What Does ‘Do Not Resuscitate?’ Mean For My Pet?

Photo by Tran Mau Tri Tam on Unsplash

Each year, my fur babies are anesthetized for their annual dental cleaning. That means I have to fill out a form that asks me whether I want the vet to proceed with all appropriate life-saving measures in the event of an unforeseen emergency (i.e., cardiac and/or respiratory arrest). The alternative is, Do Not Resuscitate (DNR).

The options are extreme ends of the opposite spectrum. If I choose DNR, I can imagine myself forever wondering whether I am responsible for my pups’ death because I did not give my vet permission to conduct “ALL appropriate life-saving measures.” On the other hand, I also don’t want my vet to saw their chest open and begin manually massaging their heart. I know the latter is extreme but the wording is so vague that this could technically be an option.

Before we get into resuscitation, let’s talk about anesthesia.

Anesthesia can increase the risk of cardiac and or respiratory arrest in pets and in humans. To anesthetize an animal, veterinarians typically give the patient a combination of drugs that will sedate them. Next, they will inject a drug through an intravenous catheter (IV) and inject a short acting anesthetic (usually propofol) that will take over the central nervous system and render the patient unconscious. Since anesthesia depresses the nervous system, that means the brain is no longer fully in charge of critical bodily functions like controlling blood pressure and breathing. This is why veterinary clinicians must closely monitor the pet’s body temperature, respiration, and heart throughout the procedure.

For all human procedures involving anesthesia, there is a trained specialist whose only job is to monitor and manage the patient’s vitals. Most general veterinary clinics, however, do not have single person who is in charge of this task. This doesn’t necessarily mean that your pet is in danger when they are given an anesthetic. In most cases, pets are unlikely to experience negative complications from anesthesia itself. This article by Tufts indicates that 1 in 1,000 dogs and cats are at risk of complications. The risk is greatest in horses (1 in 100) because they often try to stand and run away when the drugs begin wearing off.

When and if complications occur, it’s usually because of an undiagnosed underlying condition or illness. One analysis found that only 31% of pets who died while anesthetized had an illness that was clinical diagnosed, but 59% showed evidence of an underlying disease. Generally, older and overweight animals have a higher risk of experiencing negative complications. Certain species and breeds may also experience higher risks. For example, many cats and small dog breeds have heart murmurs that can affect their ability to pump blood, which may require a different type of anesthesia and closer monitoring. Veterinary clinics assess these risks and tailor each procedure accordingly.

So what happens when your pet experiences cardiac and/or respiratory arrest?

If something happens to go wrong while your pet is anesthetized, there are two primary categories to consider when it comes to resuscitating them: (1) open chest cardiopulmonary resuscitation (OC-CPR) or closed chest CPR.

OC-CPR is uncommon and is only recommended if the patient is undergoing surgery. Unless you have a large, broad-chested dog. In which case, OC-CPR is recommended as soon as possible.

Closed chest CPR is far more common. It involves getting air to the dog’s lungs with a breathing tube or oxygen tank and then compressing the chest. You can also conduct mouth-to-mouth CPR if your pet stops breathing outside of a clinic. In a clinic, the veterinary staff may also use drugs like epinephrine (aka vasopressor therapy) or electrical cardioversion to help revive your pet.

If this freaked you out, try not to worry. A recent study of over 177,000 cats and dogs showed that CPR was used on less than 1% of them. In the rare circumstances that call for CPR, the outcomes are not exactly great. Some clinics like Patton Vet Hospital shared a 5% survival rate which is similar to results I found in empirical studies (e.g., Hofmeister et al., 2009; McIntyre et al., 2014). I know these findings aren’t comforting but it’s important to note that routine procedures like dental exams are very different from a pet that needs surgery on a vital organ. The two studies that I found have a small sample size and did not account for the pet’s initial health nor did they separately examine the risk of a particular procedure. Additionally, it’s important to remember that refusing a procedure for your pet carries its own risks. Poor oral hygiene, for example, can lead to or worsen cardiovascular disease, infections, and kidney disease.

So what should I do?

While we may hope and expect that someone from the veterinary clinic will kindly explain all of the procedures they are about to do in full detail, we’re not completely helpless when they do not meet our expectations.

Share your concerns with your veterinarian. Ask them about their procedures around anesthesia and CPR. The latter is especially important since studies have found that veterinary practices around CPR vary from clinic to clinic. For example, one study found significant differences in clinicians’ willingness to perform full CPR when pets are under anesthesia versus sedated, with over 60% electing to intervene in the case with anesthesia despite a DNR order. The researchers note that this may be due to a higher likelihood of the patient surviving. Regardless, your veterinary clinician should be willing to explain what you are giving them permission to do when you allow them to perform “ALL appropriate life-saving measures.” You should also ask them which interventions they would without if you check the option for DNR. If they are unwilling or hesitate to have this conversation with you, find another vet.

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