A lot of time is spent perfecting our crash box but there is merit to creating a Basic Life Support (BLS) Kit. If we look at the RECOVER Algorithm, we can see that even before we are reaching for drugs we need to establish and maintain an airway for these patients.
If the cardiopulmonary arrest (CPA) happens whilst the patient is under anaesthesia then they should already be intubated and attached to anaesthetic circuit. Allowing us to easily provide positive pressure intermittent ventilation (IPPV).
When a patient has a CPA outside of theatre securing and maintaining an airway can be more challenging. Providing IPPV outside of theatre and without an anaesthetic circuit will be pose similar challenges but these are easy to fix.
Currently guidelines for veterinary Cardiopulmonary Resuscitation (CPR) State that ventilation and compressions form BLS and that ventilation should continue alongside compressions. Where possible intubation should also be carried out in lateral with no interruption to compressions.
On discovery of an apnoeic and unresponsive patient compressions should be started immediately. Once help has arrived the patient will be intubated using a cuffed endotracheal tube (ETT) and the tube is then secured. Securing the ETT is a crucial step and should not be skipped. Once the ETT is secure the cuff should be inflated to provide a seal against the trachea to facilitate ventilation.
Ambu-Bags for ventilation
From personal preference an Ambu-bag is the easiest way to perform IPPV outside of the theatre. These come in a number of sizes and are human size. Both paediatric and adult sizes are available and having a small, medium, and large would be recommended.
Oxygen is not a point of discussion in RECOVER Guidelines. Unless there is a respiratory factor to the CPA priority is given to effective compressions in situ without time wasted searching for oxygen. Ambu-bags can also be used to provide oxygen when used in conjunction with a flowmeter.
With all of this in mind the following should be in a BLS Kit:
Selection of ET Tubes
Tube tie
Syringe to inflate cuff
Ambu-bag(s)
Laryngoscope form a BLS Kit.
This could be a ‘small’ kit and a ‘medium/large’ kit that could be stored somewhere easy to hand.
This simple step should allow you to provide effective BLS more efficiently.
More information
Videos about ventilating during CPR can be found on our Instagram
More information and the RECOVER Guidelines can be found here.
Ambu-Bags can be purchased via ACE Veterinary Supplies
