Kardiopulmonalna reanimacija – sadašnji pristup liječenju i postupak RECOVER
Benjamin Brainard, VMD, DACVAA, DACVECC, Professor
Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens GA, USA; e-mail: email@example.com
Izvor: Knjiga sažetaka 3. međunarodnog veterinarskog specijalističkog simpozija “Hitna i intenzivna skrb u veterinarskoj medicini”
This discussion will touch on some of the highlights from this study.
One of the major recommendations, based on evidence primarily from the human literature, is that it is no longer recommended to confirm lack of cardiac function in apneic, unresponsive patients, through attempted pulse palpation. Similar to the human CPR guidelines, it is now recommended to initiate CPR immediately. Recommendations for chest compression rate are between 100-120 compressions per minute, and for 6-10 breaths per minute. Compressions may be carried out in a number of different positions, depending on the conformation of the animal. For cats and small dogs, it is recommended to direct compressions in an area directly over the heart (generally located underneath the point of the elbow, or between rib spaces 3-5). In addition, for dogs with a keel-shaped chest (eg. sighthounds, German shepherd dogs, standard poodles), compressions may also be directed to the area over the heart. By contrast, in dogs with barrel chests (eg. Labrador Retrievers, spaniels) likely have the most effective chest compressions performed with the animal in lateral recumbency and the compressions directed over the widest part of the thorax (generally over rib spaces 7-10).
Chest compressions should be performed to compress the width of the chest by 1/2 to 1/3 of its width. The recoil period is important because it is the period when blood returns to the heart for the next compression. Based on human data, rescuer fatigue resulting in decreased strength of chest compressions occurs after approximately 2 minutes, and the same is likely true for veterinary CPR. If possible, rescuers should rapidly switch the person performing chest compressions when they are feeling fatigued or as 2 minutes approaches. The time period between rescuers should be minimized, and ideally CPR should not be stopped for more than 4-8 seconds.
End-tidal carbon dioxide (ETCO 2 ) is an easily measured monitor of the adequacy of CPR.
As long as blood is circulating, CO 2 will be delivered to the lungs and exhaled, and the ETCO 2 is directly correlated to the cardiac output. When spontaneous circulation restarts, the ETCO 2 increases exponentially and so ETCO 2 provides a good indicator of the progress of CPR and can also indicate when there is a need to change rescuers or techniques.
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