目的:在2012年兽医复苏(RECOVER)CPR指南重新评估运动之后,这是基于证据的基本生命支持(BLS)共识指南的更新,高级生命支持(ALS),和持久监控。
方法:这些复苏CPR指南是使用建议分级的修改版本生成的,评估,发展,和评估(等级)系统,用于评估证据并将其转化为清晰可行的临床指导。人口中优先考虑的临床问题,干预,比较器,和结果(PICO)格式被用作信息专家进行系统的文献检索的基础,从相关出版物中提取信息,为了评估这些证据的质量,最后将研究结果转化为治疗建议。这些建议由RECOVER写作小组审查,并由兽医专业人员开放4周征求意见。
方法:跨学科,大学国际合作,专业,应急实践。
结果:总共准备了40个工作表,以评估BLS的3个领域的问题,ALS和监测,产生了90个单独的治疗建议。不再推荐使用大剂量肾上腺素,还有阿托品,如果使用,只管理一次。在未插管的动物中,袋式面罩通气优先于口鼻通气。此外,一种用于初始评估的算法,更新的心肺复苏算法,一个节律诊断工具,和更新的药物剂量表提供。
结论:虽然大多数BLS和ALS建议保持不变,由于过去10年出现的新证据,人们做出了一些值得注意的变化。证据的间接性仍然是指南制定确定性的最大障碍,并强调迫切需要对狗和猫的目标物种进行更多研究。
OBJECTIVE: After 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.
METHODS: These 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.
METHODS: Transdisciplinary, international collaboration in university, specialty, and emergency practice.
RESULTS: A 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.
CONCLUSIONS: While 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.