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Objective: To determine signalment, injury type, trauma severity score, and outcome of feline trauma patients undergoing surgical (emergency room [ER] and operating room [OR]) and nonsurgical treatments in addition to time to surgery, specialty services involved, and cost in the OR surgery population. Design: Retrospective evaluation of medical record and hospital trauma registry data on feline trauma cases. Setting: University teaching hospital. Animals: Two hundred and fifty‐one cats presenting for traumatic injury between May 2017 and July 2020. Interventions: None. Measurements and Main Results: Demographics and outcomes were compared for cats undergoing surgical intervention in an OR (12%, 31/251) or an ER (23%, 58/251) setting and feline trauma patients without surgical intervention (65%, 162/251). Between the 2 surgical groups, 99% survived to discharge compared to 73.5% of the nonsurgical group (P < 0.0001). For the OR surgical cohort, electronic medical records were reviewed to determine the specialty surgery service involved, time to and duration of anesthesia and surgery, and visit cost. The most common surgery services involved were orthopedics (41%, 12/29) and dentistry (38%, 11/29), and the most common surgeries performed were mandibular fracture stabilization (8/29) and internal fixation for long bone fractures (8/29). The ER surgical group had a significantly lower Animal Trauma Triage score than the OR group (P < 0.0001), but a significant difference was not found between OR surgical and nonsurgical groups (P = 0.0553). No difference in modified Glasgow Coma Scale score was found between any groups. Conclusions: Surgical intervention in feline trauma patients appears to be associated with higher survival rates, but no difference in mortality was found across surgery services. OR surgical intervention, in particular, orthopedic surgery, was associated with increased length of hospitalization, increased cost, and increased use of blood products. [ABSTRACT FROM AUTHOR]

Objective: To introduce the Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR registry and report cardiopulmonary arrest (CPA) and CPR event data collected to date. Design: International, multi‐institutional veterinary CPR registry data report. Setting: Veterinary private practice and university teaching hospitals. Animals: Data from 514 dogs and 195 cats undergoing CPR entered in the RECOVER CPR registry between February 2016 and November 2021. Interventions: The RECOVER CPR registry is an online medical database created for standardized collection of hospital, animal, arrest, and outcome information on dogs and cats undergoing CPR. Data were collected according to the veterinary Utstein‐style guidelines for standardized reporting of in‐hospital CPR in dogs and cats. Case records were downloaded, duplicate and incomplete cases were removed, and summary descriptive data were reported. Measurements and Main Results: Sixteen hospitals in the United States, Europe, and Australia contributed data on 709 CPR events to the registry. One hundred and forty‐two (28%) dogs and 58 (30%) cats attained return of spontaneous circulation (ROSC), 62 (12%) dogs and 25 (13%) cats had ROSC >20 minutes, and 14 (3%) dogs and 4 (2%) cats survived to hospital discharge. The reason for CPR discontinuation was reported as owner choice in 321 cases (63%). The most common suspected causes for CPA were respiratory failure (n = 142, 20%), heart failure (n = 86, 12%), and hemorrhage (n = 76, 11%). Conclusion: The RECOVER CPR registry contains the first multicenter data set on small animal CPR. It confirms poor outcomes associated with CPA, emphasizing the need for large‐sized studies to gain adequate information on characteristics associated with favorable outcomes. [ABSTRACT FROM AUTHOR]

Background: Mechanical ventilation is frequently performed in small animal critical care medicine with well‐documented survival data; quality of life in these patients following discharge from hospital is unknown. Key findings: Owners of patients surviving to discharge following mechanical ventilation were surveyed with an open ended and ranking score questionnaire. Response rate was 57% (27/47). All respondents rated their pet's quality of life prior to the illness necessitating ventilation as good to excellent (8/10–10/10). Perceived recovery periods ranged from 0 days to 6 months (the most common response being 2–3 weeks). Fourteen owners stated that their pets' quality of life was as good or better than previously. Patients with persistent quality of life concerns (n = 3) had been ventilated for neurological disease. Four owners reported changed behaviors such as startling easily or being excessively responsive to noise. One cat became deaf and at time of survey had not regained hearing. Commonly reported problems included decreased exercise tolerance (n = 3). All respondents stated that they would ventilate their pet again. Significance: Cats and dogs that are mechanically ventilated appear to recover with minimal adverse effect on their quality of life. Patients ventilated for neurological conditions may be more likely to experience quality of life limitations. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To review the current literature with respect to the physiology, pathophysiology, and measurement of lactate. Data Sources: Data were sourced from veterinary and human clinical trials, retrospective studies, experimental studies, and review articles. Articles were retrieved without date restrictions and were sourced primarily via PubMed, Scopus, and CAB Abstracts as well as by manual selection. Human and Veterinary Data Synthesis: Lactate is an important energy storage molecule, the production of which preserves cellular energy production and mitigates the acidosis from ATP hydrolysis. Although the most common cause of hyperlactatemia is inadequate tissue oxygen delivery, hyperlactatemia can, and does occur in the face of apparently adequate oxygen supply. At a cellular level, the pathogenesis of hyperlactatemia varies widely depending on the underlying cause. Microcirculatory dysfunction, mitochondrial dysfunction, and epinephrine‐mediated stimulation of Na+‐K+‐ATPase pumps are likely important contributors to hyperlactatemia in critically ill patients. Ultimately, hyperlactatemia is a marker of altered cellular bioenergetics. Conclusion: The etiology of hyperlactatemia is complex and multifactorial. Understanding the relevant pathophysiology is helpful when characterizing hyperlactatemia in clinical patients. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To review the current literature pertaining to the use of lactate as a prognostic indicator and therapeutic guide, the utility of measuring lactate concentrations in body fluids other than blood or plasma, and the clinical management of hyperlactatemia in dogs, cats, and horses. Data Sources: Articles were retrieved without date restrictions primarily via PubMed, Scopus, and CAB Abstracts as well as by manual selection. Human and Veterinary Data Synthesis: Increased plasma lactate concentrations are associated with increased morbidity and mortality. In populations with high mortality, hyperlactatemia is moderately predictive in identifying nonsurvivors. Importantly, eulactatemia predicts survival better than hyperlactatemia predicts death. Consecutive lactate measurements and calculated relative measures appear to outperform single measurements. The use of lactate as a therapeutic guide has shown promising results in people but is relatively uninvestigated in veterinary species. Increased lactate concentrations in body fluids other than blood should raise the index of suspicion for septic or malignant processes. Management of hyperlactatemia should target the underlying cause. Conclusion: Lactate is a valuable triage and risk stratification tool that can be used to separate patients into higher and lower risk categories. The utility of lactate concentration as a therapeutic target and the measurement of lactate in body fluids shows promise but requires further research. [ABSTRACT FROM AUTHOR]

Objective To examine available evidence on prehospital care in human and veterinary trauma and emergency medicine and develop best practice guidelines for use by both paramedical and nonparamedical personnel in the approach to the prehospital care of dogs and cats. Design Systematic evaluation of the literature gathered via medical databases searches of Medline, CAB abstracts, and Google Scholar. Synthesis From a review and systematic evaluation of the available evidence, consensus guidelines on the approach to prehospital care of dogs and cats in 18 scenarios were developed. Conclusions Due to the lack of current evidence in the veterinary prehospital arena, best practice guidelines were developed as an initial platform. Recommendations were based on a review of pertinent human and available veterinary literature as well as a consensus of the authors' professional opinions. It is anticipated that evidence-based additions will be made in the future. [ABSTRACT FROM AUTHOR]

Objective To determine the accuracy of an immunochromatographic cartridge (IC) test for blood typing feline type A, B, and AB blood samples. Design Prospective observational study. Setting University teaching hospital. Samples Fifty-one nonanemic and 19 anemic feline blood samples. Interventions Samples were blood typed by both card agglutination (CA) and IC techniques. Discordant results were analyzed using a back-typing technique for the presence of alloantibodies. Repeatability and reproducibility of the IC method were evaluated. Accuracy of the IC method was determined for feline whole blood anticoagulated with EDTA and citrate phosphate dextrose adenine (CPDA1), for feline-packed RBCs with CPDA1 and saline adenine glucose-mannitol, and for autoagglutinated and hemolytic samples. Accuracy of IC testing was determined for feline blood after room temperature, 4 ± 2, −20, and −80°C storage following 24, 48, 72, and 96 hours, and after 1, 2, 3, and 4 weeks of storage. Measurements and Main Results In anemic and nonanemic samples the IC technique had a specificity, sensitivity, positive predictive value, and negative predictive value of 100% in detecting feline blood types A, B, and AB, outperforming a CA test. Results were repeatable and reproducible. Using IC it was possible to blood type samples anticoagulated with EDTA and CPDA1, packed RBC samples with CPDA1 and saline adenine glucose-mannitol, autoagglutinated and hemolytic samples, and samples stored at 4 ± 2°C and at room temperature for up to 1 month. Conclusions The IC technique is an accurate assay for the identification of A, B, and AB blood types in anemic and nonanemic feline blood. It has a higher sensitivity and specificity than the CA test, and can be used in samples stored with common anticoagulants or preservative solutions used in feline transfusion medicine. [ABSTRACT FROM AUTHOR]

Objective To review magnesium physiology including absorption, excretion, and function within the body, causes of magnesium abnormalities, and the current applications of magnesium monitoring and therapy in people and animals. Etiology Magnesium plays a pivotal role in energy production and specific functions in every cell in the body. Disorders of magnesium can be correlated with severity of disease, length of hospital stay, and recovery of the septic patient. Hypermagnesemia is seen infrequently in people and animals with significant consequences reported. Hypomagnesemia is more common in critically ill people and animals, and can be associated with platelet, immune system, neurological, and cardiovascular dysfunction as well as alterations in insulin responsiveness and electrolyte imbalance. Diagnosis Measurement of serum ionized magnesium in critically or chronically ill veterinary patients is practical and provides information necessary for stabilization and treatment. Tissue magnesium concentrations may be assessed using nuclear magnetic resonance spectroscopy as well as through the application of fluorescent dye techniques. Therapy Magnesium infusions may play a therapeutic role in reperfusion injury, myocardial ischemia, cerebral infarcts, systemic inflammatory response syndromes, tetanus, digitalis toxicity, bronchospasms, hypercoagulable states, and as an adjunct to specific anesthetic or analgesic protocols. Further veterinary studies are needed to establish the frequency and importance of magnesium disorders in animals and the potential benefit of magnesium infusions as a therapeutic adjunct to specific diseases. Prognosis The prognosis for most patients with magnesium disorders is variable and largely dependent on the underlying cause of the disorder. [ABSTRACT FROM AUTHOR]

Objective To describe the clinical features, treatment, and outcome of a cat with acute neurologic signs subsequent to relief of urethral obstruction and rapid resolution of severe azotemia, suggesting a process similar to dialysis disequilibrium syndrome. Case Summary A male castrated domestic short-hair cat was presented for weakness and dull mentation. Initial physical examination was consistent with urethral obstruction and laboratory data demonstrated severe azotemia, hyperkalemia, and acidemia. Interventions for hyperkalemia and urethral catheterization were performed without complication. The patient demonstrated a marked postobstructive diuresis and 7 hours after presentation suffered a grand mal seizure and was neurologically inappropriate. These changes corresponded with marked decreases in blood urea nitrogen (from 89.25 mmol/L to 19.99 mmol/L [250 mg/dL to 56 mg/dL]) and calculated serum osmolality (429 mOsm/kg to 359 mOsm/kg) from initial presentation without other apparent cause for seizure activity. The patient was treated with hypertonic saline (bolus and continuous infusion) for presumed osmotic injury (dialysis disequilibrium-like clinical signs) along with other supportive care. All neurologic signs resolved within 48 hours, the urinary catheter was removed, and the patient was discharged after 24 hours of observation of spontaneous urination. New or Unique Information Provided Dialysis disequilibrium syndrome has been documented in small animals, but similar signs have not been reported as a sequelae of treatment of feline urethral obstruction. Urethral obstruction is a common emergency and practitioners should be aware of this potential complication as a cause of delayed neurologic recovery or seizures in the postobstructive period. [ABSTRACT FROM AUTHOR]

Objective To determine if blood pressure measured with an ultrasonic Doppler flow detector (Doppler) is in good agreement with directly measured blood pressures in anesthetized cats. Design Prospective observational study. Setting University veterinary teaching hospital. Animals Thirty-nine cats undergoing routine neutering. Interventions Cats were divided into 2 groups; 19 cats enrolled in Group A had a 24-Ga catheter inserted into a dorsal pedal artery; 20 cats in Group B had a 20-Ga catheter placed in a femoral artery. In both groups, systolic, diastolic, and mean arterial pressures were directly measured using a validated pressure measurement system. Indirect values were compared against direct blood pressure measurements. Results There was no difference between groups. Overall, there was poor agreement with a significant bias observed between Doppler and directly measured blood pressures. For the systolic arterial pressure the bias was −8.8 with limits of agreements (LOA) of −39.3 and 21.7. For the mean arterial pressure, the bias was 14.0 with LOA of −13.9 and 41.9. For the diastolic arterial pressure, the bias was 27.9 with LOA of −4.4 and 60.2. Methodology, weight, sex, and replicates did not have a significant effect on the difference between indirect and direct measurements in any model. Conclusions Results suggest poor agreement between Doppler values and directly measured blood pressures in anesthetized cats. Use of Doppler in cats could be misleading and readings should be interpreted with caution in a clinical context. [ABSTRACT FROM AUTHOR]

Objective To examine systematically the evidence on sample acquisition and handling for the thrombo elastography (TEG) and rotational thromboelastometry (ROTEM) viscoelastic point of care instruments and to identify knowledge gaps. Design Six questions were considered, addressing sampling site, collection system, anticoagulant, collection procedure, and sample storage. Standardized, systematic evaluation of the literature was performed. Relevant articles were categorized according to level of evidence (LOE). Consensus was developed regarding conclusions for application of concepts to clinical practice. Setting Academic and referral veterinary medical centers. Results PubMed and CAB abstracts were searched. Eighteen papers were initially chosen; 5 of these papers applied to > 1 domain question. Three papers were used to address 2 questions each, and 2 papers were used to address 3 questions each. Most papers were judged LOE 3 (Good or Fair). Two of 5 papers were judged to be the same LOE each time they were used; 2 papers were judged to be LOE 3, Fair for 1 question and 3, Good for a second question; 1 paper used to address 3 questions was judged LOE 3, Good twice and 3, Fair once. Fourteen additional papers were evaluated post hoc during manuscript preparation. Conclusions Jugular venipuncture is recommended, but samples from IV catheters can be used. Consistent technique is important for serial sampling, and standardized sampling protocols are recommended for individual centers performing TEG/ROTEM. There is insufficient evidence to recommend use of a specific blood collection system, although use of evacuated blood tubes and 21-Ga or larger needles is suggested. Use of 3.2% buffered sodium citrate in a strict 1:9 ratio of citrate to blood is suggested. Suggested tube draw order is discard/serum, followed by citrate, EDTA, and then heparin. Samples should be held at room temperature for 30 minutes prior to analysis. [ABSTRACT FROM AUTHOR]

Objective To systematically examine the evidence on nontraditional uses of viscoelastic coagulation monitoring in veterinary species. Design Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. Setting Academic and referral veterinary medical centers. Results Databases searched included Medline, CAB abstracts, and Google Scholar. Conclusions Nontraditional assays identified included thrombelastography (TEG)-PlateletMapping (PM), functional fibrinogen assessment, and rapid-TEG (r-TEG). Direct veterinary evidence was found for only the ADP-activated PM, which appears to generate valid data in dogs but not cats or horses. Arachidonic acid activated PM shows high variability and requires further assessment and validation in veterinary species. Functional fibrinogen assays may be performed in veterinary species but may require modification due to species differences in response to abciximab. While tissue factor (TF)-activated TEG has been well described in the veterinary literature, the specific r-TEG assay has not been assessed, but presumably would be effective for generating TEG tracings and values for maximum amplitude and angle in shorter periods of time than some traditional assays. [ABSTRACT FROM AUTHOR]

Objective To systematically examine evidence surrounding definitions and reporting of data for viscoelastic testing in veterinary medicine. Design Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. Setting Academic and referral veterinary medical centers. Results Databases searched included Medline, CAB abstracts, and Google Scholar. Conclusions All 4 standard thromboelastography (TEG) and rotational thromboelastometry (ROTEM) variables should be universally reported, and the reporting of shear elastic modulus in addition to maximum amplitude (MA) is encouraged. There is insufficient evidence to support universal usage of the coagulation index at this time. The K value and clot formation time are the most variable of the 4 parameters, with alpha angle, MA, and maximum clot firmness generally the least variable. Individual studies should report sufficient data on patients and institutional controls to enable definitions of hypo- and hypercoagulability to be evaluated post-hoc, and it is recommended that all studies specifically report how these conditions were defined. In reporting data relating to fibrinolysis, the TEG variables LY30, LY60, CL30, CL60, and the ROTEM variables LI30, LI60, ML, LOT, and LT should be documented. Studies should report sufficient data on patients and controls to enable definitions of hyper- and hypofibrinolysis to be evaluated post-hoc, and we suggest that standard TEG/ROTEM assays may be unable to detect hypofibrinolysis in companion animals. We recommend that every center establish reference intervals, which are specific to either TEG or ROTEM. These reference intervals should be established using veterinary clinical pathology guidelines, standardized protocols, and a minimum of 40 healthy animals. There are currently insufficient data in companion animals to suggest a utility for Vcurve variables beyond that of standard TEG variables. [ABSTRACT FROM AUTHOR]

Objective To systematically examine the evidence on system comparability between the thromboelastography and the rotational thromboelastometry viscoelastic point-of-care instruments and to identify knowledge gaps. Design Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. Setting Academic and referral veterinary medical centers. Results Medline via PubMed, CAB abstracts, and Google Scholar were searched. A total of 8 relevant articles were chosen, none were in support of the question, 1 was neutral to the question (level of evidence [LOE] 6, Poor), and 7 were in opposition to the question (LOE 3 Good; LOE 6 Good; LOE 6 Fair; LOE 6 Poor). Conclusions Results from the 2 analyzers are not directly comparable and extrapolation of the results from one machine to the other should be avoided. Standardization of the preanalytical variables (eg, blood collection, holding time, and temperature during holding) is strongly recommended. It is recommended that each site create their own 'site specific' reference values for each machine and that test samples be compared only to the standardized reference values established at that center. Start-up and consumable costs vary between countries and local comparisons should be performed. Decisions should be made based on the expected use of the machine and if multiple operators will be using it. [ABSTRACT FROM AUTHOR]

Objective To systematically examine the evidence on activating agents and test protocols for the thrombelastography (TEG) and rotational thrombelastometry (ROTEM) viscoelastic point-of-care instruments and to identify knowledge gaps. Design Ten questions were considered, the primary question addressed the use of activating agents and secondary questions addressed assay temperature, length of analysis, pipetting, sample volume, reproducibility, and quality controls. Standardized, systematic evaluation of the literature was performed. Relevant articles were categorized according to level of evidence (LOE). Consensus was developed regarding conclusions for application of concepts to clinical practice. Setting Academic and referral veterinary medical centers. Results PubMed and CAB abstracts were searched. Twenty papers were initially identified concerning the primary question; 16 were in support of the questions (LOE 2 Good, LOE 3 Good, LOE 5 Good, LOE 6 Good, LOE 5 Fair, LOE 6 Fair); and 4 were neutral (LOE 3 Good, LOE 6 Good, LOE Fair, LOE 5 Fair). Additional papers were evaluated post hoc during manuscript preparation. Conclusions Overall, there is a body of evidence from veterinary and human medicine that strongly suggests that TEG or ROTEM assays using citrated samples that employ an activator have significantly lower inherent variability than those that use recalcification alone. There is also strong evidence in dogs, cats, and humans that the results obtained using different activators are not directly comparable. There is no evidence to suggest that any one activating agent is superior to another for all patient populations, or drug monitoring indications. As such, use of more than one assay for complete thromboelastographic evaluation of a patient's coagulation system may be warranted. Standardization of the concentrations of activators would be beneficial. [ABSTRACT FROM AUTHOR]

Objective To review the human and veterinary literature on the role of phosphorus in the pathophysiology of chronic kidney disease ( CKD) and to explore why control of plasma phosphorus concentration is an important goal in the management of patients with this disease. Data Sources Human and veterinary studies, reviews, clinical reports, textbooks, and recent research findings focused on phosphate homeostasis and CKD patient management. Human Data Synthesis Recent studies using rodent models and human patients with CKD have focused on trying to elucidate the role of the phosphatonins, predominantly fibroblast growth factor-23, in phosphate homeostasis and the pathophysiology of secondary renal hyperparathyroidism ( SRHP). Fibroblast growth factor-23 is now considered to be a key regulator of plasma phosphorus concentration in people but has only recently been investigated in companion animal species. Veterinary Data Synthesis Cross-sectional studies of naturally occurring CKD in dogs and cats have shown hyperphosphatemia and SRHP to be highly prevalent and associated with increased morbidity and mortality in these patients. Experimental studies of surgically induced renal impairment in the dog and cat, and cases of naturally occurring CKD have emphasized the ability of renal care diets to modify plasma phosphorus and parathyroid hormone concentrations. Evidence from these studies indicates that maintaining plasma phosphorus concentrations to within the International Renal Interest Society targets for CKD patients improves survival time and reduces clinical manifestations of hyperphosphatemia and SRHP. Conclusions The maintenance of plasma phosphorus concentrations in to within the International Renal Interest Society targets is recommended in management of CKD patients. The discovery of the phosphatonins has improved understanding of the mechanisms involved in phosphorus homeostasis and SRHP and may lead to improved ability to monitor and manage these patients. [ABSTRACT FROM AUTHOR]

Objective To describe the use of vacuum-assisted peritoneal drainage ( VAPD) in dogs and cats with septic peritonitis. Design Retrospective descriptive study. Setting University Veterinary Teaching Hospital. Animals Six dogs and 2 cats with septic peritonitis. Interventions Application of VAPD after abdominal exploration. Measurements Pre- and post-operative physical and clinicopathologic data, surgical findings, treatment, VAPD fluid production, outcome, and survival are reported. Main results Eight nonconsecutive cases of septic peritonitis, consisting of 6 dogs and 2 cats, were treated surgically and had VAPD applied post-operatively. The mean duration of clinical signs prior to surgical intervention was 4 ± 3 days. VAPD therapy was applied for a mean of 2 ± 1.1 days and collected a median of 27 mL/kg/d of abdominal effusate. The median time in hospital was 5 days and abdominal closure was completed in 5 of the 8 patients. All specimens collected at surgery cultured positive for bacteria, most commonly Enterococcus spp. The peritoneum of 4 animals was cultured at the time of abdominal closure; 1 was negative and 3 were positive for Escherichia coli, Enterococcus spp. or gram-positive cocci. Cultures before and after surgery differed in 2 patients. Hypoproteinemia was present in all patients postoperatively. Three patients were considered survivors, all of which were dogs. Five patients died or were euthanized due to cardiopulmonary arrest ( n = 3), pyothorax ( n = 1), and acute, severe, septic peritonitis ( n = 1). Conclusions VAPD is available for maintaining abdominal drainage for the treatment of septic peritonitis after surgical intervention; however, similar to open abdominal drainage and closed suction drainage, nosocomial infection and hypoproteinemia remain challenges in the treatment of septic peritonitis. [ABSTRACT FROM AUTHOR]

Objective To systematically examine the evidence for interventions after the return of spontaneous circulation ( ROSC) on outcomes from veterinary cardiopulmonary resuscitation and to determine important knowledge gaps. Design Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical post-cardiac arrest care. Setting Academia, referral practice, and general practice. Results Fifteen standardized clinical questions important for post-cardiac arrest care were asked and research articles relevant to answering these questions were identified through structured, explicit literature database searches. The majority of these articles report research in species other than dogs or cats or consisted of experimental work in canine cardiac arrest models. Outcome metrics reported in these studies widely varied and ranged from quantification of mechanistic endpoints, such as elaboration of reactive oxygen species, to survival, and functional neurologic outcome. Conclusions Despite the near complete absence of clinical veterinary studies, the process allowed the formulation of statements for several postcardiac arrest treatments that were either supportive, such as mild therapeutic hypothermia or controlled reoxygenation, or neutral, such as for mannitol administration or seizure prophylaxis. Evidence grading allowed transparency in regards to the strength of these recommendations. Moreover, numerous knowledge gaps emerged that will allow generation of a road map for progress in veterinary post-cardiac arrest care. [ABSTRACT FROM AUTHOR]

Objective– To compare the placement feasibility and amount of bone trauma induced by 3 intraosseous (IO) access techniques in cats: an automatic impact penetration device (A), an automatic rotary insertion device (B), and a manual IO needle (C). Design– Prospective ex vivo study. Setting– University. Animals– Eighteen adult mixed breed feline cadavers. Interventions– Cadavers provided 72 total IO insertion locations divided equally between the right and left humerus and tibia. The 3 IO techniques were randomly allocated to these locations. Time to successful insertion, ease of insertion, and success rate were recorded. Each insertion site was analyzed for the number of bone fragments and defect diameter by computed tomography. Measurements and Main Results– Device B had lower time of insertion ( P=0.01) compared with devices A and C. Device B had better ease of insertion scores ( P<0.01) compared with devices A and C. No differences were detected between insertion sites (tibia versus humerus). No differences in the number of bone fragments, defect diameter, or success rate were detected among devices ( P=0.06, 0.31, and 0.14, respectively). Conclusions– All 3 IO access methods evaluated yield acceptable results. Device B is significantly faster and easier to place in cat cadavers when compared with other methods. [ABSTRACT FROM AUTHOR]

Objective– To provide a review of clinically relevant observations related to Bartonella species as emerging pathogens in veterinary and human medicine. Data Sources– Literature as cited in PubMed and as generated by each of the authors who have contributed to various aspects of the clinical understanding of bartonellosis. Human Data Synthesis– Important historical and recent publications illustrating the evolving role of animal reservoirs as a source of human infection. Veterinary Data Synthesis– Comprehensive review of the veterinary literature. Conclusions– In addition to inducing life-threatening illnesses, such as endocarditis, myocarditis, and meningoencephalitis and contributing to chronic debilitating disease, such as arthritis, osteomyelitis, and granulomatous inflammation in cats, dogs, and potentially other animal species; pets and wildlife species can serve as persistently infected reservoir hosts for the transmission of Bartonella spp. infection to veterinary professionals and others with direct animal contact. [ABSTRACT FROM AUTHOR]

Objective: To document the clinical practice of cardiopulmonary–cerebral resuscitation (CPCR) among academic veterinarians. Design: Survey. Setting: Eight colleges of veterinary medicine in the United States. Subjects: Two hundred and one academic veterinarians. Interventions: The survey was distributed by hand by the authors into the mailboxes of small animal faculty, residents, and interns. Demographic variables, questions regarding number of cardiopulmonary arrests (CPA) supervised and number successful, do not attempt resuscitation discussions, and Likert-style questions about client presence during CPCR, appropriateness of CPCR, and CPCR decision-making were included. Multiple linear regression models were constructed to determine the effect of multiple questions on different target variables of interest. Measurements and main results: Numerous differences were noted based on institution, gender, specialty, and position. Most institutions did not have a standard resuscitation consent form. Most respondents believed the client, house officer, and senior clinician should determine whether to perform resuscitation or not. Quality of life was the most significant determinant of whether to resuscitate or not, followed by long-term prognosis, then short-term prognosis. Conclusions: Veterinarians differ in many aspects of their approach to CPA and resuscitation. Creating consensus within the veterinary profession would benefit client service and patient care. [ABSTRACT FROM AUTHOR]

Objective: To review the current understanding of dopamine and its use in the prevention and treatment of acute renal failure (ARF). Data sources: Original research articles and scientific reviews. Human data synthesis: Low-dose dopamine administration has been shown to increase natriuresis and urinary output in both healthy individuals and in a few small studies in human patients with renal insufficiency. However, in several large meta-analyses, dopamine treatment did not change mortality or the need for dialysis. Due to the potential side effects, the use of dopamine for prevention and treatment of ARF is no longer recommended in human medicine. Veterinary data synthesis: Low-dose dopamine increases urinary output in healthy animals and animal models of ARF if given before the insult. There are no available studies looking at the effect of low-dose dopamine therapy in naturally occurring ARF in dogs or cats. Conclusion: Due to the potential side effects of low-dose dopamine therapy, the results from large human trials, and the lack of information in veterinary medicine, the use of dopamine for treatment of ARF in veterinary patients should be further evaluated. [ABSTRACT FROM AUTHOR]

To describe the technique for performing a coccygeal epidural injection of local anesthetic to facilitate catheterization in male cats with urethral obstructions using low-dose sedation. Prompt diagnosis and relief of urethral obstructions is important as many cats may have developed marked metabolic abnormalities at the time of presentation. General anesthesia in these patients may be associated with significant risk for complications. Pain management is also an essential treatment goal, and this technique relieves urethral and penile pain during the unblocking process. Coccygeal epidurals can be used safely to provide analgesia to the penis and urethra and to the authors' knowledge, is a novel treatment modality to aid in the relief of urethral obstructions in male cats. [ABSTRACT FROM AUTHOR]