RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 5: Monitoring.
OBJECTIVE
To systematically examine the evidence on patient monitoring before, during, and following veterinary CPR and to identify scientific knowledge gaps.


METHODS
Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. Relevant questions were answered on a worksheet template and reviewed by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) monitoring domain members, by the RECOVER committee and opened for comments by veterinary professionals for 3 months.


METHODS
Academia, referral practice, and general practice.


RESULTS
Eighteen worksheets evaluated monitoring practices relevant for diagnosing cardiopulmonary arrest (CPA), monitoring CPR efforts, identifying return of spontaneous circulation (ROSC), and post-ROSC monitoring.


CONCLUSIONS
Although veterinary clinical trials are lacking, experimental literature using canine models and human clinical trials provided relevant data. The major conclusions from this analysis of the literature highlight the utility of end-tidal carbon dioxide (EtCO(2)) monitoring to identify ROSC and possibly to evaluate quality of CPR. In addition, recommendations for ECG analysis during CPR were addressed. Unless the patient is instrumented at the time of CPA, other monitoring devices (eg, Doppler flow probe) are likely not useful for diagnosis of CPA, and the possibility of pulseless electrical activity makes ECG inappropriate as a sole diagnostic tool. Optimal monitoring of the intra- and postcardiac arrest patient remains to be determined in clinical veterinary medicine, and further evaluation of the prognostic and prescriptive utility of EtCO(2) monitoring will provide material for future studies in veterinary CPR.
Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602-7371, USA. brainard@uga.edu
Benjamin M
BM
Brainard
Manuel
M
Boller
Daniel J
DJ
Fletcher
D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000662:veterinary*; D002415:Cats; D004285:Dogs; D019317:Evidence-Based Medicine; D007722:Health Knowledge, Attitudes, Practice; D006323:Heart Arrest / Q000628:therapy / Q000662:veterinary*; D006801:Humans; D008991:Monitoring, Physiologic / Q000662:veterinary*; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D018634:Veterinarians / Q000523:psychology; D014730:Veterinary Medicine / Q000592:standards*