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: Favorable neurologic outcome, Survival to discharge, ROSC

0

N/A

Outcome: Surrogate markers of perfusion

2

EX

0

- -

0

0

0

0

0

Two studies using a human infant manikin model found a circumferential, 2 thumb technique generates higher pressure in a simulated arterial system compared to a 2-finger technique

Very low

Introduction

The optimal chest compression technique in cats and small dogs is unknown. Lateral chest compression can be achieved in these small sized animals with 2-finger, 1-handed, or 2-handed techniques. Alternatively, 2 hands can be used to encircle the chest, which allows the rescuer to squeeze the thorax during compressions. The current pediatric human guidelines state there is insufficient evidence to make a recommendation regarding compression technique and suggest either a 1-handed or 2-handed technique can be used.1

Consensus on science

For the most critical outcomes of FNO, Survival to discharge, and ROSC we identified no studies addressing the PICO question.

Outcome 4: Surrogate markers of perfusion

For the important outcome of surrogate markers of perfusion, we found 2 manikin-based experimental studies (very low level of evidence, downgraded for very serious indirectness).2,3 These 2 studies found that a circumferential, 2-thumb (i.e., 2-handed) technique generates higher pressure in a simulated arterial system compared to a 2-finger technique.2,3

For the less important outcome of complications, we identified no studies addressing this PICO question.

Treatment recommendation

We recommend that chest compressions in cats and small dogs be performed using 1 of the following 3 methods, based on a combination of compressor preference and real-time markers of perfusion (e.g., EtCO2, direct blood pressure monitoring):

a) using a circumferential 2-thumb chest compression technique with the animal in lateral recumbency and both of the thumbs directly over the heart.(strong recommendation, very low quality of evidence)

b) using a 1-handed technique with the dominant hand wrapped around the sternum at the level of the heart performing compressions between the flat portion of the fingers and the flat portion of the thumb.(strong recommendation, expert opinion)

c) using a 1-handed technique with heel of the dominant hand compressing 1/3 to 1/2 the chest width over the area of the heart with the animal in lateral recumbency while the non-dominant hand supports the dorsal thorax.(strong recommendation, expert opinion)

Justification of treatment recommendation

Given there is very little evidence to inform a recommendation regarding ideal compression technique in cats and small dogs, the committee believes it is appropriate to provide a variety of options, integrating recommendations from multiple sources. The circumferential 2-thumb technique is recommended based on findings that suggest it may be superior in human infants while lateral recumbency is suggested based on chest conformation. The limited available evidence suggests that a circumferential 2-thumb chest compression technique may produce higher intrathoracic pressures than a 2-finger compression technique in human infants. This may translate to improvement in critical outcomes and supports methods (a) and (b), above. Additionally, anecdotal experience suggests that compression depth appears adequate in these animals when high-quality, 1-handed chest compressions are administered in lateral recumbency in cats and small dogs, which supports method (c), above.

Knowledge gaps

There are no studies of cats or small dogs or in animal models in lateral recumbency evaluating different chest compression techniques for any outcome of interest. Further studies of chest compression technique in cats and small dogs are needed.