral practice.

Results: RECOVER is a collaborative initiative that systematically evaluated the evidence on 74 topics relevant to small animal CPR and generated 101 clinical CPR guidelines from this analysis. All primary contributors were veterinary specialists, approximately evenly split between academic institutions and private referral practices. The evidence evaluation and guideline drafting processes were conducted according to a predefined sequence of steps designed to reduce bias and increase the repeatability of the findings, including multiple levels of review, culminating in a consensus process. Many knowledge gaps were identified that will allow prioritization of research efforts in veterinary CPR.

Conclusions: Collaborative systematic evidence review is organizationally challenging but feasible and effective in veterinary medicine. More experience is needed to refine the process.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1476-4431.2012.00758.xDOI Listing
June 2012

RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 7: Clinical guidelines.

J Vet Emerg Crit Care (San Antonio) 2012 Jun;22 Suppl 1:S102-31

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

Objective: To present a series of evidence-based, consensus guidelines for veterinary CPR in dogs and cats.

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. Questions in five domains were examined: Preparedness and Prevention, Basic Life Support, Advanced Life Support, Monitoring, and Post-Cardiac Arrest Care. Standardized worksheet templates were used for each question, and the results reviewed by the domain members, by the RECOVER committee, and opened for comments by veterinary professionals for 4 weeks. Clinical guidelines were devised from these findings and again reviewed and commented on by the different entities within RECOVER as well as by veterinary professionals.

Setting: Academia, referral practice and general practice.

Results: A total of 74 worksheets were prepared to evaluate questions across the five domains. A series of 101 individual clinical guidelines were generated. In addition, a CPR algorithm, resuscitation drug-dosing scheme, and postcardiac arrest care algorithm were developed.

Conclusions: Although many knowledge gaps were identified, specific clinical guidelines for small animal veterinary CPR were generated from this evidence-based process. Future work is needed to objectively evaluate the effects of these new clinical guidelines on CPR outcome, and to address the knowledge gaps identified through this process.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1476-4431.2012.00757.xDOI Listing
June 2012

Emergency cardiopulmonary bypass: a promising rescue strategy for refractory cardiac arrest.

Crit Care Clin 2012 Apr 1;28(2):211-29. Epub 2012 Feb 1.

Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Ground Ravdin, Philadelphia, PA 19104, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ccc.2011.12.002DOI Listing
April 2012

Small animal cardiopulmonary resuscitation requires a continuum of care: proposal for a chain of survival for veterinary patients.

J Am Vet Med Assoc 2012 Mar;240(5):540-54

Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, Philadelphia, PA 19104, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2460/javma.240.5.540DOI Listing
March 2012

A combination of metabolic strategies plus cardiopulmonary bypass improves short-term resuscitation from prolonged lethal cardiac arrest.

Resuscitation 2011 Dec;82 Suppl 2:S27-34

Center for Resuscitation Science, Department of Emergency Medicine, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.

Background: The metabolic or late phase of cardiac arrest is highly lethal. Emergency cardiopulmonary bypass (ECPB) can resuscitate many patients even after prolonged cardiac arrest and provides immediate vascular access for correction of metabolic derangement during the reperfusion process. We developed a rodent model of ECPB resuscitation which showed the superiority of ECPB over conventional CPR, especially when combined with hypothermia. For this study we examined a metabolic strategy against ischemia-reperfusion injury (MS-IR) that included: leukoreduction, low Ca(2+), Mg(2+), buffered pH, red blood cells and a colloid. We tested whether ECPB plus MS-IR and/or hypothermia improves short-term hemodynamic outcomes compared to a standard ECPB reperfusate.

Methods: Using a 2×2 factorial design we tested ECPB with (a) MS-IR versus a standard crystalloid solution; and (b) hypothermia versus normothermia in our rat model. The four reperfusion strategies included: (1) MS-IR plus hypothermia, (2) MS-IR with normothermia, (3) standard plasma-lyte (STD) reperfusate plus hypothermia, or (4) STD plus normothermia. Animals underwent 12 min of untreated asphyxial arrest and were resuscitated with ECPB and one of the four strategies for 30 min. Thereafter, ECPB was discontinued and ventilatory support was provided for 3 hours, while hemodynamic, perfusion and other metrics were serially measured.

Results: All rats achieved ROSC with ECPB. Significant differences between the groups emerged after 3 hrs: the best outcomes were in animals with MS-IR plus hypothermia (lactate: 1.1 ± 0.1 mmol/L; MAP: 83 ± 4 mm Hg, seizures: 0/10), while the worst outcomes were with STD and normothermia (lactate: 8.9 ± 1.4 mmol/L, MAP: 36 ± 4 mm Hg, seizures: 7/10, p < 0.001). The outcomes of the other two groups (MS-IR only; hypothermia only) were intermediate. MS-IR and hypothermia improved outcome in an additive fashion.

Conclusions: While most human ECPB is applied with a normothermic crystalloid priming solution, we observed that in rodents the addition of MS-IR plus hypothermia resulted in considerable short-term benefit after prolonged arrest. Future long-term and translational survival studies are warranted to optimize ECPB resuscitation methods.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S0300-9572(11)70148-4DOI Listing
December 2011

Reassessment Campaign on Veterinary Resuscitation (RECOVER).

J Vet Emerg Crit Care (San Antonio) 2011 Jun;21(3):186

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1476-4431.2011.00645.xDOI Listing
June 2011

The clinical practice of CPCR in small animals: an internet-based survey.

J Vet Emerg Crit Care (San Antonio) 2010 Dec 28;20(6):558-70. Epub 2010 Sep 28.

Department of Clinical Studies, School of Veterinary Medicine, University ofPennsylvania, Philadelphia, PA 19104, USA.

Objective: To characterize the provision of CPCR by small animal veterinarians in clinical practice and to assess how this practice varies among different levels of expertise.

Design: Internet-based survey.

Setting: Academia, referral practice, and general practice.

Subjects: Six hundred and two small animal veterinarians in clinical practice. Respondents were grouped a priori according to level of expertise: board-certified (ACVECC, ACVA, ECVAA) specialists; general practitioners in emergency clinics; general practitioners in general practice (GPG).

Interventions: Email invitations to the online questionnaire were disseminated via a veterinary internet platform and mailing list server discussion groups. Questions explored respondent characteristics, CPCR preparedness, infrastructural and personnel resources, and techniques of basic and advanced life support.

Main Results: In this group of practitioners, the majority (65%) were in general practice. GPG were more likely to perform CPCR <5 times per year and to have 3 or fewer members on their resuscitation team. Most practitioners have a crash cart and drug-dosing chart available. GPG were less likely to obtain resuscitation codes on their patients, and less likely to use end-tidal carbon dioxide monitoring or defibrillation. Intubation, oxygen supplementation, vascular access, and external thoracic compressions were widely used, however, GPG were more likely to use lower chest compression rates. Drugs used for CPCR differed among the groups with GPG more likely to use doxapram and glucocorticoids.

Conclusions: CPCR is heterogeneously performed in small animal veterinary medicine; differences exist, both among and within different types of veterinarians with varying levels of expertise, in respect to available infrastructure, personnel and CPCR techniques used.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1476-4431.2010.00571.xDOI Listing
December 2010

Celebrating the 50th anniversary of cardiopulmonary resuscitation: from animals to humans…and back?

Authors:
Manuel Boller

J Vet Emerg Crit Care (San Antonio) 2010 Dec 22;20(6):553-7. Epub 2010 Oct 22.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1476-4431.2010.00593.xDOI Listing
December 2010
-->