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 = 25) and cats (n = 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 min, and animals remained hospitalized between 0.5 and 15.5 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 h PCA was 16 (6–18), and 72 h PCA was 17.5 (14–18). Median survival time was 455 days (range: 11–2650 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 h, and early discouraging findings should not prevent continuation of PCA care.