Post-Resuscitation Care Guidelines

Guideline Code

RECOVER Code(s)

Issue

Guideline

Class
(Def)

Level
(Def)

Comments

G-PA-01

PA01

IV fluids

The routine use of large volumes of intraveous fluid post-arrest is not recommended except in the case of strongly suspected or confirmed hypovolemia.

III

C

Click

G-PA-02 PA01   IV fluids should be avoided in dogs and cats post-arrest with evidence of congestive heart failure. III C Click
G-PA-03 PA02 Goal-directed therapy In hemodynamically unstable dogs and cats with ROSC after CPA, a hemodynamic optimization strategy that includes primary resuscitation endpoints of central venous O2 saturation or lactate, and secondary endpoints including arterial blood pressure, central venous pressure, PCV and arterial oxygen saturation may be considered. IIb B Click
G-PA-04 PA03 Vasopressors/inotropes The use of vasopressors and/or positive inotropes in dogs and cats with persistent hypotension/cardiovascular instability post-arrest is reasonable. IIa B Click
G-PA-05 PA06 Ventilation In dogs and cats post-arrest, routine mechanical ventilation is not recommended. III B Click
G-PA-06 PA06   In dogs and cats post-arrest that are hypoventilating or at risk of respiratory arrest, IPPV (manual or mechanical) is reasonable. IIa C Click
G-PA-07 PA06   Post-arrest, a target PaCO2 of 32-43mmHg in dogs and 26-36mmHg in cats is reasonable. IIa B Click
G-PA-08 PA08 Oxygenation In dogs and cats after ROSC, inspired oxygen should be titrated to maintain normoxia (PaO2=80-100mmHg, SpO2=94-98%); hypoxemia and hyperoxemia should be avoided. I A Click
G-PA-09 PA10 Hypothermia In hypothermic dogs and cats post-arrest, slow rewarming at a rate of 0.25-0.5C/hr is reasonable. IIa A Click
G-PA-10 PA10   In hypothermic dogs and cats post-arrest, fast rewarming at a rate > 1C/hr is not recommended. III A Click
G-PA-11 PA11   In dogs and cats that remain comatose after successful resuscitation from cardiac arrest, mild therapeutic hypothermia (32-34C) for 24-48 hrs initiated as soon as possible after ROSC is recommended, if mechanical ventilation and advanced critical care capability is available. I A Click
G-PA-12 PA12   In the absence facilities for mechanical ventilation and advanced critical care infrastructure, mild hypothermia should not be initiated. III C Click
G-PA-13 PA13 Corticosteroids Routine administration of corticosteroids to cats or dogs after successful resuscitation from cardiac arrest is not recommended. III C Click
G-PA-14 PA13   Administration of hydrocortisone (1 mg/kg followed by either 1 mg/kg q 6 hours or an infusion of 0.15 mg/kg/hr and then tapered a the patient’s condition allows) to cats or dogs that remain hemodynamically unstable despite administration of fluids and inotropes/pressors may be considered. IIb C Click
G-PA-15 PA19 Bundle of Care Induction of mild hypothermia (34 C) for 12 hours post-resuscitation, normocapnia (35-40 mmHg) for 24 hours, and sustained hypertension (140 mmHg, mean) for 4 hours after successful ROSC is reasonable. IIa B Click
G-PA-16 PA20 Level of Care For dogs and cats successfully resuscitated after CPA, referral to a specialty center with 24 hour care, higher health care provider:patient ratios, and advanced critical care capabilities is reasonable. IIa B Click
G-PA-17 PA04 Hypertension It is reasonable to tolerate hypertension in the immediate post-arrest period in dogs and cats. IIa B Click
G-PA-18 PA14 Seizure Prophylaxis Seizure prophylaxis with barbiturates may be considered in dogs and cats post-cardiac arrest. IIb B Click