Episode 22: Post-Cardiac Arrest Care in Dogs and Cats

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In this episode, Dr. Lance Wheeler, DVM, DACVECC tackles what happens after the pulse comes back - post-cardiac arrest care, one of the most complex and high-stakes phases of critical illness. Drawing from Chapter 5 of Small Animal Critical Care Medicine (3rd edition) by Manuel Boller and Daniel Fletcher, and weaving in the key updates from the 2024 RECOVER guidelines, Lance walks through a practical, structured framework for managing patients in the first minutes, hours, and days after ROSC: preventing early rearrest, recognizing the four components of post-cardiac arrest syndrome (systemic ischemia-reperfusion injury, brain injury, myocardial dysfunction, and the persistent precipitating disease), and building a physiologic environment that lets the brain and heart recover. He then moves through the practical bedside management such as controlled reoxygenation to normoxemia rather than hyperoxemia, normocapnic ventilation targets, hemodynamic goals and the fluid/norepinephrine/dobutamine approach to hypotension, glucose and adrenal considerations, targeted temperature management and slow rewarming, seizure and cerebral edema management, and the reversible nature of myocardial stunning. Along the way, he integrates the latest veterinary evidence, including 2021-2025 studies on functional outcomes after discharge, ROSC and survival predictors, post-ROSC blood-gas and electrolyte variables, global hypoxic-ischemic brain injury, neuroprognostication windows, and reversible myocardial dysfunction, and closes with a high-yield rapid-fire board review covering every key number worth memorizing.

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