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ObjectiveAfter the 2012 Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR Guidelines, this is an update of evidence-based consensus guidelines for Basic Life Support (BLS), advanced life support (ALS), and periarrest monitoring.DesignThese RECOVER CPR Guidelines were generated using a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for evidence evaluation and translation of this evidence into clear and actionable clinical instructions. Prioritized clinical questions in the Population, Intervention, Comparator, and Outcome (PICO) format were used as the basis to conduct systematic literature searches by information specialists, to extract information from relevant publications, to assess this evidence for quality, and finally to translate the findings into treatment recommendations. These recommendations were reviewed by the RECOVER writing group and opened for comment by veterinary professionals for 4 weeks.SettingTransdisciplinary, international collaboration in university, specialty, and emergency practice.ResultsA total of 40 worksheets were prepared to evaluate questions across the 3 domains of BLS, ALS and Monitoring, resulting in 90 individual treatment recommendations. High-dose epinephrine is no longer recommended, and atropine, if used, is only administered once. Bag-mask ventilation is prioritized over mouth-to-nose ventilation in nonintubated animals. In addition, an algorithm for initial assessment, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug dosing table are provided.ConclusionsWhile the majority of the BLS and ALS recommendations remain unchanged, some noteworthy changes were made due to new evidence that emerged over the past 10 years. Indirectness of evidence remains the largest impediment to the certainty of guidelines formulation and underscores an urgent need for more studies in the target species of dogs and cats.

ObjectiveTo systematically review evidence on and devise treatment recommendations for patient monitoring before, during, and following CPR in dogs and cats, and to identify critical knowledge gaps.DesignStandardized, systematic evaluation of literature pertinent to peri-CPR monitoring following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by Monitoring Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk:benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization.SettingTransdisciplinary, international collaboration in university, specialty, and emergency practice.ResultsThirteen questions pertaining to hemodynamic, respiratory, and metabolic monitoring practices for identification of cardiopulmonary arrest, quality of CPR, and postcardiac arrest care were examined, and 24 treatment recommendations were formulated. Of these, 5 recommendations pertained to aspects of end-tidal CO2 (ETco2) measurement. The recommendations were founded predominantly on very low quality of evidence, with some based on expert opinion.ConclusionsThe Monitoring Domain authors continue to support initiation of chest compressions without pulse palpation. We recommend multimodal monitoring of patients at risk of cardiopulmonary arrest, at risk of re-arrest, or under general anesthesia. This report highlights the utility of ETco2 monitoring to verify correct intubation, identify return of spontaneous circulation, evaluate quality of CPR, and guide basic life support measures. Treatment recommendations further suggest intra-arrest evaluation of electrolytes (ie, potassium and calcium), as these may inform outcome-relevant interventions.

ObjectivesTo expand the number of conditions and interventions explored for their associations with thrombosis in the veterinary literature and to provide the basis for prescribing recommendations.DesignA population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. The revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated in this iteration included heartworm disease (dogs and cats), immune-mediated hemolytic anemia (cats), protein-losing nephropathy (cats), protein-losing enteropathy (dogs and cats), sepsis (cats), hyperadrenocorticism (cats), liver disease (dogs), congenital portosystemic shunts (dogs and cats) and the following interventions: IV catheters (dogs and cats), arterial catheters (dogs and cats), vascular access ports (dogs and cats), extracorporeal circuits (dogs and cats) and transvenous pacemakers (dogs and cats).ResultsOf the diseases evaluated in this iteration, a high risk for thrombosis was defined as heartworm disease or protein-losing enteropathy. Low risk for thrombosis was defined as dogs with liver disease, cats with immune-mediated hemolytic anemia, protein-losing nephropathy, sepsis, or hyperadrenocorticism.ConclusionsAssociations with thrombosis are outlined for various conditions and interventions and provide the basis for management recommendations. Numerous knowledge gaps were identified that represent opportunities for future studies.

Background: Reported incidence of blood transfusion reactions (TR) varies greatly. Objective: To prospectively evaluate the incidence of acute TRs in dogs receiving allogenic blood products, using consensus definitions, and to assess factors associated with TRs. Animals: Dogs (n = 858) administered allogenic blood products (n = 1542) between March and November 2022. Methods: Prospective, multicenter surveillance study occurring in referral hospitals in the United States, United Kingdom, and Australia recording TRs in dogs administered blood products as defined by the consensus guidelines published by The Association of Veterinary Hematology and Transfusion Medicine in 2021. Results: The incidence of acute TR was 8.9% (95% CI 7.0‐11.1) for packed red blood cells (pRBCs) and 4.5% (95% CI 2.9‐6.6) for plasma products. The most frequently reported TRs were febrile nonhemolytic TRs (FNHTR; 4%, 95% CI 2.8‐5.5) when administering pRBCs and allergic TRs (3.2%, 95% CI 1.80‐5.10) when administering plasma products. A higher dose of pRBC (adjusted odds ratio [aOR] 1.04 [95% CI 1.00‐1.08]) was associated with a higher odds of TR. Administration of pRBCs stored for longer than 28 days was associated with higher odds of FNHTR (aOR 4.10 [95% CI 1.58‐10.65]) and acute hemolytic TR (AHTR; OR 15.2 [95% CI 3.35‐68.70]) when compared with pRBCs stored for 14 days or fewer. Leukoreduction of pRBC was not associated with lower odds of developing a TR (OR 1.47 [95% CI 0.89‐2.42]). Conclusions and Clinical Importance: Clinicians should be mindful of the age and dose of pRBC prescribed to dogs. [ABSTRACT FROM AUTHOR]

ObjectiveTo establish and compare the repeatability and reproducibility of activated thromboelastography (TEG) and thromboelastometry (ROTEM) assays.DesignMulticenter in vitro test standardization.SettingVeterinary academic centers.AnimalsTest samples were obtained from normal, healthy dogs. Sixty identical 5 mL aliquots of canine platelet-rich plasma collected by apheresis, frozen in 6% dimethyl sulfoxide, were tested initially. Sixty identical 6 mL aliquots of canine fresh frozen plasma with admixed cryoprecipitate were subsequently evaluated.InterventionsNone.Measurements and main resultsFrozen study samples, quality controls, reagents, and consumables were distributed to participating centers (7 TEG and 3 ROTEM). TEG centers analyzed study samples with kaolin and tissue factor activated assays; ROTEM centers ran proprietary ellagic acid activated and tissue factor activated assays. All machines underwent quality control prior to sample analysis. Within- and between-center coefficients of variation (CVs) were calculated and compared using Mann-Whitney tests and calculation of intraclass correlation coefficients. Within and between centers, individual parameters for both TEG and ROTEM assays were comparable. Both within-center and between-center CVs varied markedly (0.7-120.5% and 1.4-116.5%, respectively) with assay type, instrument, and parameter. CVs for equivalent parameters were not significantly different between the 2 platforms. Intraclass correlation coefficients suggested moderate agreement between centers. In general, individual parameter CVs for platelet-rich plasma samples were lower in TEG centers, while CVs for canine fresh frozen plasma with admixed cryoprecipitate samples were lower in ROTEM centers.ConclusionsMore variation within and between centers was identified than anticipated, but some parameters such as alpha angle were repeatable and reproducible. Sample types for future multicenter standardization efforts will require further optimization and may need to be adapted separately to each platform. Individual centers using viscoelastic tests for evaluation and management of clinical patients should take steps to minimize preanalytical and analytical sources of variation.

RBC aggregation and deformability characteristics are altered by inflammatory, microcirculatory, and hemorheologic disease. These changes can be indirectly evaluated using the erythrocyte sedimentation rate (ESR). Newer point-of-care devices employ syllectometry to evaluate RBC rheology, which can give information beyond the ESR. We evaluated 2 point-of-care rheometers (iSED and MIZAR; Alcor Scientific) in 52 dogs presented to a university teaching hospital. Whole blood samples were analyzed for correlation between the ESR using the Westergren (ESRw) method (measured at 1 h and 24 h) and the predicted ESR using iSED. Plasma fibrinogen and cell-free DNA concentrations were also measured as probable markers of inflammation. The iSED-predicted ESR was positively correlated to the ESRw method at 1 h (r = 0.74; p < 0.001) and 24 h (r = 0.62; p < 0.001). Comparing dogs with or without inflammation (defined as plasma fibrinogen concentration >3.5 g/L [350 mg/dL]), significant differences were seen in the MIZAR parameters of base point, amplitude, integral, and half-time. Median cell-free DNA concentrations were higher in the group of dogs with inflammation (117 [range: 51–266] ng/mL vs. 82.7 [range: 19–206] ng/mL; p = 0.024). The iSED-predicted ESR is a good predictor of the ESRw and was obtained more rapidly. Rheometric parameters measured by MIZAR may be useful in detecting inflammation and monitoring secondary morphologic and functional changes in canine RBCs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate blood thiamine concentration in healthy and critically ill hospitalized dogs over 72 hours of hospitalization and to identify any association of thiamine concentration with patient morbidity and mortality. Design: Prospective, observational, clinical study. Setting: University veterinary teaching hospital. Animals: Thirty-one hospitalized healthy dogs and 37 dogs with critical illness. Dogs with critical illness had nonseptic (n = 24) or septic (n = 13) etiologies. Interventions: None. Measurements and Main Results: Whole blood EDTA samples were collected within 24 hours of admission and 72 hours later. Samples were stored at -80°C and batch analyzed. Total thiamine (tB1) and thiamine diphosphate (TDP) concentrations were measured using high-performance liquid chromatography, and free thiamine concentration was determined using liquid chromatography with tandemmass spectrometry. Collected patient data included CBC, biochemistry profile, plasma lactate concentration, shock index, Acute Patient Physiologic and Laboratory Evaluation Score (APPLEfast) score, comorbid conditions, and patient outcome. Approximately 92% of tB1 present in whole blood is measured as TDP. TDP concentration was strongly correlated with tB1 (R = 0.97, P < 0.0001). Thiamine concentration, represented by TDP, was not different at admission or at 72 hours in all dogs. TDP concentration was lower in septic dogs requiring surgery at admission (P=0.044) and 72 hours later (P=0.008), compared to dogs not requiring surgery. TDP concentration was not different between dogs with and without stable chronic diseases at any time point. Older dogs had lower TDP concentration. Positive correlations were seen between TDP and body weight, APPLEfast score, and WBC count. Critically ill dogswith lower admission plasma lactate concentration were more likely to have an increase in thiamine over time (P = 0.0142). Conclusions: Differences in thiamine concentration were not identified in hospitalized healthy or critically ill dogs. Further investigation into the clinical relevance of thiamine deficiency is indicated in septic dogs undergoing surgery. [ABSTRACT FROM AUTHOR]