Post-Cardiopulmonary Arrest Care and Functional Outcomes in Dogs and Cats Surviving to Hospital Discharge Since Publication of the RECOVER Guidelines: 2012-2022.

Abstract

OBJECTIVE: To describe the in-hospital postcardiac arrest (PCA) care and short- and long-term functional outcomes of dogs and cats surviving to hospital discharge after naturally occurring cardiopulmonary arrest (CPA) and CPR. DESIGN: Multicenter retrospective observational study. SETTING: Three veterinary teaching hospitals. ANIMALS: Client-owned dogs (n&#xa0;=&#xa0;25) and cats (n&#xa0;=&#xa0;15). MEASUREMENTS AND MAIN RESULTS: Medical records of animals that underwent CPR and survived to discharge were retrospectively reviewed, and information was recorded regarding CPR event, PCA hospitalization, and short- and long-term outcomes. Ninety-two percent of CPA events occurred in hospital and were witnessed, and 8% occurred out of hospital. Eighty-five percent of events occurred during general anesthesia or sedation. CPR efforts ranged from <1 to 18&#xa0;min, and animals remained hospitalized between 0.5 and 15.5&#xa0;days after return of spontaneous circulation. Seventy-three percent of animals required supplemental oxygen, 13% required mechanical ventilation, and 20% required vasopressor, positive inotropic, or glucocorticoid therapy. Hyperosmolar therapies were administered to 38% of animals, anticonvulsants were given to 18%, and 8% of animals developed new-onset PCA seizures. The median (range) modified Glasgow Coma Scale score before CPA was 18 (11-18), 12&#xa0;h PCA was 16 (6-18), and 72&#xa0;h PCA was 17.5 (14-18). Median survival time was 455&#xa0;days (range: 11-2650&#xa0;days). Twenty-five percent of owners perceived a persistent disability in their pets, from behavioral changes to required nutritional and recumbent care. Nonetheless, all owners reported their pet's PCA quality of life to be good. CONCLUSIONS: Good short- and long-term functional outcomes post-CPA can be achieved in dogs and cats. Functional survival remains possible in some cases of out-of-hospital CPA and after prolonged CPR, suggesting a benefit of high-quality CPR in all scenarios. Patient stabilization and neurological improvement may take 48-72&#xa0;h, and early discouraging findings should not prevent continuation of PCA care.