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,
very low, none

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

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

Introduction

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

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)

Justification of treatment recommendation

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.

Knowledge gaps

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.