Something that often comes up in my in-house sessions is what should each member of the team be doing, and some roles during veterinary CPR are quite obvious who to delegate too and others are a little less clear.
First of all, let me say that vets you do not have to be performing compressions to be an active part of CPR. Consider what needs to be done during Veterinary CPR, well first of all basic life support (BLS) needs to be happening, more about that later and then we move onto advanced life support (ALS). Alongside that we need to be troubleshooting what’s led the patient to arrest and communication with the owner. Exactly when this might be is something that may change depending on the patient and is something the vet will have to use clinical judgement with.
The most appropriate person to be having these conversations with the owner is the vet. No one else can do this, so if other roles can delegated then do that. Vets you also do not have to be coordinating/running the crash to be fulfilling your role. The phrase ‘most experience’ relates to CPR Experience not years in the industry.
Now we’ve cleared that up let’s talk roles. First up let’s explore BLS. So, someone is going to shout CRASH and the chances are that same person is going to jump straight into compressions. Then another person is going to secure an airway and start ventilating.
This is BLS covered, compressor and ventilator. Both these roles can be covered by appropriately trained team members, including non-clinical. With the exception of intubation, this can be very challenging in a cardiopulmonary arrest and should be performed by someone experienced.
Now BLS is underway we follow the algorithm into ALS and ensure the patient has an intravenous catheter (IVC) placed and monitoring attached. Once this is in place it’s time to consider reversals, a decision that should ideally be made by the vet. Once the patient has an IVC placed and monitoring attached I encourage that, numbers permitting, the 3rd person to join the BLS team, ensuring there is continuity there and allowing enough personnel for feedback.
Outside of the BLS roles we need to have someone scribing, timing, and drawing up drugs.
Scribe and timer can be combined and again with appropriate training can be delegated to non-clinical team members. Drug administration should be allocated to a clinical team member as this provides opportunities for double checking.
Finally, the most controversial role, the lead. RESUS UK guidelines and RECOVER both advise that this falls to the most experience individual. Like I mentioned earlier this does not always equate to the vet, often at times an RVN may be more experienced with running a code and so they would be most appropriate. I find keeping the vet role and the lead role as two different roles offers clarity. Again, if numbers are restricted, we may find this becomes combined but as we discussed at the start there are many tasks that fall only under the remit of the vet so surely there is value in the two roles being separate?
Summary:
Non-Clinical team with adequate training:
Timing
Ventilator
Compressor
Scribe- ensure they are familiar with the paperwork and the terminology used. For an easy-to-follow CPR record you can download our CPR record here
Clinical team with adequate training:
All of the above
Plus
Drug preparation
Drug administration (Ideally under VS direction)
And finally the ‘Lead’ – well hopefully by now we’ve all realised that this is the most experienced person.