Biomedical Engineering Reference
In-Depth Information
material in this section is drawn from recommendations in
the veterinary literature referencing the AHA CPRC
Guidelines (
Plunkett and McMichael, 2008; Neumar et al.,
2010
).
If a decision to resuscitate is made, it is critical that
CPCR be administered as soon as possible after CPA is
recognized. One of the most common reasons for poor
outcome of CPCR is the delayed recognition of arrest and
initiation of treatment. The time to establishment of
oxygenation and circulation after CPA occurs is a critical
determinant of outcome. If animals are being monitored
closely prior to CPA, such as during a surgical procedure,
there are often signs of an impending incident such as
alterations in spontaneous respiratory rate/character,
bradycardia, hypotension, changes in expired CO
2
concentrations, and cyanosis. These circumstances offer
the best possibility for a positive outcome because of early
recognition, the presence of access for drug delivery, and
the availability of monitoring equipment.
There are several steps that can be taken to prepare for
an emergency situation requiring CPCR. These include the
ready availability of monitoring equipment, emergency
supplies, and preparatory training of personnel. A “crash
cart” containing supplies to establish circulatory and
airway access as well as emergency medication is an
essential preparatory step to decrease the time to initiation
of treatment.
Table 15.1
contains a list of items that should
be contained in a typical crash cart. In addition to the
supplies listed in
Table 15.1
, proper personal protective
equipment should be available and utilized to address
biosafety issues inherent with the handling of nonhuman
primates and their body fluids.
Personnel to be trained in CPRC include veterinarians
and technical staff that are involved in the care and use of
nonhuman primates. Training sessions allow individuals to
practice techniques in a low-stress situation. Training
should include lecture format as well as hands on experi-
ence with stuffed animals or resuscitation dummies using
the actual supplies and equipment that would be used during
an emergency. It may be helpful to outline treatment algo-
rithms in a flow chart format based on expected possible
outcomes during assessment and treatment. Training should
include a review of what materials should be contained in
the crash cart and ensuring that staff are aware of its loca-
tion. Standard operating procedures (SOPs) should be
developed and drills should be conducted. Since early
recognition and treatment are essential for success, SOPs
should include information regarding what steps should be
taken initially and which procedures will be performed by
each member of the resuscitation team. Procedure assign-
ments are dependent on how many individuals are available
to provide CPCR (e.g. one for chest compressions, one for
ventilation, one for abdominal compressions, and one to
draw up and administer medication).
TABLE 15.1
Drugs and Equipment that should be
Stocked in a Crash Cart to be Immediately Available in
the Event that Resuscitation Procedures Need to be
Performed in Animals Experiencing Cardiopulmonary
Arrest
Supplies
Equipment
Endotracheal tubes (ET) with
stylet
Rolled gauze to secure ET
Intravenous catheters, luer lock
catheter caps and tape to secure
placement
Rigid catheters or feeding tubes
for ET drug administration
Electrocardiogram monitor
Oxygen source
Pulse oximetry device
Laryngoscope with multiple
blades
Syringes (various volumes)
prepared with needles in place
Needles (20 or 22 gauge)
Epinephrine
Atropine
Naloxone
Calcium gluconate or calcium
chloride
Magnesium chloride
Vasopressin
0.9% saline
50% dextrose
Sterile water for injection
Emergency drug dosage
reference table
Treatment algorithms
Ambubag
The goals of CPCR are to implement cardiac
compressions and cardiovascular support, obtain airway
access, provide artificial ventilation and supplemental
oxygen, recognize and treat arrhythmias, and provide
stabilization and treatment for cardiovascular, pulmonary,
and cerebral
function in the event of a successful
resuscitation.
Basic life support should be initiated as soon as CPA is
confirmed. The CAB approach to CPCR is advocated in
veterinary medicine (
Ford and Mazzaferro, 2005; Plunkett
and McMichael, 2008; Wells, 2008
). This approach starts
with Compressions first, followed by Airway and
Breathing. Chest compression provides some gas
exchange by passively moving air into and out of the
larger conducting airways and circulates pulmonary blood
that has recently been saturated with O
2
. The current
recommendation is to avoid interruption in chest
compressions (
Neumar et al., 2010; Plunkett and McMi-
chael, 2008
). Chest compressions should be continuous,
with no pauses during administration of ventilatory
breaths, and minimal pauses for placement of IV cathe-
ters, endotracheal intubation, ECG assessment, palpation
of pulses, and administration of medications (
Plunkett and
