Uso de cloreto de cálcio como adjuvante na reanimação cardiopulmonar cerebral (RCPC) em cães

Acta Scientiae Veterinariae

Telefone: (51) 3308-6964
ISSN: 16799216
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Início Publicação: 31/12/1969
Periodicidade: Trimestral
Área de Estudo: Medicina Veterinária

Uso de cloreto de cálcio como adjuvante na reanimação cardiopulmonar cerebral (RCPC) em cães

Ano: 2011 | Volume: 39 | Número: 3
Autores: Cláudio Corrêa Natalini, José Pedro Nogueira Estrella, Alexandre da Silva Polydoro, FábioFutema, Priscila Beatriz da Silva Serpa
Autor Correspondente: Cláudio Corrêa Natalini | [email protected]

Palavras-chave: parada cardiopulmonar, rcpc, cães, cloreto de cálcio

Resumos Cadastrados

Resumo Inglês:

Background: Treatment of cardiopulmonary arrest has been a source of discussion in both medicine as in veterinary with an
emphasis on the use of solutions with calcium because of its importance as an ion essential for heart’s functionality. Only a few
studies have showed the use of Ca2+ in CPCR. Based on this, the present study aimed to evaluate the use of calcium chloride
as an adjuvant therapy in CPCR in dogs.
Materials, Methods & Results: Eighteen cases of CPCR from the hospital routine of HCV-UFRGS were studied. Cases were
selected from those in which occurred a cardiopulmonary arrest with reversal to a ventricular asystole in dogs. These animals
were divided into two groups. In nine animals from the group called EPI, epinephrine was administered intravenously at a dose
of 0.1 or by pulmonary route in a dose of 0.2 In the remaining nine animals, named EPIC group, the protocol
was similar to the previous group, with the addition of the administration of calcium chloride 10% immediately after
administration of epinephrine. In EPI group, the overall rate of success was 55.6%, and three of the cases treated showed
reversion to normal sinus rhythm asystole. In the remaining six cases, four progressed to nonresponsive transient ventricular
tachycardia (VT) and death, and two progressed to junctional rhythm. In the EPIC group, the overall rate of success was 22.2%.
Four animals had VF from an asystole, in which in two of them were reversed by electric defibrillation, and in two of them the
reversal was not obtained. In the other five treated animals, a ventricular tachycardia was developed followed by an irreversible
cardiac arrest.
Discussion: The incidence and prevalence of cardiac arrest diagnosed in animals in both hospitals and outpatients are still
scarce data. However when it comes to patients under anesthesia, the success rate of CPCR are low compared to medicine.
Calcium ion is indispensable in order to generate activation of the cardiac myofilaments to produce contraction of the heart.
Cardiopulmonary arrest leads to a series of physiological changes that decrease the ability of the myocardium to maintain their
automaticity and, in turn, generate a cardiac pacemaker, as well as its contractility. Several studies show that such these
changes could be because of a severe hypocalcemia, found in both humans and dogs. Despite of the recent consensus against
its use, calcium chloride in CPCR can increase the intracellular levels of this ion, which can cause inhibition of cellular
respiration and energy production in mitochondrias, triggering an enzymatic proteolytic reaction, leading to cell death.
However there is a clear exception in cases where the patient is in a framework of hypocalcemia. The EPI group has reached
better rates of success; however, in the EPIC group was observed a reversal of asystole to VF, a fact that did not occur in group
EPI. The treatment for VF is electric defibrillation, with a better prognosis when compared to asystole. Although the EPI group
has obtained the best result and epinephrine rather is the best treatment of choice to CPCR, the EPIC group demonstrated that
the use of calcium chloride may be an alternative to try to transform a VF in an asystole, with the possibility of using electric
defibrillator in patients unresponsive to epinephrine alone.