Ionized calcium during CPR in the canine model

Best, Randall; Martin, Gérard B.; Carden, Donna L.; Tomlanovich, Michael C.; Foreback, Craig C.; Nowak, Richard M.

doi:10.1016/s0196-0644(85)80876-3

Cited by 15 publications

(3 citation statements)

References 20 publications

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“…In a study of 22 patients with traumatic CPA and open‐chest CPR, 12 (55%) had ionized hypocalcemia 117 . Multiple experimental studies in dogs and swine have documented statistically significant decreases in plasma ionized calcium during CPR that persist in the PCA period 97,131–134 . In a clinical retrospective study, ionized hypocalcemia was found in 18% of dogs and cats undergoing CPR (mean: 1.21 mmol/L, range: 0.68–1.59 mmol/L, reference interval: 1.1–1.5 mmol/L) 98 …”

Section: Measurement Of Electrolytes and Other Blood Chemistry Compon...mentioning

confidence: 99%

2024 RECOVER Guidelines: Monitoring. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR

Brainard,

Lane,

Burkitt‐Creedon

et al. 2024

J Vet Emergen Crit Care

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ObjectiveTo systematically review evidence on and devise treatment recommendations for patient monitoring before, during, and following CPR in dogs and cats, and to identify critical knowledge gaps.DesignStandardized, systematic evaluation of literature pertinent to peri‐CPR monitoring following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by Monitoring Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co‐Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk:benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization.SettingTransdisciplinary, international collaboration in university, specialty, and emergency practice.ResultsThirteen questions pertaining to hemodynamic, respiratory, and metabolic monitoring practices for identification of cardiopulmonary arrest, quality of CPR, and postcardiac arrest care were examined, and 24 treatment recommendations were formulated. Of these, 5 recommendations pertained to aspects of end‐tidal CO2 (ETco2) measurement. The recommendations were founded predominantly on very low quality of evidence, with some based on expert opinion.ConclusionsThe Monitoring Domain authors continue to support initiation of chest compressions without pulse palpation. We recommend multimodal monitoring of patients at risk of cardiopulmonary arrest, at risk of re‐arrest, or under general anesthesia. This report highlights the utility of ETco2 monitoring to verify correct intubation, identify return of spontaneous circulation, evaluate quality of CPR, and guide basic life support measures. Treatment recommendations further suggest intra‐arrest evaluation of electrolytes (ie, potassium and calcium), as these may inform outcome‐relevant interventions.

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Section: Measurement Of Electrolytes and Other Blood Chemistry Compon...mentioning

confidence: 99%

2024 RECOVER Guidelines: Monitoring. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR

Brainard,

Lane,

Burkitt‐Creedon

et al. 2024

J Vet Emergen Crit Care

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“…Another laboratory investigation of canine CPR (LOE 3) found that arterial ionized calcium decreased within 5 minutes of starting CPR and continued to decrease in dogs that could not be resuscitated . Other studies of ionized calcium levels during canine CPR (LOE 3) did not identify ionized hypocalcemia (LOE 3) …”

Section: Monitoring During Cprmentioning

confidence: 99%

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

Brainard

Boller

Fletcher

2012

J Vet Emergen Crit Care

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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. Crit Care 2012; 22(S1): 65-84) (J Vet Emerg

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“…Their prospective studies confirmed lack of efficacy of calcium in asystole (Stueven et al 1985a) but showed more successful initial resuscitation results in patients in EMD with wide QRS complexes or ischaemic changes given calcium (Stueven et al 1985b). Several animal studies have shown no restoration of rhythm with calcium in asystole or EMD (Vincent et al 1981;Niemann et al 1983;Best et al 1985;Blecic et al 1987).…”

Section: Calciummentioning

confidence: 99%