Return of spontaneous circulation after cardiopulmonary arrest in an adult horse recovering from anaesthesia.
Abstract: This report describes successful cardiopulmonary resuscitation of a healthy, 525 kg, 8 years 9 months-old Quarter horse gelding. After successful pelvic limb orthopaedic surgery to excise a metatarsal bone under general anaesthesia, with the horse in left lateral recumbency, the horse was hoisted into recovery. After the horse was positioned in recovery, a routine cardiac check by thoracic auscultation was performed. Cardiopulmonary arrest (CPA) was identified by absence of cardiac sounds and pulse, as evaluated by digital palpation of the facial artery, absence of the right palpebral reflex, mydriasis and pale coloration of the tongue. Chest compressions were started immediately, using the knee-drop technique, at 40-53 compressions minute-1. Compressions were performed by four people (body masses ranging from 61 to 100 kg) with a different person taking a turn every 2 minutes. Intermittent positive pressure ventilation continued at 4-6 breaths minute-1 using oxygen delivered via demand valve. Following two intravenous doses of epinephrine (0.002 mg kg-1 per dose) and four compression cycles, end-tidal carbon dioxide varied between 10 and 21 mmHg (1.3-2.8 kPa), increasing during the fifth cycle to 31 mmHg (4.1 kPa), suggesting return of spontaneous circulation (ROSC). A sixth cycle was started and stopped after 28 seconds for thoracic auscultation, when heart sounds were audible and a pulse present on palpation of the facial artery, indicating ROSC. After standing, the horse showed signs of distress (shaking and sweating) and was non-weight bearing on its right thoracic limb. A grade 3/6 left-sided systolic heart murmur and tachycardia (56 beats minute-1) were present. Two days post-CPA, the heart murmur was undetectable, and the horse was weight bearing on all limbs. This case describes successful ROSC in an adult horse with low compression rates and highlights the importance of capnography to assess compression quality and ROSC.
Copyright © 2025. Published by Elsevier Ltd.
Publication Date: 2025-03-06 PubMed ID: 40158903DOI: 10.1016/j.vaa.2025.02.015Google Scholar: Lookup
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Summary
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The research article reports on a successful cardiopulmonary resuscitation of an adult horse post-surgery, illustrating the significant role capnography plays in monitoring and assessing compression rate and the return of spontaneous circulation.
Case Description
- The subject of the study was a healthy adult horse (8 years 9 months old, 525 kg) of the Quarter horse breed which underwent a successful orthopedic surgery under general anesthesia to remove a metatarsal bone.
- After being arranged in the recovery position, the horse underwent a routine cardiovascular examination. The healthcare professionals noted an absence of pulse and heartbeat, no right palpebral reflex, widened pupils, and a pale tongue, which are markers of cardiopulmonary arrest (CPA).
Resuscitation Procedure
- Upon noticing the signs of CPA, chest compressions were immediately initiated, using the knee-drop technique at a rate of 40-53 compressions per minute. This process involved a total of four people with varying body weights, with an individual swapped every 2 minutes.
- Concurrently, intermittent positive pressure ventilation was performed using an oxygen demand valve at 4-6 breaths per minute.
Recovery Indication
- The team administered two intravenous doses of epinephrine (0.002 mg/kg per dose) and conducted four compression cycles. This resulted in end-tidal carbon dioxide levels fluctuating between 10 and 21 mmHg.
- The levels rose to 31 mmHg during the fifth compression cycle, which was a possible indication of a return of spontaneous circulation (ROSC).
- A sixth cycle was initiated but was halted after 28 seconds when they heard heart sounds and felt a pulse, confirming the ROSC.
Post-Recovery Observations
- Post-recovery the horse was found in distress, showed non-weight bearing on its right thoracic limb, and had a grade 3/6 left-sided systolic heart murmur and tachycardia.
- However, two days post-CPA, these symptoms had ameliorated with the disappearance of the heart murmur, and the horse returned to bearing weight on all limbs.
The Importance of Capnography
- This case emphasizes the value of capnography in tracking ROSC. By monitoring the varying levels of end-tidal carbon dioxide, the vet team was able to assess and measure the quality of the chest compressions and identify the ROSC.
Cite This Article
APA
Munerato MS, Simon O, Nicholson A.
(2025).
Return of spontaneous circulation after cardiopulmonary arrest in an adult horse recovering from anaesthesia.
Vet Anaesth Analg, 52(5), 671-676.
https://doi.org/10.1016/j.vaa.2025.02.015 Publication
Researcher Affiliations
- University of Adelaide, School of Animal and Veterinary Sciences, Roseworthy, SA, Australia. Electronic address: marina.sallesmunerato@adelaide.edu.au.
- University of Adelaide, School of Animal and Veterinary Sciences, Roseworthy, SA, Australia.
- University of Adelaide, School of Animal and Veterinary Sciences, Roseworthy, SA, Australia.
MeSH Terms
- Animals
- Horses
- Heart Arrest / veterinary
- Heart Arrest / therapy
- Male
- Horse Diseases / therapy
- Return of Spontaneous Circulation
- Cardiopulmonary Resuscitation / veterinary
- Cardiopulmonary Resuscitation / methods
- Anesthesia, General / veterinary
- Anesthesia Recovery Period
Conflict of Interest Statement
Conflict of interest statement The authors declare no conflict of interest.
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