Cardiopulmonary cerebral resuscitation (CPCR) involves not only basic life support and advanced life support techniques, it also includes postresuscitation care. In humans, international standards have been created and published. Many of these principles may also apply to veterinary patients; however, more clinical research on the interventions is needed. Advanced life support may require equipment that veterinarians may not have, such as electrical defibrillators (some of the newer defibrillators allow transthoracic cardiac pacing). Establishing intravenous access for fluid and drug therapy is vital for CPCR because the guidelines include vasopressors, vagolytics, and antiarrhythmics. Although shock doses of intravenous fluids are often used in veterinary medicine, such doses should be reserved for patients with preexisting hypovolemia or significant ongoing loss. Cardiopulmonary arrest associated with general anesthesia is uncommon in veterinary patients; however, if the animal has received an absolute or relative overdose of an opioid, benzodiazepine, or α2-adrenergic agonist, prompt administration of specific reversal agents is indicated. In some cases, additional doses of the reversal agent may be needed.

Once a return to spontaneous circulation has been achieved, it is important to search for the cause of arrest and correct any problems if possible. Postresuscitation problems may include hypotension, hypoventilation, and coagulopathy. Also, renal, gastrointestinal, and nervous system injury may have occurred,requiring management.

COMMENTARY: This article has something for everyone. It includes a review from human medicine of the international standards for the performance of CPCR and their application in veterinary medicine. In addition, for practitioners desiring an easy-to-use resource, the article includes an algorithm that is suitable to copy and frame for handy reference (see

Cardiopulmonary cerebral resuscitation in small animals-a clinical practice review. Part II. Cole SG, Otto CM, Hughes D. J VET EMERG CRITICAL CARE 13:13-33, 2003.