Manju Gauri Kunchur BVSc, MS, Teri Jo Mauch MD, PhD, FAAP, FASN, Max Parkanzky DVM, MS, DACVIM, Louisa J. Rahilly DVM, DACVECC
Objective
To review the current scientific literature on renal tubular acidosis (RTA) in people and small animals, focusing on diseases in veterinary medicine that result in secondary RTA.
Data Sources
Scientific reviews and original research publications on people and small animals focusing on RTA.
Summary
RTA is characterized by defective renal acid–base regulation that results in normal anion gap hyperchloremic metabolic acidosis. Renal acid–base regulation includes the reabsorption and regeneration of bicarbonate in the renal proximal tubule and collecting ducts and the process of ammoniagenesis. RTA occurs as a primary genetic disorder or secondary to disease conditions. Based on pathophysiology, RTA is classified as distal or type 1 RTA, proximal or type 2 RTA, type 3 RTA or carbonic anhydrase II mutation, and type 4 or hyperkalemic RTA. Fanconi syndrome comprises proximal RTA with additional defects in proximal tubular function. Extensive research elucidating the genetic basis of RTA in people exists. RTA is a genetic disorder in the Basenji breed of dogs, where the mutation is known. Secondary RTA in human and veterinary medicine is the sequela of diseases that include immune-mediated, toxic, and infectious causes. Diagnosis and characterization of RTA include the measurement of urine pH and the evaluation of renal handling of substances that should affect acid or bicarbonate excretion.
Conclusions
Commonality exists between human and veterinary medicine among the types of RTA. Many genetic defects causing primary RTA are identified in people, but those in companion animals other than in the Basenji are unknown. Critically ill veterinary patients are often admitted to the ICU for diseases associated with secondary RTA, or they may develop RTA while hospitalized. Recognition and treatment of RTA may reverse tubular dysfunction and promote recovery by correcting metabolic acidosis.
{"title":"A review of renal tubular acidosis","authors":"Manju Gauri Kunchur BVSc, MS, Teri Jo Mauch MD, PhD, FAAP, FASN, Max Parkanzky DVM, MS, DACVIM, Louisa J. Rahilly DVM, DACVECC","doi":"10.1111/vec.13407","DOIUrl":"10.1111/vec.13407","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To review the current scientific literature on renal tubular acidosis (RTA) in people and small animals, focusing on diseases in veterinary medicine that result in secondary RTA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources</h3>\u0000 \u0000 <p>Scientific reviews and original research publications on people and small animals focusing on RTA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Summary</h3>\u0000 \u0000 <p>RTA is characterized by defective renal acid–base regulation that results in normal anion gap hyperchloremic metabolic acidosis. Renal acid–base regulation includes the reabsorption and regeneration of bicarbonate in the renal proximal tubule and collecting ducts and the process of ammoniagenesis. RTA occurs as a primary genetic disorder or secondary to disease conditions. Based on pathophysiology, RTA is classified as distal or type 1 RTA, proximal or type 2 RTA, type 3 RTA or carbonic anhydrase II mutation, and type 4 or hyperkalemic RTA. Fanconi syndrome comprises proximal RTA with additional defects in proximal tubular function. Extensive research elucidating the genetic basis of RTA in people exists. RTA is a genetic disorder in the Basenji breed of dogs, where the mutation is known. Secondary RTA in human and veterinary medicine is the sequela of diseases that include immune-mediated, toxic, and infectious causes. Diagnosis and characterization of RTA include the measurement of urine pH and the evaluation of renal handling of substances that should affect acid or bicarbonate excretion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Commonality exists between human and veterinary medicine among the types of RTA. Many genetic defects causing primary RTA are identified in people, but those in companion animals other than in the Basenji are unknown. Critically ill veterinary patients are often admitted to the ICU for diseases associated with secondary RTA, or they may develop RTA while hospitalized. Recognition and treatment of RTA may reverse tubular dysfunction and promote recovery by correcting metabolic acidosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 4","pages":"325-355"},"PeriodicalIF":1.1,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Briana M. McConnell DVM, Yonaira Cortes DVM, DACVECC, Dennis Bailey DVM, DACVIM
Objective
To assess the relationship between shock index (SI) and mortality in dogs with head trauma (HT). A secondary objective was to compare SI with the animal trauma triage (ATT) score and Modified Glasgow Coma Scale (MCGS) score in HT cases. A tertiary aim was to assess if SI is predictive of survival to discharge or improvement in presenting neurologic signs.
Design
Retrospective study from January 2015 to December 2020.
Setting
Tertiary referral level II veterinary trauma center.
Animals
Eighty-six dogs with evidence of HT presenting through emergency for various traumas compared to 60 healthy control dogs.
Measurements and Main Results
SI was calculated using the quotient of heart rate over systolic blood pressure measured on presentation. SI was significantly higher in HT patients than healthy controls (P = 0.0019). SI was not significantly different between traumatic brain injury dogs that died or were euthanized and HT dogs that lived until the time of discharge (P = 0.98). SI was not significantly different between HT dogs that were neurologically normal at the time of discharge and HT dogs that were static or improved but not normal neurologically at the time of discharge (P = 0.84). In HT dogs, SI did not correlate with ATT score (P = 0.16) or MGCS score (P = 0.75). There was no significant difference in SI and length of hospitalization until death or discharge (P = 0.78).
Conclusions
SI was significantly higher in HT patients compared to control patients. Interestingly, SI was not correlated with ATT score or MGCS score. The use of SI in HT patients warrants further investigation to assess the efficacy in predicting mortality.
目的：评估休克指数（SI）与头部外伤（HT）犬死亡率之间的关系：评估休克指数（SI）与犬头部外伤（HT）死亡率之间的关系。次要目的是将休克指数与动物创伤分流（ATT）评分和改良格拉斯哥昏迷量表（MCGS）评分进行比较。第三个目的是评估 SI 是否可预测出院后的存活率或出现的神经体征是否有所改善：设计：2015 年 1 月至 2020 年 12 月的回顾性研究：三级转诊二级兽医创伤中心：86只因各种创伤急诊就诊的有HT证据的狗与60只健康对照狗进行比较：SI用发病时测量的心率与收缩压之商计算。HT 患者的 SI 明显高于健康对照组（P = 0.0019）。死亡或安乐死的脑外伤犬与存活至出院的 HT 犬之间的 SI 无明显差异（P = 0.98）。出院时神经系统正常的 HT 狗与出院时静止或有所改善但神经系统不正常的 HT 狗之间的 SI 没有明显差异（P = 0.84）。在 HT 狗中，SI 与 ATT 评分（P = 0.16）或 MGCS 评分（P = 0.75）不相关。SI与死亡或出院前的住院时间没有明显差异（P = 0.78）：结论：与对照组患者相比，高血压患者的 SI 明显更高。有趣的是，SI 与 ATT 评分或 MGCS 评分无关。在高血压患者中使用 SI 值得进一步研究，以评估其在预测死亡率方面的功效。
{"title":"Retrospective evaluation of shock index and mortality in dogs with head trauma (2015–2020): 86 cases","authors":"Briana M. McConnell DVM, Yonaira Cortes DVM, DACVECC, Dennis Bailey DVM, DACVIM","doi":"10.1111/vec.13411","DOIUrl":"10.1111/vec.13411","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the relationship between shock index (SI) and mortality in dogs with head trauma (HT). A secondary objective was to compare SI with the animal trauma triage (ATT) score and Modified Glasgow Coma Scale (MCGS) score in HT cases. A tertiary aim was to assess if SI is predictive of survival to discharge or improvement in presenting neurologic signs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective study from January 2015 to December 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Tertiary referral level II veterinary trauma center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>Eighty-six dogs with evidence of HT presenting through emergency for various traumas compared to 60 healthy control dogs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Main Results</h3>\u0000 \u0000 <p>SI was calculated using the quotient of heart rate over systolic blood pressure measured on presentation. SI was significantly higher in HT patients than healthy controls (<i>P</i> = 0.0019). SI was not significantly different between traumatic brain injury dogs that died or were euthanized and HT dogs that lived until the time of discharge (<i>P</i> = 0.98). SI was not significantly different between HT dogs that were neurologically normal at the time of discharge and HT dogs that were static or improved but not normal neurologically at the time of discharge (<i>P</i> = 0.84). In HT dogs, SI did not correlate with ATT score (<i>P</i> = 0.16) or MGCS score (<i>P</i> = 0.75). There was no significant difference in SI and length of hospitalization until death or discharge (<i>P</i> = 0.78).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SI was significantly higher in HT patients compared to control patients. Interestingly, SI was not correlated with ATT score or MGCS score. The use of SI in HT patients warrants further investigation to assess the efficacy in predicting mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 4","pages":"387-392"},"PeriodicalIF":1.1,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To determine the number of homologous blood transfusions received by canine surgical patients after introducing a cell salvage device (CSD), trends in surgeries requiring blood transfusion, and the incidence of transfusion reactions.
Study Design
Retrospective study.
Setting
Single referral hospital.
Animals
All dogs having surgery at a single center (November 2015 to February 2021).
Interventions
Medical records of dogs having surgical treatment, including those that received either an autologous or homologous blood transfusion, were reviewed. The surgical patients were the baseline population, and the 2 transfusion groups were compared within this population to analyze the trends.
Main Results
A total of 37 and 86 dogs received autologous and homologous blood transfusions, respectively. There was an upward trend in the number of total monthly blood transfusions. No significant increase in the monthly number of homologous transfusions was observed before or after acquisition of the CSD. There was also an upward trend in total monthly surgeries, including those with higher risks of hemorrhage. Dogs receiving homologous blood transfusions had a higher incidence of clinical signs consistent with transfusion reactions (6.98%).
Conclusions
An upward trend in autologous blood transfusions was seen with the introduction of a CSD. Hospitals with large surgical caseloads at high risk of hemorrhage may see a decreased need for outsourced blood products with the use of the CSD. The device can lead to a more responsible use of an increasingly scarce resource and decrease the risk of a blood transfusion reaction in dogs.
{"title":"Impact of a cell salvage device on blood transfusions to dogs undergoing surgery at a referral veterinary hospital","authors":"Núria Comas Collgros LV, Vasilis Zapridis DVM, Janet Diana Godolphin BSc, PhD, Nicholas Bacon MA, VetMB, DECVS, DACVS","doi":"10.1111/vec.13403","DOIUrl":"10.1111/vec.13403","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the number of homologous blood transfusions received by canine surgical patients after introducing a cell salvage device (CSD), trends in surgeries requiring blood transfusion, and the incidence of transfusion reactions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Retrospective study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Single referral hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>All dogs having surgery at a single center (November 2015 to February 2021).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>Medical records of dogs having surgical treatment, including those that received either an autologous or homologous blood transfusion, were reviewed. The surgical patients were the baseline population, and the 2 transfusion groups were compared within this population to analyze the trends.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>A total of 37 and 86 dogs received autologous and homologous blood transfusions, respectively. There was an upward trend in the number of total monthly blood transfusions. No significant increase in the monthly number of homologous transfusions was observed before or after acquisition of the CSD. There was also an upward trend in total monthly surgeries, including those with higher risks of hemorrhage. Dogs receiving homologous blood transfusions had a higher incidence of clinical signs consistent with transfusion reactions (6.98%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>An upward trend in autologous blood transfusions was seen with the introduction of a CSD. Hospitals with large surgical caseloads at high risk of hemorrhage may see a decreased need for outsourced blood products with the use of the CSD. The device can lead to a more responsible use of an increasingly scarce resource and decrease the risk of a blood transfusion reaction in dogs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 4","pages":"376-386"},"PeriodicalIF":1.1,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel S. Gordon DVM, MS, DACVECC, Cathy E. Langston DVM, DACVIM
Objective
To describe the use of intermittent hemodialysis (IHD) to remove gadolinium (28.1 mg/kg dose) in a dog with severe kidney disease.
Case Summary
A 12-year-old neutered female Yorkshire Terrier presented with severe acute-on-chronic kidney injury and concurrent neurological signs. The dog received extracorporeal therapy as part of management. Uremia improved after hemodialysis, but central nervous system signs persisted; therefore, a contrast-enhanced magnetic resonance imaging was performed, immediately followed by IHD. Two IHD treatments with a low-flux dialyzer were performed 1.5 and 25.75 hours after administration of gadolinium, with almost complete removal of gadolinium. More than 96% of gadolinium was removed with a single treatment.
New or Unique Information Provided
Extracorporeal therapy is effective at removing gadolinium-based chelated contrast agents and could be considered if magnetic resonance imaging is indicated in a patient with substantial kidney impairment. Alternatively, newer contrast agents that have been deemed safer in this patient population could be used.
{"title":"Effective removal of gadolinium with hemodialysis in a dog with severe acute on chronic kidney injury","authors":"Daniel S. Gordon DVM, MS, DACVECC, Cathy E. Langston DVM, DACVIM","doi":"10.1111/vec.13404","DOIUrl":"10.1111/vec.13404","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe the use of intermittent hemodialysis (IHD) to remove gadolinium (28.1 mg/kg dose) in a dog with severe kidney disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Summary</h3>\u0000 \u0000 <p>A 12-year-old neutered female Yorkshire Terrier presented with severe acute-on-chronic kidney injury and concurrent neurological signs. The dog received extracorporeal therapy as part of management. Uremia improved after hemodialysis, but central nervous system signs persisted; therefore, a contrast-enhanced magnetic resonance imaging was performed, immediately followed by IHD. Two IHD treatments with a low-flux dialyzer were performed 1.5 and 25.75 hours after administration of gadolinium, with almost complete removal of gadolinium. More than 96% of gadolinium was removed with a single treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> New or Unique Information Provided</h3>\u0000 \u0000 <p>Extracorporeal therapy is effective at removing gadolinium-based chelated contrast agents and could be considered if magnetic resonance imaging is indicated in a patient with substantial kidney impairment. Alternatively, newer contrast agents that have been deemed safer in this patient population could be used.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 4","pages":"406-411"},"PeriodicalIF":1.1,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sabrina N. Hoehne Dr med vet, DACVECC, DECVECC, Kate Hopper BVSc, PhD, DACVECC, Marlis L. Rezende DVM, PhD, DACVAA, Angela Borchers Dr med vet, DVM, DACVIM, DACVECC, Steven E. Epstein DVM, DACVECC
<div> <section> <h3> Objective</h3> <p>To evaluate differences in point-of-care (POC) variables obtained from arterial and jugular venous blood in dogs undergoing manual basic life support (BLS) and report changes over time.</p> </section> <section> <h3> Design</h3> <p>Experimental study.</p> </section> <section> <h3> Setting</h3> <p>Small animal research facility.</p> </section> <section> <h3> Animals</h3> <p>Twenty-four purpose-bred research dogs.</p> </section> <section> <h3> Interventions</h3> <p>Dogs were anesthetized, and arterial catheters were placed before euthanasia. One minute after cardiopulmonary arrest, BLS consisting of manual chest compressions and ventilation delivered via endotracheal intubation, face mask, mouth-to-nose, or no ventilation was initiated. Paired arterial and jugular venous blood samples were obtained for POC testing before euthanasia (<i>T</i><sub>0</sub>), at 3 minutes (<i>T</i><sub>3</sub>), and at 6 minutes (<i>T</i><sub>6</sub>) into BLS.</p> </section> <section> <h3> Measurements and Main Results</h3> <p>The association of POC variables with arterial or venous sample type while controlling for type of ventilation and sampling timepoint was determined using a generalized linear mixed model. Variables obtained from arterial and venous blood samples were compared over time using repeated measures ANOVA or Friedman test. Pa<span>o</span><sub>2</sub>, anion gap, potassium, chloride, glucose concentration, and PCV were significantly higher in arterial blood samples compared with venous samples (<i>P</i> < 0.03). By <i>T</i><sub>6</sub>, arterial glucose concentration, arterial and venous base excess, venous pH, and plasma lactate, potassium, creatinine, bicarbonate, and sodium concentrations were significantly increased, and arterial and venous P<span>o</span><sub>2</sub>, ionized calcium concentration, PCV, and total plasma protein concentration were significantly decreased from <i>T</i><sub>0</sub> (<i>P</i> < 0.05).</p> </section> <section> <h3> Conclusions</h3> <p>Although statistically significant, arteriovenous differences and changes in POC blood variables during BLS were small and not clinically relevant over time. Given the challenges of arterial blood sampling, it may be reasonable to pursue venous blood sampling during CPR. Further studies in dogs undergoing BLS and advanced life support are needed to better understand the potential clinical r
{"title":"Serial paired arterial and jugular venous point-of-care values in dogs undergoing manual basic life support","authors":"Sabrina N. Hoehne Dr med vet, DACVECC, DECVECC, Kate Hopper BVSc, PhD, DACVECC, Marlis L. Rezende DVM, PhD, DACVAA, Angela Borchers Dr med vet, DVM, DACVIM, DACVECC, Steven E. Epstein DVM, DACVECC","doi":"10.1111/vec.13406","DOIUrl":"10.1111/vec.13406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate differences in point-of-care (POC) variables obtained from arterial and jugular venous blood in dogs undergoing manual basic life support (BLS) and report changes over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Experimental study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Small animal research facility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>Twenty-four purpose-bred research dogs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>Dogs were anesthetized, and arterial catheters were placed before euthanasia. One minute after cardiopulmonary arrest, BLS consisting of manual chest compressions and ventilation delivered via endotracheal intubation, face mask, mouth-to-nose, or no ventilation was initiated. Paired arterial and jugular venous blood samples were obtained for POC testing before euthanasia (<i>T</i><sub>0</sub>), at 3 minutes (<i>T</i><sub>3</sub>), and at 6 minutes (<i>T</i><sub>6</sub>) into BLS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Main Results</h3>\u0000 \u0000 <p>The association of POC variables with arterial or venous sample type while controlling for type of ventilation and sampling timepoint was determined using a generalized linear mixed model. Variables obtained from arterial and venous blood samples were compared over time using repeated measures ANOVA or Friedman test. Pa<span>o</span><sub>2</sub>, anion gap, potassium, chloride, glucose concentration, and PCV were significantly higher in arterial blood samples compared with venous samples (<i>P</i> < 0.03). By <i>T</i><sub>6</sub>, arterial glucose concentration, arterial and venous base excess, venous pH, and plasma lactate, potassium, creatinine, bicarbonate, and sodium concentrations were significantly increased, and arterial and venous P<span>o</span><sub>2</sub>, ionized calcium concentration, PCV, and total plasma protein concentration were significantly decreased from <i>T</i><sub>0</sub> (<i>P</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although statistically significant, arteriovenous differences and changes in POC blood variables during BLS were small and not clinically relevant over time. Given the challenges of arterial blood sampling, it may be reasonable to pursue venous blood sampling during CPR. Further studies in dogs undergoing BLS and advanced life support are needed to better understand the potential clinical r","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 4","pages":"368-375"},"PeriodicalIF":1.1,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marie E. Kerl DVM, MPH, MBA, Diplomate, ACVIM (SAIM) ACVECC, Nancy Rinkardt DVM, DVSc, Diplomate, ACVIM (SAIM), Scott Shaw DVM, Diplomate, ACVECC
<p></p><p>On April 30, 2024, fellow Veterinary Emergency and Critical Care diplomate Dr. Kari Moore lost her valiant 18-month-long battle with T-cell prolymphocytic leukemia, and we lost a great advocate for promoting the highest standards of veterinary care for patients, clients, and the veterinary medical team.</p><p>Kari obtained her Doctor of Veterinary Medicine from Texas A&M University in 1994 and completed a rotating internship in small animal medicine and surgery at Rowley Memorial Animal Hospital. Following 2 years in general practice in Dallas, Kari completed a residency in Small Animal Emergency and Critical Care at Tufts University from 1997 to 2000 and became board-certified by the American College of Veterinary Emergency and Critical Care. Kari was a staff veterinarian at Angell Memorial Animal Hospital from 2000 to 2001 and then joined VCA Veterinary Referral Associates (VCA VRA) in Gaithersburg Maryland where she was the Intern and Resident Director and established an emergency practice before relocating to California in 2005. Kari served as Regional Medical Director from 2005 to 2007 with responsibility for 39 hospitals. In 2007, Kari became the medical director and intern director of VCA Sacramento Veterinary Referral Center (VCA SVRC), a position that she held until 2016 when she resumed a full-time role as Regional Medical Director with responsibility for 32 specialty and general practice hospitals in Northern California, Hawaii, and Colorado. Kari also was passionate about veterinary rehabilitation and became certified in animal rehabilitation.</p><p>Kari was a strong advocate for teaching throughout her career. As a first-year resident, she went out of her way to teach students, interns, and residents, and her contributions continued through her time at Angell Memorial, VCA VRA, and on the west coast. Kari was committed to nurturing the internship program in her home hospital of VCA SVRC as well as her other specialty hospitals in California, Colorado, and Hawaii. Kari also guided other specialists in her hospitals about their expectations to teach and mentor as a part of their work commitment.</p><p>Kari was deeply respected as a member of the VCA Regional Medical Director team.</p><p>She stood out as a competent and caring leader for her hospitals through being a person of “quiet strength.” She built trusting relationships with her hospital teams through frequent visits, always focusing on quality improvement and support no matter the size of the hospital. Leading and growing specialty hospitals can be challenging, but Kari's expertise and talent in this area were unparalleled. Her knowledge made her a trusted advisor for evaluating new equipment and innovations. She was also resourceful, quickly finding novel ways to help her hospitals manage communications and patient care challenges during the COVID-19 pandemic. In her mission to help more animals, Kari guided her hospitals through multiple wildfire disaster respons
{"title":"In memoriam for Dr. Kari Elaine Moore","authors":"Marie E. Kerl DVM, MPH, MBA, Diplomate, ACVIM (SAIM) ACVECC, Nancy Rinkardt DVM, DVSc, Diplomate, ACVIM (SAIM), Scott Shaw DVM, Diplomate, ACVECC","doi":"10.1111/vec.13402","DOIUrl":"10.1111/vec.13402","url":null,"abstract":"<p></p><p>On April 30, 2024, fellow Veterinary Emergency and Critical Care diplomate Dr. Kari Moore lost her valiant 18-month-long battle with T-cell prolymphocytic leukemia, and we lost a great advocate for promoting the highest standards of veterinary care for patients, clients, and the veterinary medical team.</p><p>Kari obtained her Doctor of Veterinary Medicine from Texas A&M University in 1994 and completed a rotating internship in small animal medicine and surgery at Rowley Memorial Animal Hospital. Following 2 years in general practice in Dallas, Kari completed a residency in Small Animal Emergency and Critical Care at Tufts University from 1997 to 2000 and became board-certified by the American College of Veterinary Emergency and Critical Care. Kari was a staff veterinarian at Angell Memorial Animal Hospital from 2000 to 2001 and then joined VCA Veterinary Referral Associates (VCA VRA) in Gaithersburg Maryland where she was the Intern and Resident Director and established an emergency practice before relocating to California in 2005. Kari served as Regional Medical Director from 2005 to 2007 with responsibility for 39 hospitals. In 2007, Kari became the medical director and intern director of VCA Sacramento Veterinary Referral Center (VCA SVRC), a position that she held until 2016 when she resumed a full-time role as Regional Medical Director with responsibility for 32 specialty and general practice hospitals in Northern California, Hawaii, and Colorado. Kari also was passionate about veterinary rehabilitation and became certified in animal rehabilitation.</p><p>Kari was a strong advocate for teaching throughout her career. As a first-year resident, she went out of her way to teach students, interns, and residents, and her contributions continued through her time at Angell Memorial, VCA VRA, and on the west coast. Kari was committed to nurturing the internship program in her home hospital of VCA SVRC as well as her other specialty hospitals in California, Colorado, and Hawaii. Kari also guided other specialists in her hospitals about their expectations to teach and mentor as a part of their work commitment.</p><p>Kari was deeply respected as a member of the VCA Regional Medical Director team.</p><p>She stood out as a competent and caring leader for her hospitals through being a person of “quiet strength.” She built trusting relationships with her hospital teams through frequent visits, always focusing on quality improvement and support no matter the size of the hospital. Leading and growing specialty hospitals can be challenging, but Kari's expertise and talent in this area were unparalleled. Her knowledge made her a trusted advisor for evaluating new equipment and innovations. She was also resourceful, quickly finding novel ways to help her hospitals manage communications and patient care challenges during the COVID-19 pandemic. In her mission to help more animals, Kari guided her hospitals through multiple wildfire disaster respons","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 4","pages":"417-418"},"PeriodicalIF":1.1,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13402","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstracts from the International Veterinary Emergency and Critical Care Symposium, the European Veterinary Emergency and Critical Care Annual Congress, and the ACVECC VetCOT Veterinary Trauma & Critical Care Conference 2023. 2023. J Vet Emerg Crit Care., 33: S1-S1. https://doi.org/10.1111/vec.13338
In the Abstracts Supplement published in September 2023, the abstract cited above had an omission in the authorship list.
The correct authorship is:
Ryan M, Ford R, Hall KE, Guillaumin J, Venn EC, Edwards TH, Hoareau GL
国际兽医急诊与重症监护研讨会、欧洲兽医急诊与重症监护年会以及 ACVECC VetCOT 2023 年兽医创伤与重症监护会议摘要。2023.J Vet Emerg Crit Care., 33: S1-S1. https://doi.org/10.1111/vec.13338In 2023 年 9 月出版的摘要增刊中，上述摘要的作者名单有一处遗漏。正确的作者是：Ryan M, Ford R, Hall KE, Guillaumin J, Venn EC, Edwards TH, Hoareau GL
{"title":"Correction to “Evaluating the efficacy of shelf stable blood products for resuscitation in a canine hemorrhagic shock model”","authors":"","doi":"10.1111/vec.13401","DOIUrl":"10.1111/vec.13401","url":null,"abstract":"<p>Abstracts from the International Veterinary Emergency and Critical Care Symposium, the European Veterinary Emergency and Critical Care Annual Congress, and the ACVECC VetCOT Veterinary Trauma & Critical Care Conference 2023. 2023. <i>J Vet Emerg Crit Care</i>., 33: S1-S1. https://doi.org/10.1111/vec.13338</p><p>In the Abstracts Supplement published in September 2023, the abstract cited above had an omission in the authorship list.</p><p>The correct authorship is:</p><p>Ryan M, Ford R, Hall KE, Guillaumin J, Venn EC, Edwards TH, Hoareau GL</p>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 4","pages":"419"},"PeriodicalIF":1.1,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13401","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141679826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel J. Fletcher PhD, DVM, DACVECC, Manuel Boller Dr med vet, MTR, DACVECC, Jamie M. Burkitt-Creedon DVM, DACVECC, Erik Fausak MSLIS, RVT, Megan G. Van Noord MSIS, Kim Mears MLIS, AHIP, Kate Hopper BVSc, PhD, DACVECC, Steven E. Epstein DVM, DACVECC
Objective
To describe the methodology used by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) to re-evaluate the scientific evidence relevant to CPR in small and large animals, to newborn resuscitation, and to first aid and to formulate the respective consensus-based clinical guidelines.
Design
This report describes the evidence-to-guidelines process employed by RECOVER that is based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and includes Information Specialist-driven systematic literature search, evidence evaluation conducted by more than 200 veterinary professionals, and provision of clinical guidelines in the domains of Preparedness and Prevention, Basic Life Support, Advanced Life Support, Post-cardiac Arrest Care, Newborn Resuscitation, First Aid, and Large Animal CPR.
Setting
Transdisciplinary, international collaboration in academia, referral practice, and general practice.
Results
For this update to the RECOVER 2012 CPR guidelines, we answered 135 Population, Intervention, Comparator, and Outcome (PICO) questions with the help of a team of Domain Chairs, Information Specialists, and more than 200 Evidence Evaluators. Most primary contributors were veterinary specialists or veterinary technician specialists. The RECOVER 2024 Guidelines represent the first veterinary application of the GRADE approach to clinical guideline development. We employed an iterative process that follows a predefined sequence of steps designed to reduce bias of Evidence Evaluators and to increase the repeatability of the quality of evidence assessments and ultimately the treatment recommendations. The process also allowed numerous important knowledge gaps to emerge that form the foundation for prioritizing research efforts in veterinary resuscitation science.
Conclusions
Large collaborative, volunteer-based development of evidence- and consensus-based clinical guidelines is challenging and complex but feasible. The experience gained will help refine the process for future veterinary guidelines initiatives.
{"title":"2024 RECOVER Guidelines: Methods, evidence identification, evaluation, and consensus process for development of treatment recommendations","authors":"Daniel J. Fletcher PhD, DVM, DACVECC, Manuel Boller Dr med vet, MTR, DACVECC, Jamie M. Burkitt-Creedon DVM, DACVECC, Erik Fausak MSLIS, RVT, Megan G. Van Noord MSIS, Kim Mears MLIS, AHIP, Kate Hopper BVSc, PhD, DACVECC, Steven E. Epstein DVM, DACVECC","doi":"10.1111/vec.13388","DOIUrl":"10.1111/vec.13388","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe the methodology used by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) to re-evaluate the scientific evidence relevant to CPR in small and large animals, to newborn resuscitation, and to first aid and to formulate the respective consensus-based clinical guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This report describes the evidence-to-guidelines process employed by RECOVER that is based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and includes Information Specialist-driven systematic literature search, evidence evaluation conducted by more than 200 veterinary professionals, and provision of clinical guidelines in the domains of Preparedness and Prevention, Basic Life Support, Advanced Life Support, Post-cardiac Arrest Care, Newborn Resuscitation, First Aid, and Large Animal CPR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Transdisciplinary, international collaboration in academia, referral practice, and general practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For this update to the RECOVER 2012 CPR guidelines, we answered 135 Population, Intervention, Comparator, and Outcome (PICO) questions with the help of a team of Domain Chairs, Information Specialists, and more than 200 Evidence Evaluators. Most primary contributors were veterinary specialists or veterinary technician specialists. The RECOVER 2024 Guidelines represent the first veterinary application of the GRADE approach to clinical guideline development. We employed an iterative process that follows a predefined sequence of steps designed to reduce bias of Evidence Evaluators and to increase the repeatability of the quality of evidence assessments and ultimately the treatment recommendations. The process also allowed numerous important knowledge gaps to emerge that form the foundation for prioritizing research efforts in veterinary resuscitation science.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Large collaborative, volunteer-based development of evidence- and consensus-based clinical guidelines is challenging and complex but feasible. The experience gained will help refine the process for future veterinary guidelines initiatives.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 S1","pages":"3-15"},"PeriodicalIF":1.1,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13388","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Benjamin M. Brainard VMD, DACVAA, DACVECC, Selena L. Lane DVM, DACVECC, Jamie M. Burkitt-Creedon DVM, DACVECC, Manuel Boller Dr. Med. Vet.MTR, DACVECC, Daniel J. Fletcher PhD, DVM, DACVECC, Molly Crews MLS, Erik D. Fausak MSLISRVT, the RECOVER Monitoring Domain Evidence Evaluators
<div> <section> <h3> Objective</h3> <p>To 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.</p> </section> <section> <h3> Design</h3> <p>Standardized, 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.</p> </section> <section> <h3> Setting</h3> <p>Transdisciplinary, international collaboration in university, specialty, and emergency practice.</p> </section> <section> <h3> Results</h3> <p>Thirteen 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 CO<sub>2</sub> (ET<span>co</span><sub>2</sub>) measurement. The recommendations were founded predominantly on very low quality of evidence, with some based on expert opinion.</p> </section> <section> <h3> Conclusions</h3> <p>The 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 ET<span>co</span><sub>2</sub> 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.</p>
{"title":"2024 RECOVER Guidelines: Monitoring. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR","authors":"Benjamin M. Brainard VMD, DACVAA, DACVECC, Selena L. Lane DVM, DACVECC, Jamie M. Burkitt-Creedon DVM, DACVECC, Manuel Boller Dr. Med. Vet.MTR, DACVECC, Daniel J. Fletcher PhD, DVM, DACVECC, Molly Crews MLS, Erik D. Fausak MSLISRVT, the RECOVER Monitoring Domain Evidence Evaluators","doi":"10.1111/vec.13390","DOIUrl":"10.1111/vec.13390","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Standardized, 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Transdisciplinary, international collaboration in university, specialty, and emergency practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirteen 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 CO<sub>2</sub> (ET<span>co</span><sub>2</sub>) measurement. The recommendations were founded predominantly on very low quality of evidence, with some based on expert opinion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The 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 ET<span>co</span><sub>2</sub> 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.</p>\u0000 ","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 S1","pages":"76-103"},"PeriodicalIF":1.1,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jacob Wolf DVM, DACVECC, Gareth J. Buckley MA, VetMB, DACVECC, DECVECC, Elizabeth A. Rozanski DVM, DACVIM, DACVECC, Daniel J. Fletcher PhD, DVM, DACVECC, Manuel Boller Dr med vet, MTR, DACVECC, Jamie M. Burkitt-Creedon DVM, DACVECC, Kelly A. Weigand DVM, MLS, Molly Crews MLS, Erik D. Fausak MSLIS, RVT, and the RECOVER Advanced Life Support Domain Worksheet Authors
Objective
To systematically review the evidence and devise clinical recommendations on advanced life support (ALS) in dogs and cats and to identify critical knowledge gaps.
Design
Standardized, systematic evaluation of literature pertinent to ALS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by ALS 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.
Setting
Transdisciplinary, international collaboration in university, specialty, and emergency practice.
Results
Seventeen questions pertaining to vascular access, vasopressors in shockable and nonshockable rhythms, anticholinergics, defibrillation, antiarrhythmics, and adjunct drug therapy as well as open-chest CPR were reviewed. Of the 33 treatment recommendations formulated, 6 recommendations addressed the management of patients with nonshockable arrest rhythms, 10 addressed shockable rhythms, and 6 provided guidance on open-chest CPR. We recommend against high-dose epinephrine even after prolonged CPR and suggest that atropine, when indicated, is used only once. In animals with a shockable rhythm in which initial defibrillation was unsuccessful, we recommend doubling the defibrillator dose once and suggest vasopressin (or epinephrine if vasopressin is not available), esmolol, lidocaine in dogs, and/or amiodarone in cats.
Conclusions
These updated RECOVER ALS guidelines clarify the approach to refractory shockable rhythms and prolonged CPR. Very low quality of evidence due to absence of clinical data in dogs and cats continues to compromise the certainty with which recommendations can be made.
目的系统回顾证据，为犬和猫的高级生命支持（ALS）制定临床建议，并确定关键的知识缺口：设计：按照建议、评估、开发和评价分级（GRADE）方法，对有关 ALS 的文献进行标准化、系统化的评估。优先考虑的问题分别由证据评估员进行审核，审核结果由 ALS 领域主席和兽医复苏再评估运动（RECOVER）联合主席进行协调，以得出与证据质量、风险与收益关系以及临床可行性相称的治疗建议。在实施这一过程中，每个问题都使用了证据概况工作表，其中包括引言、科学共识、治疗建议、这些建议的理由以及重要的知识差距。这些工作表的草稿在定稿前分发给兽医专业人员征求意见，为期 4 周：环境：大学、专科和急救实践中的跨学科国际合作：审查了与血管通路、可电击和不可电击心律的血管加压剂、抗胆碱能药、除颤、抗心律失常药、辅助药物治疗以及开胸心肺复苏术有关的 17 个问题。在制定的 33 项治疗建议中，有 6 项建议涉及非电击性心搏停止节律患者的管理，10 项建议涉及电击性心搏停止节律，6 项建议提供了开胸心肺复苏的指导。我们建议即使在长时间心肺复苏后也不要使用大剂量肾上腺素，并建议在必要时只使用一次阿托品。对于有可电击心律但初次除颤不成功的动物，我们建议将除颤器剂量加倍一次，并建议使用血管加压素（如果没有血管加压素，则使用肾上腺素）、埃斯莫洛尔、利多卡因（犬）和/或胺碘酮（猫）：这些更新的 RECOVER ALS 指南明确了处理难治性可电击心律和延长心肺复苏时间的方法。由于缺乏犬和猫的临床数据，证据质量很低，这继续影响了提出建议的确定性。
{"title":"2024 RECOVER Guidelines: Advanced Life Support. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR","authors":"Jacob Wolf DVM, DACVECC, Gareth J. Buckley MA, VetMB, DACVECC, DECVECC, Elizabeth A. Rozanski DVM, DACVIM, DACVECC, Daniel J. Fletcher PhD, DVM, DACVECC, Manuel Boller Dr med vet, MTR, DACVECC, Jamie M. Burkitt-Creedon DVM, DACVECC, Kelly A. Weigand DVM, MLS, Molly Crews MLS, Erik D. Fausak MSLIS, RVT, and the RECOVER Advanced Life Support Domain Worksheet Authors","doi":"10.1111/vec.13389","DOIUrl":"10.1111/vec.13389","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To systematically review the evidence and devise clinical recommendations on advanced life support (ALS) in dogs and cats and to identify critical knowledge gaps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Standardized, systematic evaluation of literature pertinent to ALS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by ALS 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Transdisciplinary, international collaboration in university, specialty, and emergency practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventeen questions pertaining to vascular access, vasopressors in shockable and nonshockable rhythms, anticholinergics, defibrillation, antiarrhythmics, and adjunct drug therapy as well as open-chest CPR were reviewed. Of the 33 treatment recommendations formulated, 6 recommendations addressed the management of patients with nonshockable arrest rhythms, 10 addressed shockable rhythms, and 6 provided guidance on open-chest CPR. We recommend against high-dose epinephrine even after prolonged CPR and suggest that atropine, when indicated, is used only once. In animals with a shockable rhythm in which initial defibrillation was unsuccessful, we recommend doubling the defibrillator dose once and suggest vasopressin (or epinephrine if vasopressin is not available), esmolol, lidocaine in dogs, and/or amiodarone in cats.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These updated RECOVER ALS guidelines clarify the approach to refractory shockable rhythms and prolonged CPR. Very low quality of evidence due to absence of clinical data in dogs and cats continues to compromise the certainty with which recommendations can be made.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 S1","pages":"44-75"},"PeriodicalIF":1.1,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13389","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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