Abstract：
OBJECTIVE: To systematically review the evidence and devise clinical recommendations on advanced life support (ALS) in dogs and cats and to identify critical knowledge gaps.
METHODS: Standardized, systematic evaluation of literature pertinent to ALS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by ALS 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.
METHODS: Transdisciplinary, international collaboration in university, specialty, and emergency practice.
RESULTS: Seventeen questions pertaining to vascular access, vasopressors in shockable and nonshockable rhythms, anticholinergics, defibrillation, antiarrhythmics, and adjunct drug therapy as well as open-chest CPR were reviewed. Of the 33 treatment recommendations formulated, 6 recommendations addressed the management of patients with nonshockable arrest rhythms, 10 addressed shockable rhythms, and 6 provided guidance on open-chest CPR. We recommend against high-dose epinephrine even after prolonged CPR and suggest that atropine, when indicated, is used only once. In animals with a shockable rhythm in which initial defibrillation was unsuccessful, we recommend doubling the defibrillator dose once and suggest vasopressin (or epinephrine if vasopressin is not available), esmolol, lidocaine in dogs, and/or amiodarone in cats.
CONCLUSIONS: These updated RECOVER ALS guidelines clarify the approach to refractory shockable rhythms and prolonged CPR. Very low quality of evidence due to absence of clinical data in dogs and cats continues to compromise the certainty with which recommendations can be made.
METHODS: Standardized, systematic evaluation of literature pertinent to ALS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by ALS 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.
METHODS: Transdisciplinary, international collaboration in university, specialty, and emergency practice.
RESULTS: Seventeen questions pertaining to vascular access, vasopressors in shockable and nonshockable rhythms, anticholinergics, defibrillation, antiarrhythmics, and adjunct drug therapy as well as open-chest CPR were reviewed. Of the 33 treatment recommendations formulated, 6 recommendations addressed the management of patients with nonshockable arrest rhythms, 10 addressed shockable rhythms, and 6 provided guidance on open-chest CPR. We recommend against high-dose epinephrine even after prolonged CPR and suggest that atropine, when indicated, is used only once. In animals with a shockable rhythm in which initial defibrillation was unsuccessful, we recommend doubling the defibrillator dose once and suggest vasopressin (or epinephrine if vasopressin is not available), esmolol, lidocaine in dogs, and/or amiodarone in cats.
CONCLUSIONS: These updated RECOVER ALS guidelines clarify the approach to refractory shockable rhythms and prolonged CPR. Very low quality of evidence due to absence of clinical data in dogs and cats continues to compromise the certainty with which recommendations can be made.
摘要：
目的：系统地审查证据并制定关于犬和猫的高级生命支持（ALS）的临床建议，并确定关键的知识差距。
方法：标准化，在建议分级后，对与ALS相关的文献进行系统评估，评估,发展,和评估(等级)方法。优先考虑的问题均由证据评估人员进行审查，ALS领域主席和兽医复苏再评估运动（RECOVER）联合主席对调查结果进行了协调，以得出与证据质量相称的治疗建议，风险：利益关系，和临床可行性。此过程是使用证据概况工作表对每个问题实施的，其中包括介绍，关于科学的共识，治疗建议,这些建议的理由，和重要的知识差距。在定稿之前，这些工作表的草稿已分发给兽医专业人员以征求意见4周。
方法：跨学科，大学国际合作，专业,应急实践。
结果：关于血管通路的十七个问题，在可电击和不可电击节律中的血管加压药，抗胆碱能药,除颤,抗心律失常药,对辅助药物治疗以及开胸CPR进行了回顾。在制定的33项治疗建议中，6项建议解决了对具有不可电击的停搏节律的患者的管理，10个已解决的可电击节奏，6提供了开胸心肺复苏的指导。我们建议即使在长时间的心肺复苏后也不要使用大剂量肾上腺素，并建议阿托品，当指示时，只使用一次。在具有可电击节律的动物中，初始除颤不成功，我们建议将除颤器剂量加倍一次，并建议使用血管加压素（如果没有血管加压素，则使用肾上腺素），艾司洛尔,利多卡因在狗，和/或猫的胺碘酮。
结论：这些更新的RECOVERALS指南阐明了治疗难治性可电击节律和延长CPR的方法。由于缺乏狗和猫的临床数据，证据质量非常低，这继续损害了可以提出建议的确定性。
方法：标准化，在建议分级后，对与ALS相关的文献进行系统评估，评估,发展,和评估(等级)方法。优先考虑的问题均由证据评估人员进行审查，ALS领域主席和兽医复苏再评估运动（RECOVER）联合主席对调查结果进行了协调，以得出与证据质量相称的治疗建议，风险：利益关系，和临床可行性。此过程是使用证据概况工作表对每个问题实施的，其中包括介绍，关于科学的共识，治疗建议,这些建议的理由，和重要的知识差距。在定稿之前，这些工作表的草稿已分发给兽医专业人员以征求意见4周。
方法：跨学科，大学国际合作，专业,应急实践。
结果：关于血管通路的十七个问题，在可电击和不可电击节律中的血管加压药，抗胆碱能药,除颤,抗心律失常药,对辅助药物治疗以及开胸CPR进行了回顾。在制定的33项治疗建议中，6项建议解决了对具有不可电击的停搏节律的患者的管理，10个已解决的可电击节奏，6提供了开胸心肺复苏的指导。我们建议即使在长时间的心肺复苏后也不要使用大剂量肾上腺素，并建议阿托品，当指示时，只使用一次。在具有可电击节律的动物中，初始除颤不成功，我们建议将除颤器剂量加倍一次，并建议使用血管加压素（如果没有血管加压素，则使用肾上腺素），艾司洛尔,利多卡因在狗，和/或猫的胺碘酮。
结论：这些更新的RECOVERALS指南阐明了治疗难治性可电击节律和延长CPR的方法。由于缺乏狗和猫的临床数据，证据质量非常低，这继续损害了可以提出建议的确定性。
