Association of point‐of‐care blood variables obtained from dogs and cats during cardiopulmonary resuscitation and following return of spontaneous circulation with patient outcomes

Abstract

Objective: To investigate the association of point-of-care biochemical variables obtained during CPR or within 24 hours of return of spontaneous circulation (ROSC) with patient outcomes. Design: Retrospective study. Setting: University teaching hospital. Animals: Ninety-four dogs and 27 cats undergoing CPR according to the Reassessment Campaign on Veterinary Resuscitation guidelines. Interventions: None. Measurements and Main Results: Blood gas, acid-base, electrolyte, glucose, and plasma lactate values obtained during CPR or within 24 hours of ROSC were retrospectively evaluated and are described. The blood sample type and collection time with respect to CPR initiation and ROSC were recorded. Measured variables, collection times, and species were included in a multivariable logistic regression model to estimate the odds ratio (OR) and 95% confidence interval of ROSC, sustained ROSC (≥20 min), and survival to hospital discharge. Significance was set at P < 0.05. Seventytwo venous blood samples obtained during CPR and 45 first venous and arterial blood samples obtained after ROSC were included in logistic regression analysis. During CPR, PvO 2 (1.09 [1.036-1.148], P = 0.001) and venous standard base excess (SBE) (1.207 [1.094-1.331], P < 0.001) were associated with ROSC. PvO 2 (1.075 [1.028-1.124], P = 0.002), SBE (1.171 [1.013-1.353], P = 0.032), and potassium concentration (0.635 [0.426-0.946], P = 0.026) were associated with sustained ROSC. Potassium concentration (0.235 [0.083-0.667], P = 0.007) was associated with survival to hospital discharge. Following ROSC, pH (69.110 [4.393-1087], P = 0.003), potassium

Prevalence and factors associated with initial and subsequent shockable cardiac arrest rhythms and their association with patient outcomes in dogs and cats undergoing cardiopulmonary resuscitation: A RECOVER registry study

“…Dyskalemia, dyscalcemia, dysmagnesemia, and acidosis can be arrhythmogenic and have the potential to enhance the propensity for VF 50–53 . While details on the nature of metabolic and electrolyte alterations were not available for this population, previous studies report high prevalence of dyskalemia, dyscalcemia, metabolic, and respiratory acidosis in small animals undergoing CPR and make it likely that similar changes in this population could explain the association with I‐SHKRs 54,55 …”

“…[50][51][52][53] While details on the nature of metabolic and electrolyte alterations were not available for this population, previous studies report high prevalence of dyskalemia, dyscalcemia, metabolic, and respiratory acidosis in small animals undergoing CPR and make it likely that similar changes in this population could explain the association with I-SHKRs. 54,55 Animals suspected to have hemorrhage or brain disease as the cause for their CPA were more likely to develop a S-SHKR. Physiologic responses to hemorrhage depend on its magnitude and the rate of the hemorrhage; however, the immediate response typically involves baroreceptor-mediated stimulation of the sympathetic nervous system.…”

Serial paired arterial and jugular venous point‐of‐care values in dogs undergoing manual basic life support

“…Decreased cardiac output and tissue oxygen delivery frequently result in alterations in blood gases, acid-base status, and electrolyte concentrations over the course of resuscitative efforts and are associated with patient outcomes. [6][7][8][9][10][11] An improved understanding of the extent of POC bloodwork abnormalities in dogs might help guide therapeutic interventions, uncover factors contributing to CPA, and may have prognostic value. 6,[9][10][11][12][13][14][15] Several factors, such as the technique and quality of CPR provided, the blood sampling site, and the timing of blood sample acquisition with respect to CPA, can influence the observed abnormalities.…”

“…[6][7][8][9][10][11] An improved understanding of the extent of POC bloodwork abnormalities in dogs might help guide therapeutic interventions, uncover factors contributing to CPA, and may have prognostic value. 6,[9][10][11][12][13][14][15] Several factors, such as the technique and quality of CPR provided, the blood sampling site, and the timing of blood sample acquisition with respect to CPA, can influence the observed abnormalities. Although experimental studies provide important insights into changes to POC blood variables that could be expected in clinical veterinary patients, their study in dogs undergoing manual CPR may provide more relevant information to guide clinical practice.…”

“…[16][17][18] Only 2 veterinary clinical studies have investigated abnormalities in blood gases, acid-base parameters, electrolyte, glucose, and plasma lactate concentrations in dogs and cats experiencing naturally occurring CPA. 11,15 Both studies only reported results of venous POC blood variables, and the blood sampling site and timing were not standardized. 11,15 The objectives of the current study were to compare venous and arterial POC variables obtained from dogs undergoing standardized, manual BLS and to describe their changes at predefined sampling timepoints over time.…”