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BLS-05-v1
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RECOVER 2.0 Worksheet
QUESTION ID: BLS-05
PICO Question:
In wide-chested dogs in CPA (P), does performing chest compressions with the dog in lateral recumbency (I) compared to dorsal recumbency (C), improve ... (O)?
Outcomes:
Favorable neurologic outcome, Surrogate marker(s) of perfusion, Survival to discharge, ROSC
Prioritized Outcomes (1= most critical; final number = least important):
- Favorable neurologic outcome
- Survival to discharge
- ROSC
- Surrogate markers of perfusion
Domain chairs: Steve Epstein, Kate Hopper; final edits by Jamie Burkitt
Evidence evaluators: Kathy Gerken, Leon Warne
Conflicts of interest: none
Search strategy: See attached document
Evidence Review:
|
Study Design |
Reduced Quality Factors
0 = no serious, - = serious,
- - = very serious |
Positive Quality Factors
0 = none, + = one, ++ = multiple |
Dichotomous Outcome Summary |
Non-Dichotomous Outcome Summary
Brief description |
Overall Quality
High, moderate, low, |
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|
No of studies |
Study Type |
RoB |
Indirectness |
Imprecision |
Inconsistency |
Large Effect |
Dose-Response |
Confounder |
# Intervention with Outcome |
# Control with Outcome |
RR (95% CI) |
|
|
|
Outcome: ROSC |
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|
1 |
EXPT |
0 |
- - |
0 |
0 |
0 |
0 |
0 |
|
|
|
14/18 successful CPR and no difference in body position |
Very low |
|
1 |
OBS |
- |
- |
0 |
0 |
0 |
0 |
+ |
|
|
OR 46.6, 95% CI 4.1-535.6
|
|
Very low |
PICO Question Summary
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Introduction |
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In clinical veterinary patients, chest compressions during CPR are most commonly performed with animals in lateral recumbency, in contrast to experimental animal and clinical human studies where dorsal recumbency is most common. Wide chested dogs such as Bulldogs often can be placed in dorsal recumbency without restraint, making sternal chest compressions feasible clinically in these animals. The previous veterinary guidelines suggest that sternal compressions in dorsal recumbency for wide chested dogs may be considered.1
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Consensus on science |
|
For the most critical outcomes of favorable neurologic outcome and survival to discharge, we identified no studies addressing the PICO question.
Outcome 3: ROSC:
For the next most important outcome of ROSC we found 1 experimental animal study (very low quality of evidence, downgraded for very serious indirectness) and 1 observational study (very low quality of evidence, downgraded for serious risk of bias and serious indirectness, upgraded for effect despite confounding).2,3 One experimental study in cats with an asphyxiation model of cardiopulmonary arrest failed to demonstrate a difference between chest compressions in dorsal vs lateral recumbency.2 One 2009 observational study in a veterinary teaching hospital documented that dogs in CPA receiving chest compressions in lateral recumbency had higher odds of ROSC OR 46.6, 95% CI (4.1 – 535.6) in multivariate logistic regression. Body conformation was not reported in this study.3
For the important outcome of surrogate markers of perfusion, we identified no studies addressing the PICO question. |
|
Treatment recommendation |
|
In wide chested dogs that are positionally stable in dorsal recumbency, we suggest performing chest compressions in dorsal recumbency during CPR. (weak recommendation, expert opinion)
In wide chested dogs that are not positionally stable in dorsal recumbency (e.g., whose bodies lie naturally in lateral recumbency), we suggest performing chest compressions in lateral recumbency during CPR. (weak recommendation, expert opinion) |
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Justification of treatment recommendation |
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Despite the lack of clear evidence to make a specific recommendation, we suggest performing sternal chest compressions with wide-chested dogs positioned in dorsal recumbency. As wide-chested dogs may not require restraint to undergo sternal compressions in dorsal recumbency, and their chest conformation may allow greater deformation of the thorax in this position, it is reasonable to consider this option for CPR in wide-chested dogs. |
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Knowledge gaps |
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There are no studies that directly evaluate the efficacy of chest compressions performed with the animal positioned in dorsal vs lateral recumbency in wide-chested dogs.
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References
1. Fletcher DJ, Boller M, Brainard BM, et al. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 7: Clinical guidelines: RECOVER clinical guidelines. Journal of Veterinary Emergency and Critical Care. 2012;22(s1):S102-S131.
2. Henik RA, Wingfield WE, Angleton GM, Porter RE. Effects of body position and ventilation/compression ratios during cardiopulmonary resuscitation in cats. American journal of veterinary research. 1987;48(11):1603-1606.
3. Hofmeister EH, Brainard BM, Egger CM, Kang SW. Prognostic indicators for dogs and cats with cardiopulmonary arrest treated by cardiopulmonary cerebral resuscitation at a university teaching hospital. Journal of the American Veterinary Medical Association. 2009;235(1):50-57.
General Document Comments 0
Hey Rebecca! The term we used before was “flat-chested”, but there were some concerns about that term and we felt that “wide-chested” was probably more descriptive of the conformation. Would love to hear other feedback on this term, and other ideas.
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