Journal of veterinary emergency and critical care最新文献_第6页

2024 RECOVER Guidelines: Methods, evidence identification, evaluation, and consensus process for development of treatment recommendations 2024 RECOVER 指南：制定治疗建议的方法、证据识别、评估和共识过程。

IF 1.1 3区农林科学 Q3 VETERINARY SCIENCES

Journal of veterinary emergency and critical care

Pub Date : 2024-06-26 DOI: 10.1111/vec.13388

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.

目的：描述兽医复苏再评估运动（RECOVER）所采用的方法，以重新评估与大小型动物心肺复苏术、新生儿复苏术和急救相关的科学证据，并制定相应的基于共识的临床指南：本报告介绍了 RECOVER 采用的从证据到指南的过程，该过程基于建议评估、发展和评价分级法（GRADE），包括由信息专家驱动的系统文献检索、由 200 多名兽医专业人员进行的证据评估，以及在准备和预防、基本生命支持、高级生命支持、心脏骤停后护理、新生儿复苏、急救和大型动物心肺复苏等领域提供临床指南：环境：学术界、转诊实践和普通实践中的跨学科国际合作：为了更新 RECOVER 2012 心肺复苏指南，我们在领域主席、信息专家和 200 多名证据评估员团队的帮助下，回答了 135 个 "人群、干预措施、参照物和结果"（PICO）问题。大多数主要贡献者是兽医专家或兽医技术专家。RECOVER 2024 指南是兽医界首次应用 GRADE 方法制定临床指南。我们采用了一个迭代过程，该过程遵循预先确定的步骤顺序，旨在减少证据评估员的偏差，提高证据评估质量的可重复性，并最终提高治疗建议的可重复性。这一过程还使许多重要的知识差距得以显现，为确定兽医复苏科学研究工作的优先顺序奠定了基础：结论：以志愿者为基础的大规模合作制定以证据和共识为基础的临床指南具有挑战性和复杂性，但却是可行的。获得的经验将有助于完善未来兽医指南计划的流程。

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引用次数: 0

2024 RECOVER Guidelines: Monitoring. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR 2024 RECOVER 准则：监测。小动物心肺复苏的证据和知识差距分析及治疗建议。

IF 1.1 3区农林科学 Q3 VETERINARY SCIENCES

Journal of veterinary emergency and critical care

Pub Date : 2024-06-26 DOI: 10.1111/vec.13390

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>

目的系统回顾猫狗心肺复苏术前、术中和术后患者监护的相关证据并提出治疗建议，同时找出关键的知识缺口：设计：按照建议、评估、发展和评价分级（GRADE）方法，对心肺复苏术前监测的相关文献进行标准化、系统化评估。优先考虑的问题分别由证据评估员进行审查，审查结果由监测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、提出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：研究了 13 个与识别心肺骤停的血液动力学、呼吸和代谢监测方法、心肺复苏术质量和心肺骤停后护理有关的问题，并制定了 24 项治疗建议。其中，5 项建议与潮气末二氧化碳 (ETco2) 测量有关。这些建议主要建立在极低质量的证据基础上，其中一些是基于专家意见：监测领域的作者继续支持在没有脉搏触诊的情况下开始胸外按压。我们建议对有心肺骤停风险、有再次骤停风险或全身麻醉的患者进行多模式监护。本报告强调了 ETco2 监测在验证插管是否正确、确定自发循环是否恢复、评估心肺复苏质量和指导基本生命支持措施方面的作用。治疗建议进一步建议在心跳停止时对电解质（即钾和钙）进行评估，因为电解质可为与结果相关的干预措施提供依据。

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引用次数: 0

2024 RECOVER Guidelines: Advanced Life Support. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR 2024 年 RECOVER 指南：高级生命支持。小动物心肺复苏的证据和知识差距分析及治疗建议。

IF 1.1 3区农林科学 Q3 VETERINARY SCIENCES

Journal of veterinary emergency and critical care

Pub Date : 2024-06-26 DOI: 10.1111/vec.13389

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。

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引用次数: 0

2024 RECOVER Guidelines: Updated treatment recommendations for CPR in dogs and cats 2024 年 RECOVER 指南：猫狗心肺复苏术的最新治疗建议。

IF 1.1 3区农林科学 Q3 VETERINARY SCIENCES

Journal of veterinary emergency and critical care

Pub Date : 2024-06-26 DOI: 10.1111/vec.13391

Jamie M. Burkitt-Creedon DVM, DACVECC, Manuel Boller Dr med vet, MTR, DACVECC, Daniel J. Fletcher PhD, DVM, DACVECC, Benjamin M. Brainard VMC, DACVA, DACVECC, Gareth J. Buckley MA, VetMB, DACVECC, DECVECC, Steven E. Epstein DVM, DACVECC, Erik D. Fausak MSLIS, RVT, Kate Hopper BVSc, PhD, DACVECC, Selena L. Lane DVM, DACVECC, Elizabeth A. Rozanski DVM, DACVECC, DACVIM, Jacob Wolf DVM, DACVECC

Objective

After the 2012 Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR Guidelines, this is an update of evidence-based consensus guidelines for Basic Life Support (BLS), advanced life support (ALS), and periarrest monitoring.

Design

These RECOVER CPR Guidelines were generated using a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for evidence evaluation and translation of this evidence into clear and actionable clinical instructions. Prioritized clinical questions in the Population, Intervention, Comparator, and Outcome (PICO) format were used as the basis to conduct systematic literature searches by information specialists, to extract information from relevant publications, to assess this evidence for quality, and finally to translate the findings into treatment recommendations. These recommendations were reviewed by the RECOVER writing group and opened for comment by veterinary professionals for 4 weeks.

Setting

Transdisciplinary, international collaboration in university, specialty, and emergency practice.

Results

A total of 40 worksheets were prepared to evaluate questions across the 3 domains of BLS, ALS and Monitoring, resulting in 90 individual treatment recommendations. High-dose epinephrine is no longer recommended, and atropine, if used, is only administered once. Bag–mask ventilation is prioritized over mouth-to-nose ventilation in nonintubated animals. In addition, an algorithm for initial assessment, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug dosing table are provided.

Conclusions

While the majority of the BLS and ALS recommendations remain unchanged, some noteworthy changes were made due to new evidence that emerged over the past 10 years. Indirectness of evidence remains the largest impediment to the certainty of guidelines formulation and underscores an urgent need for more studies in the target species of dogs and cats.

目的：继 2012 年兽医复苏再评估运动（RECOVER）心肺复苏指南之后，本指南更新了基于证据的基本生命支持（BLS）、高级生命支持（ALS）和复苏前监测的共识指南：这些 RECOVER 心肺复苏指南是采用建议、评估、发展和评价分级（GRADE）系统的改进版进行证据评估，并将这些证据转化为清晰可行的临床指导。信息专家以 "人群、干预措施、比较者和结果"（PICO）格式为基础，对临床问题进行优先排序，进行系统的文献检索，从相关出版物中提取信息，对证据进行质量评估，最后将结果转化为治疗建议。这些建议由 RECOVER 编写小组进行审核，并在 4 周内公开征求兽医专业人士的意见：环境：大学、专科和急诊的跨学科国际合作：结果：共准备了 40 份工作表来评估 BLS、ALS 和监测 3 个领域的问题，最终提出了 90 项单独的治疗建议。不再推荐使用大剂量肾上腺素，如果使用阿托品，只需注射一次。对于未插管的动物，袋罩通气优先于口鼻通气。此外，还提供了初步评估算法、最新心肺复苏算法、心律诊断工具和最新药物剂量表：结论：尽管大多数 BLS 和 ALS 建议保持不变，但由于过去 10 年中出现的新证据，还是做出了一些值得注意的改动。证据的间接性仍然是指南制定确定性的最大障碍，并强调迫切需要在犬和猫这一目标物种中开展更多研究。

{"title":"2024 RECOVER Guidelines: Updated treatment recommendations for CPR in dogs and cats","authors":"Jamie M. Burkitt-Creedon DVM, DACVECC, Manuel Boller Dr med vet, MTR, DACVECC, Daniel J. Fletcher PhD, DVM, DACVECC, Benjamin M. Brainard VMC, DACVA, DACVECC, Gareth J. Buckley MA, VetMB, DACVECC, DECVECC, Steven E. Epstein DVM, DACVECC, Erik D. Fausak MSLIS, RVT, Kate Hopper BVSc, PhD, DACVECC, Selena L. Lane DVM, DACVECC, Elizabeth A. Rozanski DVM, DACVECC, DACVIM, Jacob Wolf DVM, DACVECC","doi":"10.1111/vec.13391","DOIUrl":"10.1111/vec.13391","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>After the 2012 Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR Guidelines, this is an update of evidence-based consensus guidelines for Basic Life Support (BLS), advanced life support (ALS), and periarrest monitoring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>These RECOVER CPR Guidelines were generated using a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for evidence evaluation and translation of this evidence into clear and actionable clinical instructions. Prioritized clinical questions in the Population, Intervention, Comparator, and Outcome (PICO) format were used as the basis to conduct systematic literature searches by information specialists, to extract information from relevant publications, to assess this evidence for quality, and finally to translate the findings into treatment recommendations. These recommendations were reviewed by the RECOVER writing group and opened for comment by veterinary professionals for 4 weeks.</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>A total of 40 worksheets were prepared to evaluate questions across the 3 domains of BLS, ALS and Monitoring, resulting in 90 individual treatment recommendations. High-dose epinephrine is no longer recommended, and atropine, if used, is only administered once. Bag–mask ventilation is prioritized over mouth-to-nose ventilation in nonintubated animals. In addition, an algorithm for initial assessment, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug dosing table are provided.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While the majority of the BLS and ALS recommendations remain unchanged, some noteworthy changes were made due to new evidence that emerged over the past 10 years. Indirectness of evidence remains the largest impediment to the certainty of guidelines formulation and underscores an urgent need for more studies in the target species of dogs and cats.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 S1","pages":"104-123"},"PeriodicalIF":1.1,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13391","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461185","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}

引用次数: 0

2024 RECOVER Guidelines: Basic Life Support. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR 2024 年 RECOVER 指南：基本生命支持。小动物心肺复苏的证据和知识差距分析及治疗建议。

IF 1.1 3区农林科学 Q3 VETERINARY SCIENCES

Journal of veterinary emergency and critical care

Pub Date : 2024-06-26 DOI: 10.1111/vec.13387

Kate Hopper BVSc, PhD, DACVECC, Steven E. Epstein DVM, DACVECC, Jamie M. Burkitt-Creedon DVM, DACVECC, Daniel J. Fletcher PhD, DVM, DACVECC, Manuel Boller Dr med vet, MTR, DACVECC, Erik D. Fausak MSLIS, RVT, Kim Mears MLIS, AHIP, Molly Crews MLS, the RECOVER Basic Life Support Domain Evidence Evaluators

<div> <section> <h3> Objective</h3> <p>To systematically review evidence and devise treatment recommendations for basic life support (BLS) in dogs and cats and to identify critical knowledge gaps.</p> </section> <section> <h3> Design</h3> <p>Standardized, systematic evaluation of literature pertinent to BLS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by 2 Evidence Evaluators, and findings were reconciled by BLS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk to 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>Twenty questions regarding animal position, chest compression point and technique, ventilation strategies, as well as the duration of CPR cycles and chest compression pauses were examined, and 32 treatment recommendations were formulated. Out of these, 25 addressed chest compressions and 7 informed ventilation during CPR. The recommendations were founded predominantly on very low quality of evidence and expert opinion. These new treatment recommendations continue to emphasize the critical importance of high-quality, uninterrupted chest compressions, with a modification suggested for the chest compression technique in wide-chested dogs. When intubation is not possible, bag–mask ventilation using a tight-fitting facemask with oxygen supplementation is recommended rather than mouth-to-nose ventilation.</p> </section> <section> <h3> Conclusions</h3> <p>These updated RECOVER BLS treatment recommendations emphasize continuous chest compressions, conformation-specific chest compression techniques, and ventilation for all animals. Very low quality of evidence due to absence of clinical data in dogs and cats consistently compromised the certainty of recommendations, emphasizing the need for more veterinary re

目的系统回顾证据，为猫狗的基本生命支持（BLS）制定治疗建议，并确定关键的知识缺口：设计：按照建议、评估、发展和评价分级（GRADE）方法，对有关 BLS 的文献进行标准化、系统化的评估。优先考虑的问题分别由两名证据评估员进行审查，并由 BLS 领域主席和兽医复苏再评估运动 (RECOVER) 联合主席对审查结果进行协调，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，每个问题都要使用证据概况工作表，其中包括引言、科学共识、治疗建议、提出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：研究了有关动物体位、胸外按压点和技术、通气策略以及心肺复苏周期和胸外按压暂停时间的 20 个问题，并制定了 32 项治疗建议。其中，25 项建议涉及胸外按压，7 项建议涉及心肺复苏过程中的通气。这些建议主要基于质量很低的证据和专家意见。这些新的治疗建议继续强调了高质量、不间断胸外按压的重要性，并建议对宽胸犬的胸外按压技术进行修改。在无法插管的情况下，建议使用密合面罩进行袋罩通气并补充氧气，而不是口对鼻通气：这些更新的 RECOVER BLS 治疗建议强调对所有动物进行持续胸外按压、针对特定体型的胸外按压技术和通气。由于缺乏狗和猫的临床数据，证据质量很低，这一直影响着建议的确定性，强调了在这一领域开展更多兽医研究的必要性。

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引用次数: 0

Traumatic pericardial rupture with secondary cardiac herniation in a dog 一只狗的外伤性心包破裂并继发心脏疝。

IF 1.1 3区农林科学 Q3 VETERINARY SCIENCES

Journal of veterinary emergency and critical care

Pub Date : 2024-06-24 DOI: 10.1111/vec.13392

Marisa I. C. Lourenço DVM, Agustina Anson DVM, PhD, DECVDI, Ian M. DeStefano DVM, DACVECC, Katherine S. Logwood VMD, DACVR, Tiffany Stockman DVM, John Berg DVM, MS, DACVS

Objective

To describe the unique finding and treatment of a dog with cardiac herniation due to traumatic pericardial rupture.

Case Summary

A 6.5-year-old entire male Yorkshire Terrier was presented for further management after being hit by a car. Despite suspected significant intrathoracic trauma at that time, the patient regained hemodynamic stability and had orthopedic surgery to correct a right iliac fracture. The patient was readmitted to the hospital 12 days following the initial visit due to considerable respiratory difficulty after accidentally being dropped several feet. Thoracic radiographs revealed an unusual severe mediastinal shift to the left with an atypical position of the cardiac silhouette against the left lateral thoracic wall. Due to the severe respiratory compromise of the patient and newly developed pneumothorax, an exploratory thoracotomy was recommended, where a complete rupture of the pericardium was identified, with secondary left-sided prolapse of the heart. Other more common intrathoracic injuries (ie, lung perforation, rib fractures) were also identified and partially repaired. The patient recovered successfully and was discharged 4 days postoperatively.

New or Unique Information Provided

This is the first case report in the veterinary literature of traumatic pericardial rupture and cardiac herniation. According to human case descriptions, this is a rare and often fatal occurrence, which can be significantly challenging to diagnose preoperatively or antemortem. Emergency veterinary clinicians should be aware of this rare but important complication of blunt thoracic trauma. Surgical intervention may be necessary in cases with suspected or confirmed entrapment of great vessels or cardiac chambers, although these abnormalities were not present in this case.

目的：描述一只因外伤性心包破裂导致心脏疝气的狗的独特发现和治疗方法：病例摘要：一只 6.5 岁的整只雄性约克夏梗犬在被车撞伤后接受了进一步治疗。尽管当时怀疑患者有明显的胸腔内创伤，但患者恢复了血液动力学稳定，并接受了矫形手术以矫正右髂骨骨折。首次就诊后 12 天，患者因意外跌落数英尺后呼吸困难再次入院。胸片显示纵隔向左侧严重移位，心脏轮廓与左侧胸壁的位置不典型。由于患者呼吸功能严重受损，且新近出现气胸，医生建议对其进行探查性开胸术，术中发现心包完全破裂，心脏继发左侧脱垂。此外，还发现了其他更常见的胸腔内损伤（如肺穿孔、肋骨骨折），并进行了部分修补。患者恢复顺利，术后 4 天出院：这是兽医文献中第一例外伤性心包破裂和心脏疝的病例报告。根据人类病例的描述，这是一种罕见且经常致命的情况，在术前或死前诊断时可能会遇到很大的挑战。急诊兽医临床医生应了解钝性胸部创伤这种罕见但重要的并发症。在怀疑或证实大血管或心腔被卡住的病例中，可能有必要进行手术干预，尽管本病例中并不存在这些异常情况。

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引用次数: 0

The use of injectable subcutaneous terbutaline and topical nitroglycerin ointment in the treatment of peripheral vasopressor extravasation in 3 dogs 在 3 只狗身上使用皮下注射特布他林和局部硝酸甘油软膏治疗外周血管外渗。

IF 1.1 3区农林科学 Q3 VETERINARY SCIENCES

Journal of veterinary emergency and critical care

Pub Date : 2024-06-20 DOI: 10.1111/vec.13393

Chele N. Lathroum MS, DVM, DACVECC, Hernan Lizardo Angulo Bracho MVZ, Esp, DVM, Kayla M. Alessandrino BVMS, Julie M. Walker DVM, DACVECC

Objective

To describe the clinical course and treatment of 3 dogs with peripheral vasopressor extravasation.

Case Series Summary

Although vasopressor extravasation (VE) is a well-documented complication in human medicine, literature describing VE and its management in veterinary patients is sparse. VE increases patient morbidity by causing local tissue injury and necrosis. The gold standard treatment for VE, phentolamine, has been periodically limited in supply in human medicine and is not consistently available for use in veterinary medicine. An alternative protocol proposed for use in people with VE combines topical nitroglycerin application with subcutaneous terbutaline infiltration. In this report, a treatment protocol utilizing these therapies was used to treat 3 dogs with VE and secondary tissue injury.

New or Unique Information Provided

This report describes 3 cases of VE-induced tissue injury in dogs. In addition, this report describes the use of perivascular terbutaline infiltration and topical nitroglycerin application as therapeutic management for VE in dogs.

目的：描述 3 只患有外周血管加压外渗的狗的临床过程和治疗方法：病例系列摘要：虽然血管加压素外渗（VE）是人类医学中一种证据确凿的并发症，但描述兽医患者血管加压素外渗及其治疗的文献却很少。VE会造成局部组织损伤和坏死，从而增加患者的发病率。酚妥拉明是治疗VE的金标准，但在人类医学中的供应定期受到限制，在兽医学中也无法持续使用。建议用于 VE 患者的替代方案是将硝酸甘油局部应用与特布他林皮下浸润相结合。在本报告中，利用这些疗法的治疗方案治疗了 3 只患有 VE 和继发性组织损伤的狗：本报告描述了 3 例 VE 引起的犬组织损伤。此外，该报告还介绍了使用血管周围特布他林浸润和局部硝酸甘油来治疗犬 VE 的方法。

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引用次数: 0

Prothrombin and activated partial thromboplastin times, thromboelastography, hematocrit, and platelet count in a feline hemorrhage/over-resuscitation model using lactated Ringer's solution or 6% tetrastarch 130/0.4 使用乳酸林格氏液或 6% tetrastarch 130/0.4 对猫出血/过度复苏模型进行凝血酶原和活化部分凝血活酶时间、血栓弹力图、血细胞比容和血小板计数的研究。

IF 1.1 3区农林科学 Q3 VETERINARY SCIENCES

Journal of veterinary emergency and critical care

Pub Date : 2024-06-14 DOI: 10.1111/vec.13376

Gareth E. Zeiler BVSc(Hons), MMedVet(Anaesth), PhD, DECVECC, DECVAA, DACVAA, Brighton T. Dzikiti BVSc, MSc, PhD, Eva Rioja BVSc, DVM, PhD, DACVAA, Peter Kamerman BSc, PhD, Roxanne K. Buck BVSc, MMedVet(Anaesth), DECVAA, Friederike Pohlin BVSc, PhD, Andrea Fuller BSc, PhD

<div> <section> <h3> Objective</h3> <p>To describe and compare prothrombin time (PT), activated partial thromboplastin time (aPTT), thromboelastography (TEG), HCT, and platelet count measurements in a hemorrhage/over-resuscitation model.</p> </section> <section> <h3> Design</h3> <p>Randomized crossover study.</p> </section> <section> <h3> Setting</h3> <p>University teaching hospital.</p> </section> <section> <h3> Animals</h3> <p>Six cats.</p> </section> <section> <h3> Interventions</h3> <p>Anesthetized cats underwent 3 treatments at 2-month intervals. The treatments were as follows: NHR—no controlled hemorrhage and sham resuscitation; LRS—controlled hemorrhage and lactated Ringer's solution (LRS) for resuscitation; and Voluven—controlled hemorrhage and 6% tetrastarch 130/0.4 for resuscitation. The LRS and Voluven were administered at 60 and 20 mL/kg/h, respectively, for 120 minutes. Blood samples were drawn for PT, aPTT, TEG, HCT, and platelet count measurements at a healthy check (T − 7d), after controlled hemorrhage (T0), at 60 and 120 minutes of resuscitation (T60 and T120), and at 24 hours after completion of resuscitation (T24h). Data were analyzed using a general linear mixed model approach (significance was <i>P</i> < 0.05).</p> </section> <section> <h3> Measurements and Main Results</h3> <p>Total median blood loss (controlled hemorrhage and blood sampling from T0 to T120) at T120 was 11.4, 31.0, and 30.8 mL/kg for NHR, LRS, and Voluven, respectively. PT and aPTT during LRS and Voluven were prolonged at T60 and T120 compared to NHR (<i>P</i> < 0.001). On TEG, the reaction time, kinetic time, and alpha-angle were within reference intervals for cats at all time points in all treatments, while maximum amplitude was less than the reference interval (40 mm) at T0, T60, and T120 during Voluven and at T60 and T120 during LRS compared to NHR (both <i>P</i> < 0.001). The HCT and platelet count were significantly lower at T60 and T120 during LRS and Voluven compared to NHR (<i>P</i> < 0.001).</p> </section> <section> <h3> Conclusions</h3> <p>Hypocoagulopathy was observed during hemorrhage and liberal fluid resuscitation. Prolongation of PT and aPPT and decreased clot strength may have been caused by hemodilution and platelet loss.</p>

目的描述并比较出血/过度复苏模型中凝血酶原时间（PT）、活化部分凝血活酶时间（aPTT）、血栓弹力图（TEG）、HCT 和血小板计数的测量结果：随机交叉研究：动物：六只猫六只猫：干预措施：麻醉猫接受 3 次治疗，每次间隔 2 个月。治疗方法如下NHR-无控制出血和假复苏；LRS-控制出血和乳酸林格氏液（LRS）复苏；Voluven-控制出血和 6% 四淀粉 130/0.4 复苏。LRS和Voluven的给药速度分别为60毫升/千克/小时和20毫升/千克/小时，持续120分钟。在健康检查（T - 7d）、控制出血后（T0）、复苏 60 分钟和 120 分钟（T60 和 T120）以及复苏结束后 24 小时（T24h）抽取血样进行 PT、aPTT、TEG、HCT 和血小板计数测量。数据采用一般线性混合模型方法进行分析（显著性为 P 测量和主要结果：T120时，NHR、LRS和Voluven的总失血中位数（T0至T120的控制性出血和采血）分别为11.4、31.0和30.8 mL/kg。与 NHR 相比，LRS 和 Voluven 在 T60 和 T120 时的 PT 和 aPTT 延长（P 结论）：在大出血和大量液体复苏期间可观察到低凝血功能。PT 和 aPPT 的延长以及凝血强度的降低可能是由血液稀释和血小板丢失引起的。

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引用次数: 0

Issue Information - Prelim 发行信息 - 初稿

IF 1.3 3区农林科学 Q3 VETERINARY SCIENCES

Journal of veterinary emergency and critical care

Pub Date : 2024-06-14 DOI: 10.1111/vec.13305

引用次数: 0

Suspected cerebral salt wasting syndrome secondary to traumatic brain injury in a dog 疑似脑盐耗损综合征，继发于一只狗的脑外伤。

IF 1.3 3区农林科学 Q3 VETERINARY SCIENCES

Journal of veterinary emergency and critical care

Pub Date : 2024-05-29 DOI: 10.1111/vec.13375

Amanda E. Chromiak DVM, MS, Joanna Finstad DVM, MS, Edward Cooper VMD, MS, DACVECC

Objective

To describe a dog with suspected cerebral salt wasting syndrome (CSWS) secondary to traumatic brain injury (TBI).

Case Summary

A 2-month-old intact male Chihuahua-American Pitbull Terrier mix weighing 1.94 kg presented to a veterinary teaching emergency room after suffering bite wound-penetrating trauma to the head. Treatment was initiated with hyperosmotic agents, fluid resuscitation, and analgesia. The dog's neurologic dysfunction warranted hospitalization and continuous monitoring. Within 24 hours, the dog developed hyponatremia (133 mmol/L compared to 143 mmol/L on presentation [reference interval 142–149 mmol/L]). As the dog had concurrent tachycardia, increase in urine sodium concentration, polyuria, and weight loss, a diagnosis of cerebral salt wasting was suspected. A 2% hypertonic saline constant rate infusion was administered for volume replacement, and the patient showed improvement in clinical signs and blood sodium concentration. The dog was discharged on Day 5. Recheck examination showed significant neurologic improvement with sodium just below the low end of the reference range (141 mmol/L [reference interval 142–149 mmol/L]).

New or Unique Information Provided

This is the first description of suspected CSWS in veterinary medicine. Hyponatremia is a common finding in critically ill neurologic people, including those with TBI, and is typically associated with either syndrome of inappropriate antidiuretic hormone or CSWS. As treatment recommendations for syndrome of inappropriate antidiuretic hormone and CSWS are diametrically opposed, identifying the presence of hyponatremia and distinguishing between these 2 clinical entities is critical for improving patient care for those with TBI. This case highlights the characteristics and clinical progression regarding the diagnosis and management of suspected CSWS.

目的：描述一只继发性脑外伤（TBI）后疑似患有脑盐耗损综合征（CSWS）的犬：病例摘要：一只 2 个月大的完整雄性吉娃娃-美国比特斗牛梗混血犬，体重 1.94 千克，在头部遭受咬伤-穿透性外伤后被送往兽医教学急诊室。治疗开始时使用了高渗剂、液体复苏和镇痛剂。由于该犬神经功能失调，需要住院并接受持续监测。24 小时内，该犬出现低钠血症（133 毫摩尔/升，而发病时为 143 毫摩尔/升[参考区间 142-149 毫摩尔/升]）。由于该犬同时伴有心动过速、尿钠浓度升高、多尿和体重减轻，因此被怀疑诊断为脑性盐耗竭。患者的临床症状和血钠浓度均有所改善。该犬在第 5 天出院。复查显示神经系统症状明显改善，血钠浓度略低于参考值范围的低端（141 mmol/L [参考值范围 142-149 mmol/L]）：这是兽医学领域首次描述疑似 CSWS。低钠血症是神经系统重症患者（包括创伤性脑损伤患者）的常见症状，通常与抗利尿激素不当综合征或CSWS有关。由于抗利尿激素不当综合征和 CSWS 的治疗建议截然相反，因此识别低钠血症的存在并区分这两种临床实体对于改善 TBI 患者的护理至关重要。本病例强调了疑似 CSWS 诊断和管理的特征和临床进展。

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引用次数: 0