Dolittler: To resuscitate or not…what’s an overwrought owner/vet to do? (DNR for pets)

Related Blog Entries

Refusing euthanasia: A vet’s prerogative? (April 6, 2008)

Comments

Possibly a topic for a later post would be: what are the effects of CPR on dogs?

As a first-responder I've done my fair share of CPR and know all about the numbers in humans (every minute without CPR starts to cause brain damage after the first ten minutes or so, etc.) but I haven't been able to find any such information on dogs (or pets in general).

Also, if a dog would survive with the aid of CPR, what are typical complications afterwards (bruised or cracked ribs etc.)?

# Posted By ramin | 6/13/08 8:25 AM

Ramin: Thanks for your comment (your dog is gorgeous, btw, as is your website).

On your Q: Pet CPR typically does not typically yield rib fractures, as in humans, due to the shape of the chest. In some barrel chested breeds (like bulldogs), however, it is indeed possible to crack a few. Pulmonary contusions? Probably. But I'm not sure of the incidence. Open chest massage is the best--but it's infrequently done outside of the most sophisticated medical centers. One quote I love from one of these high-tech ER docs: "I can always get the heart beating but I've never discharged a pet who needed open chest CPR."

Typical complications? Neuro signs due to hypoxia. Blindness is most comon.

# Posted By Dr. Patty Khuly | 6/13/08 9:54 AM

I'd always heard anecdotally that pretty much NO animals revived by CPR ever go home alive. We did have a cat at our clinic recently that lost heartbeat/breathing after a dental cleaning, she was given epinephrine and some other injectables and she survived remarkably well except for becoming completely blind. I think it's pretty rare that an outcome is that good and we all refer to her as a miracle cat.

For my own pets I would sign a DNR as long as that did not preclude the use of injectable agents.

# Posted By anonymous in boston | 6/13/08 11:45 AM

Anecdotally... hell, very few *humans* who benefit from CPR survive. (There are a few exceptions, mostly depending on the mechanism of injury -- cardiac arrest from lightning strikes are quite survivable. Cardiac arrest from trauma, pretty much nil.) And all CPR is intended to do these days is to keep blood circulating while the defib's are brought in.

Still, in your average healthy human and/or pet... it's worth a try, no?

I've had to sign DNR's for my pets before. I've always found it a bit hard to see what I'm signing through the tears.

# Posted By Donna | 6/13/08 11:52 AM

My husband and I were faced with a very similar situation. At the time we chose "save at all costs", but later when we had left the heat of the moment we talked it out. Our options were external cpr, internal rescue measures and nothing. We really don't know the long term issues related to each of these and our pup is so small. We are going to talk to our vet next time we are in to get her opinion. None the less, the question really adds a level of severity to the situation that wasn't quite that high before.

# Posted By Sarah | 6/13/08 12:47 PM

Hi Patty,

I just wanted to send along a hug and my concern for Sophie Sue. I hope there is some good news in her future and know how hard this must be for you and yours.

Natalie

# Posted By Natalie | 6/13/08 1:51 PM

We have a similar blurb at the end of our estimates (we only offer do or do not perform CPR, we don't have euthanize as an option). The first reaction from the client is alarm--they think we think their pet is going to die. I explain to owners that this is just a routine question we ask for ALL pets left at our hospital; we do not expect anything to happen but we need to know, just in case, same as if they were to go to the hospital for a procedure. Then the client just may not know how to decide. I tell them that it is a personal decision, again, same as if if thy were deciding for themselves. If they are still having trouble deciding, I usually advise that they should mark "do." That way, if something should happen, we can start CPR while we notify them what is happening. Then, if they want us to stop, we can. It doesn't work as well if they choose "do not," and then change their minds.

The worst case scenario is when a patient presents to us critical or already in cardiac or respiratory arrest. It is very difficult to get an answer from a distraught client and in these situations seconds count, obviously. Although no one likes to think of their pets in life threatening situations, it would be great if they had some sort of plan in mind just in case something bad does happen.

# Posted By robyn w | 6/13/08 2:23 PM

Dear Dr. Khuly,

You, Sophie Sue, your son, etc. have been in my thoughts. My heart goes out to you.

Janet

# Posted By Janet | 6/13/08 7:45 PM

Dr. Khuly -

How heart-wrenching this whole process must be. I send you and Sophie Sue my very best wishes for a happy outcome.

# Posted By Pik | 6/13/08 11:25 PM

First- my prayers are with you and yours. Second- I love my dogs, but I would draw the line at cpr. My guys are young and healthy. But I would have to ask myself what put them in the position that they would need cpr? Probably trauma...and as previously stated...not a good chance of a successful outcome.

I believe that when it's time to go, it's time to go. My sisters and I had a DNR for our dad years ago. He had had terminal cancer for 27 years. He was 6ft 4 and weighed less than 110 lbs when he died. He was 74 years old and worn out. It was time to let him go.

That's how I feel about my animals..... I love em enough to let them go.

# Posted By Agadoresmama | 6/13/08 11:50 PM

Having an old fellow myself, just diagnosed with Cushing's and possibly something more aggressive, I'd opt for euthanasia. My dog has comorbid conditions, is old and as I've often said "there are worse ways to go than under a general anaesthetic on the table".

He's not displaying any serious symptoms or anything at this point but once the liver starts to pack it, it's pretty much game over in my experience.

Incidentally, I'd check the same box for myself in the same situation.

# Posted By Caveat | 6/14/08 10:22 AM

Dr. Khuly, Sophie Sue is in my prayers for some good quality life left and successful management of her disease.

caveat & agadoresmama: couldn't say it any better.....ditto

# Posted By Barbara A. Albright/New Hampshire | 6/14/08 3:47 PM

Hoping for news of Sophie Sue...

# Posted By Natalie | 6/16/08 11:22 PM

[Add Comment]