Abstract
Objective
To determine whether physiological, haematological, biochemical or electrolyte variables
can predict severe haemorrhage in cats.
Study design
Randomized crossover study whereby each cat underwent mild and severe haemorrhage,
with a 2 month period between events.
Animals
A group of six domestic cats aged 21 ± 1 months and weighing 4.9 ± 1.2 kg, mean ±
standard deviation.
Methods
Cats were anaesthetized (buprenorphine, alfaxalone, isoflurane in oxygen at a fixed
end-tidal concentration of 1.7%) before the haemorrhage event. In total, 34 variables
were measured twice (prehaemorrhage and posthaemorrhage). The difference and percent
change for each variable were compared between haemorrhage events (paired t test). Significant variables were placed into 13 different ratios (posthaemorrhage
value of one variable divided by a posthaemorrhage value of a second variable) and
compared (paired t test), and Cohen’s d (d) was calculated. Receiver operating characteristic curves were plotted and cut-off
values for weak, moderate and strong indicators of severe haemorrhage were obtained.
Results
The blood loss was 4.5 ± 1.1 mL kg–1 and 26.8 ± 5.5 mL kg–1 for mild and severe haemorrhage events, respectively. The most significant variables
with large effect sizes were heart rate (HR), systolic arterial blood pressure (SAP),
end-tidal carbon dioxide (Pe′CO2), serum albumin, haematocrit and actual bicarbonate ion concentration [HCO3−(act)]. The most robust ratios were: 1) shock index (d = –2.8; HR:SAP); 2) HR:Pe′CO2 (d = –2.9); 3) serum albumin: haematocrit (d = 1.5); and 4) HR:HCO3−(act) (d = –1.6). These ratios were included in the final proposed Cat Acute Bleeding Scoring
System (CABSS).
Conclusions
and clinical relevance Cats subjected to mild and severe haemorrhage demonstrated statistically and clinically
relevant changes whereby four ratios could be created to make up the CABSS. The ratios
detected and quantified the presence of severe haemorrhage in anaesthetized cats.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Veterinary Anaesthesia and AnalgesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Shockindex.Dt Med Wschr. 1967; 43: 1947-1950
- ABC of major trauma. Management of hypovolaemic shock.Br Med J. 1990; 300: 1453-1457
- Outcomes of thoracic surgery in dogs and cats.Aus Vet J. 1996; 1: 25-30
- Venous hypercarbia in canine hemorrhagic shock.Crit Care Med. 1987; 15: 516-518
- Feline anesthetic deaths in veterinary practice.Top Companion Anim Med. 2010; 25: 189-194
- The massive transfusion score as a decision aid for resuscitation: learning when to turn the massive transfusion protocol on and off.J Trauma Acute Care Surg. 2016; 80: 450-456
- POSSUM: a scoring system for surgical audit.Br J Surg. 1991; 78: 355-360
- Massive transfusion predictive score in trauma. Experience of a transfusion registry.Med Intensiva. 2011; 35: 546-551
- Randomizing the order in which subjects receive multiple treatments.2008 (Last accessed 31 March 2017)
- Perianesthetic mortality in domestic animals: a retrospective study of postmortem lesions and review of autopsy procedures.Vet Path. 2016; 53: 1078-1086
- End-tidal CO2 pressure in the monitoring of cardiac output during canine hemorrhagic shock.J Crit Care. 1990; 5: 42-46
- Some circulatory responses to haemorrhage in the cat: a critical level of blood volume for the onset of hypotension.J Physiol. 1965; 172: 385-405
- Incidence of blood transfusion requirement and factors associated with transfusion following liver lobectomy in dogs and cats: 72 cases (2007-2015).J Am Vet Med Assoc. 2017; 251: 929-934
- Blood transfusions in the perioperative period.Clin Techniq Sm Anim Prac. 2004; 19: 75-82
- Actual or standard bicarbonate.Lancet. 1979; 28: 201-202
- Capnography in the emergency department: A review of uses, waveforms and limitations.J Emerg Med. 2017; 53: 829-842
- Transfusion therapy in emergency and critical care medicine.Vet Clin N Am: Sm Anim Prac. 1995; 25: 1365-1386
- Evaluation of the use of shock index in identifying acute blood loss in healthy blood donor dogs.J Vet Emerg Critic Care. 2017; 27: 524-531
- The effect of haemorrhage on haemoglobin concentration, blood volume and arterial pressure in kittens and cats.J Physiol. 1968; 194: 659-667
- The flat cat part 1.J Fel Med Surg. 2013; 15: 175-188
- Control of major haemorrhage and damage control surgery.Surg. 2013; 31: 574-581
- Predicting the need for massive transfusion in trauma patients: the traumatic bleeding severity score.J Trauma Acute Care Surg. 2014; 76: 1243-1250
- Assessment of shock index in healthy dogs and dogs in hemorrhagic shock.J Vet Emerg Crit Care. 2013; 23: 545-550
- Prehospital advanced trauma life support for critical penetrating wounds to the thorax and abdomen.J Trauma. 1985; 25: 828-832
- Trauma overview.in: Drobatz K.J. Hopper K. Rozanski E.A. Silverstein D.C. Textbook of Small Animal Emergency Medicine. 2nd edition. Wiley Blackwell, USA2018: 1041-1051
- Vital signs after haemorrhage – caution is appropriate.Trend Anaesth Crit Care. 2015; 5: 89-92
- Catheter replacement of the needle in percutaneous arteriography: a new technique.Acta Radiol. 1953; 39: 368-376
- A systematic review of sevoflurane and isoflurane minimum alveolar concentration in domestic cats.Vet Anaesth Analg. 2014; 41: 1-13
- Using effect size – or why the P value is not enough.J Grad Med Educ. 2012; 4: 279-282
- Prediction of massive bleeding in a prehospital setting: validation of six scoring systems.Med Intensiva. 2019; 43: 131-138
- Arterial vs venous blood gas differences during hemorrhagic shock.World J Crit Care Med. 2014; 4: 55-60
- Trauma associated severe haemorrhage (TASH)-score: probability of mass transfusion as surrogate for life threatening haemorrhage after multiple trauma.J Trauma. 2006; 60: 1228-1237
- Anaesthetic, analgesic and cardiorespiratory effects of intramuscular medetomidine-ketamine combination alone or with morphine or tramadol for orchiectomy in cats.Vet Anaesth Analg. 2014; 41: 411-420
Article info
Publication history
Published online: April 02, 2020
Accepted:
November 7,
2019
Received:
June 16,
2019
Identification
Copyright
© 2020 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.
