Plus-Hex CLINICAL
It is worth noting that not all parameters are essential to CPR , such as blood oxygen staturation ( SpO 2
) and blood pressure . These parameters will not provide any information relating to the effectiveness of the CPR , but should be obtained once CPR is successful .
In terms of the required parameters for CPR documentation , as per the RECOVER guidelines , the following should be considered :
• End-tidal carbon dioxide ( ETCO 2
) capnography , which will provide information about the effectiveness of chest compressions and ventilation . It can also alert you to the return of spontaneous circulation ( ROSC )
• ECG , which , although classed as part of ALS , will provide direction when considering which drug therapy is indicated .
The sample CPR record on the RECOVER website indicates that details such as personnel , drug therapy and fluid choice should be included in the CPR record . Start and end times should also be noted , as well as the reason for ceasing CPR ( e . g . owner request ).
This information is useful and important for an effective debrief , which is recommended after every CPR . Debriefs allow members of the team to discuss and process what has happened – reflecting on what went well , and perhaps what did not go so well – before resuming their duties [ 1 ] .
Training and standardisation
The process of standardising CPR can be described as shown in the example in Table 2 , but the actions and procedures involved in CPR are of course more complex , and training should therefore encompass clinical skills and communication skills , as closed-loop communication is more effective in CPR attempts [ 1 ] . Training should include the identification of early warning signs , but this should be tailored to an individual ' s expected clinical responsibilities .
The Resuscitation Council UK [ 3 ] advises that in-house CPR should be standardised to ensure that all new staff are trained as they enter the practice . It also advises that all staff undergo resuscitation training at induction and at regular intervals . The exact interval is yet to be determined – even when reviewing current best practice in the human medical field – although there are suggestions that it needs to be as frequent as every 3 months .
Annual training , as a minimum , is advised by the Resuscitation Council UK , but it is imperative to ensure that an update is provided when new equipment is introduced or there is a change to protocols . The method of communicating this information will vary , but the most effective method should be adopted , and it is perhaps worth noting that , based on the author ' s experience , email communication is rarely effective . Assessments are recommended as part of any updates . These could take the form of a simulation or professional discussion . In the human field , there is evidence to suggest that simulations are effective and that they provide a similar level of stress as a person would experience in a real CPR attempt [ 4 ] .
It is advisable to appoint a member of the practice team as the ‘ resuscitation lead ’. While they may not be solely responsible for all training , they would be responsible for delegation and ensuring the training is carried out and recorded [ 3 ] . This documentation would also be valuable for practices looking at the RCVS practice schemes and awards .
The Resuscitation Council UK also advises that those who play a leading role in CPR have additional training . Having a well-trained and effective team has been shown to have a positive impact on CPR [ 5 ] . The RECOVER initiative could be an initial starting point for this training , as these guidelines are evidence-based and easily accessible .
A key point to take away from the guidelines of the Resuscitation Council UK is that the individual running or taking the lead on CPR is not always the most senior , and that ‘ skill and experience take precedence over seniority ’ [ 3 ] . This is especially important on occasions when there is not a veterinary surgeon on site . Interestingly , a paper by Hunziker et al . [ 6 ] looking at teamwork in human CPR also identified a reluctance for junior doctors to take over the running of CPR attempts , reinforcing that this role falls to those who are skilled and experienced .
A range of modalities can be used when training , but consideration must be given to the individual ' s learning style , resources , cost and time . Methods could be didactic – including webinars ( externally provided or internally created ) and in-practice teaching sessions – as well as role play and simulations . Human factors have a significant impact on the success of CPR , which reinforces the merits of simulations [ 6 ] .
There is much to be gained by debriefing after a CPR attempt , both when spontaneous circulation has returned and when it has not . Successful CPR is not determined by the outcome but by how the team performed . A team that does not work well together can leave individuals feeling unheard and unvalued .
Although not specifically related to CPR , in a wellknown case in the human field , it was concluded that communication and teamwork led to a poor outcome for the patient , Elaine Bromiley . Further details on the inquest into her death are available via the Clinical Human Factors Group ( CHFG ) [ 7 ] . The case emphasises the importance of appropriate training and standardising . Lack of situational awareness was also identified as a contributing factor , and training around this could also be supplementary and beneficial to the team .
Volume 38 ( 6 ) • December 2023
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