Episode 7 – What Happens if My Pet Needs CPR with Dr. Rachael Boyd

Emergency veterinary hospitals see a lot of critical patients who are in need of two types of immediate care. Stabilization is the first step—an early intervention that helps reverse a critical patient, while resuscitation or CPR is for pets who are imminently dying and medical intervention is needed to revive them.

Dr. Rachael Boyd, Partner’s Lead Emergency Veterinarian in our Richmond location, has been practicing ER medicine with a focus on Trauma Medicine for more than 10 years. In this podcast, she explains what’s involved with both stabilization and resuscitation, what training our teams go through to provide these medical interventions, and the overall success rate of both. 

What You’ll Learn?

The difference between stabilization of a pet vs. resuscitation.
What’s involved with both and how successful are they
The training our team undergoes to make these life-saving efforts available to your pets.
What you can expect when your pet needs to be resuscitated.
What is a veterinary DNR and why you are asked to sign one

It can be really hard to make the DNR call; you might feel like you’re giving up on your pet. We urge you to talk to your doctor and medical team—they will be honest about your pet’s chances and will help make these difficult decisions so you’re not alone. In the end, our team is here to support you and help you make the call that’s best for your pet and your family.

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Narrator:

Welcome back to “Did You Know,” a podcast by Partner Veterinary. In this series, we explore all things veterinary medicine and all things Partner. In each episode, we answer some of the most common questions we are asked—from HR to emergencies and everything in between. If it happens at Partner, we’ll cover it.

Dr. Rachel Boyd, Partner’s lead emergency veterinarian in our Richmond location, returns to the podcast to discuss what is involved in stabilization and resuscitation in emergency and specialty medicine. We know that difficult decisions are made in our hospital every day. We strive to help you understand your options and support you every step of the way.

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Dr. Boyd:

“I’m Dr. Rachel Boyd. I have been an emergency veterinarian my entire career. When I graduated in 2015 from Virginia-Maryland Regional College of Veterinary Medicine, I had already known I loved ER medicine, and that’s what I’ve practiced for the last almost 10 years now—that’s what I focus on.”

Jen Mellace:

“What is your role with Partner?”

Dr. Boyd:

“I’m currently the lead veterinarian for the ER department, and I help advocate for my ER team of veterinarians. I make sure that we can have a good relationship with all of the specialty and support teams that help us provide good patient care.”

Jen Mellace:

“Today we’re going to talk about stabilization versus resuscitation. While it may be self-explanatory, can you give us a quick description of the difference between the two?”

Dr. Boyd:

“Yeah, absolutely. When we have a patient present very sick to the emergency department, there are two types of immediate care we can provide: stabilization or resuscitation. Stabilization is kind of the first step—ideally, if we can get to them early enough. These patients usually will have a low blood pressure or a low body temperature. They may need additional oxygen support, so these patients start to get some early interventions and get an IV catheter. We can give them fluids or pain control, and we can often reverse some of the things that are going on there. Whereas resuscitation is for pets that are really, really to the point where they are at death’s door or imminently dying, and we have to try and provide interventions to bring them back—bring back their ability to breathe, bring back their heartbeat sometimes, or speed it up. So it’s a lot more involved.”

Jen Mellace:

“What does stabilization involve—and you did touch upon this a little bit, but just going a little more into depth—and how successful is it most of the time?”

Dr. Boyd:

“Stabilization can be very successful for our patients because there are things that we can often rapidly correct. There are things like blood pressure, like I said, that we can correct with fluid boluses we can administer through an IV catheter. We can go ahead and correct body temperature by providing heat support for them. Patients who are struggling to breathe—we can provide them with oxygen therapies through a mask or through nasal cannulas. Some of the basics of stabilization can be provided and can be very successful. We can see a pretty dramatic turnaround in some of these patients from the state where they come in to about one to two hours later.

Most patients who require stabilization do need to stay in our ICU because whatever made them sick enough to require stabilization efforts will take a little more time to fully turn around. But taking them from as sick as they are when they hit the door in the ER Department to being a more stable patient who can stay in our ICU can really happen in one to two hours and can be very successful in many of these patients.”

Jen Mellace:

“And what about resuscitation? What does that involve and what’s the success rate?”

Dr. Boyd:

“Resuscitation is more what we think about with CPR, and it is much less successful. These patients are much more sick or injured, and their body is already starting the process of shutting down. So while there are things that we can do to try and get them back, it just overall has a lower success rate due to the severity of their illness or injury and due to just the time that we’re, you know, almost a little behind by the time that they hit the doors of the emergency department.

These patients will get an IV catheter, they do get intubated with a breathing tube that is placed into their airway, and we will breathe for them manually. We will do chest compressions if there’s no heartbeat, and we will administer rescue drugs to try and get their heartbeat back and appropriate. The overall success rates for veterinary resuscitation through CPR is about 44% for getting their heartbeat back, but unfortunately, their actual survival to go home, even after we get their heartbeat back, is only about 8 to 10%. So even if we’re initially successful at getting them back through resuscitation and CPR, we may not be successful in getting them to the ultimate goal, which is to go home with their family.”

Jen Mellace:

“Does the age of the pet have anything to do with how successful either stabilization or resuscitation can be?”

Dr. Boyd:

“Yeah, it definitely can play a role. Patients who have experienced a very quick onset of illness or injury tend to have a better success rate of stabilization and resuscitation, whereas when they’ve been sicker for a long period of time or if they have multiple illnesses going on, then that can make it harder to stabilize or resuscitate them. Older pets are just going to have more things typically going on with them, and they tend to have been sicker for longer than a younger pet.”

Jen Mellace:

“And I imagine this also plays into how quickly a pet owner can get their pet in if they either see something that doesn’t seem right or obviously a traumatic injury. The quicker people get their pets in, the better success rate there would be, I would imagine?”

Dr. Boyd:

“Yeah, absolutely. In our hospital, we employ a triage process where every patient that hits the door gets triaged right away, and we get an immediate set of vital signs so we know what’s going on. We recognize that with these patients who are sometimes sicker than we see at home, time is of the essence. I think that can be very hard across America in general right now—many veterinary ERs are overwhelmed with the amount of sick pets. It can become a barrier for care for clients even when they identify things early, but for us, we try and make it a priority to be able to triage these pets and identify the ones that need intervention right away.”

Jen Mellace:

“What training does our team undergo to make these life-saving efforts available to our patients?”

Dr. Boyd:

“We practice resuscitation very regularly in our ER. I’d say if not every day, at least three times a week. We do have a trainer who’s onsite who’s very experienced in all sorts of things, but especially resuscitation and stabilization. She will work with new hires on getting familiar with the structure. Each morning, we assign staff members to particular jobs during a resuscitation and stabilization event because we know that people who know exactly what they need to do in that time frame can get to it faster and get the pet the care they need. So people are assigned to placing an IV catheter or intubating, and when the pet arrives, they already know what they need to be doing. We also have a lot of staff that go through the RECOVER certification, which is a veterinary-specific CPR certification that keeps us up to date, and we become recertified in that frequently.”

Jen Mellace:

“What can clients expect when resuscitation is needed and what their pet will go through?”

Dr. Boyd:

“That’s a really hard moment for everyone when a pet needs resuscitation, and it can be really hard, especially when this has come on very suddenly, to have to make decisions about whether to pursue resuscitation or not. Ultimately, we know that resuscitation is not very successful in many of our patients—like I said, 8 to 10% of them ultimately get to go home at the end of it. So having an idea of the true success rate for resuscitation events is very important.

I think understanding what it looks like for our pets is important. Like I said, IV catheter placement is very easy, but when we start talking about placing a breathing tube, doing chest compressions—those things can be traumatizing and scary, especially if a patient has some degree of awareness, depending on where they are in their arrest, their heart stopping, or their respiratory stopping. So it can be very difficult for clients.

It doesn’t mean that choosing a DNR or ‘do not resuscitate’ is always the right choice. CPR can be successful in patients who, like you mentioned earlier, are young or who’ve had a very acute onset or short duration of their illness or injury—we can successfully bring them back. But when we have an older pet who’s fighting kind of an uphill battle or a longer battle, it may not be the kindest thing to go forward with that because it can be very hard on the body and the mind.”

Jen Mellace:

“Can you please explain what the DNR entails and are all clients asked to sign a DNR when their pet comes into the hospital?”

Dr. Boyd:

“Because CPR has such a variable rate of success with our patients, we ask everybody their personal preference on whether they would like their pet to have CPR or be what we call a DNR patient, which is where we do not resuscitate them. There is a little bit of confusion around DNR—sometimes people think that means that we’re not going to support their pet when they become sicker, and that’s not true. We still provide full stabilization to all our pets, whether they’re hitting the door at our ER for the first time or they’re hospitalized with us in the ICU.

So they’ll still get a fluid bolus if we need to correct their blood pressure, we’ll still provide flow-by oxygen if they’re struggling to breathe, but what we won’t do is if their heart stops or they’re no longer breathing, we’re not going to place a breathing tube, we’re not going to administer epinephrine to try and jump-start the heart, and we’re not going to do compressions on their chest if they’re a DNR.

For patients who are very sick and for patients who are older, often DNR can be the kinder option for them. I think there’s a little bit of difficulty because it can feel really hard to make that decision—to make that DNR call can feel like you’re giving up on your pet, but that’s not true. We know that the science tells us these guys don’t always come back, especially when they meet those criteria of being older, having a more severe illness, or having a protracted illness. So asking them to go through a CPR event at the last, at the tail end of their life, can sometimes not be the right choice for them or for you. That’s why we ask everybody their individual preference: do you want us to perform CPR on your pet, or would you rather us allow them to pass on their own?”

Jen Mellace:

“Yeah, I imagine that it is a hard call for a pet owner to make, especially when they’re going through something so big like that. I imagine it’s just very difficult for everybody involved.”

Dr. Boyd:

“It can be an incredibly hard decision to make. I think one of the big things is talking to your doctor and your medical team when you’re at an ER about their thoughts. Most of us have a good feeling about which patients should probably be provided CPR and resuscitation and which ones it’s unlikely to be helpful for. Your medical team will be honest with you if you ask those questions of, ‘Hey, do you think it’s worthwhile to do CPR on my pet if they were to go into cardiac or pulmonary arrest?’ They’ll let you know—they’ll be honest with you.

Jen Mellace:

So making that decision doesn’t have to be alone or by yourself. We’re here to help you and support you and provide you that information and make the best call for your pet and your family. At the end of the day, that’s what you’re here for—hopefully to get pets home with their family or to make the kindest decision for them.”

Dr. Boyd:

“Yeah, absolutely.

Narrator:

Thank you for listening to ‘Did You Know.’ Is there something about Partner that you want to know? Email us at [email protected]. Who knows? We might turn your question into an entire episode! You can now find us wherever you listen to all of your other favorite podcasts. Subscribe now!”

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