CARDIAC ARREST

1. Inform the veterinary surgeon, and note the time.
2. Call for assistance.
3. Cease anaesthetic administration.
4. Establish a patent AIRWAY ideally with an endotracheal tube.
5. BREATHING - Ventilate the lungs with 100% oxygen - see key notes RESPIRATORY ARREST.
6. CIRCULATION - Position the patient in right lateral recumbency with the head tilting slightly downwards. Commence cardiac massage at a rate of 1 compression every half second in small animals and 1 compression every 2 seconds in larger dogs. Ideally 2 people should resuscitate the patient; one to perform respiration and the other to perform cardiac massage.
7. If alone, cardiac massage should be applied for 5 seconds, and then the chest inflated 3 times and repeated until the circulation restarts.
8. Open chest massage may be considered - if the chest is already open, closed massage does not produce a detectable pulse within 2 minutes or if ventricular fibrillation is diagnosed/suspected.
9. DRUGS - Drugs may be administered in accordance with the request of the veterinary surgeon eg. adrenaline (cardiac stimulant). And after circulation is re-established rapid intravenous fluids (to restore the normal volume of fluid to the circulation) and sodium bicarbonate (to correct acidosis) may be also administered.
10. Electrical defibrillation may be performed. Monitoring equipment must be disconnected and staff to stand well clear. For internal DC defibrillation, the electrodes are wrapped in saline soaked gauge and applied to the right atrium and left ventricle. The shock is applied for 0.1-0.5 seconds. The operator should be prepared for the animal to convulse, and must not touch the exposed electrodes, animal or operating table. External defibrillation involves the application of electrodes to the right thoracic wall in the region of the base of the heart and the left thoracic wall in the region of the apex.