Dec. 20, 2022
Story and photos by Jens Odegaard

Otto, a two-year-old mutt mix, collapses on the exam table. Third-year veterinary student Madison Cates is doing his physical exam. She listens for a heartbeat, feels for his pulse and calls for help. 

Five fellow third-year students rush over and start triaging the situation. Courtney Craig assumes the leadership role – keep the team organized and on track. Clarissa Crothal and Maria Axenoff double check Otto’s vitals. His pulse is flitting and fluttering. Kira Blackstad-Pimental starts keeping notes and assessing which medications Otto might need based on his case history. Kathryn Donovan hooks Otto up to a monitor displaying his vital signs. (See photo.)

Then, Otto’s heart stops completely. 

For the next 5 or so minutes it’s a whirlwind of activity. Otto is intubated with a cuffed endotracheal tube which is used to provide ventilating “breaths” by pumping oxygenated air into the tube. Cates starts chest compressions, while Crothal administers the breaths. 

Compression on the beat of nearly two per second. Ventilation breaths every six seconds. Epinephrine and other medications as needed. As Cates’ arms get tired, she switches with Donovan who in turn switches with Axenoff. Rinse and repeat as needed. 

And then … 

Kathump, kathump, KATHUMP. 

Just as quickly as it stopped, Otto’s heart springs back into rhythm. His blood pumps out through his arteries. It courses back through his veins. His pulse returns. Then stabilizes. The vital signs monitor goes from flatline to peaks and valleys.

The team cheers. And so do the six other teams of students observing the exercise as part of their Clinical Skills Laboratory. Joining in the applause are instructors Kimmie Warren and Trevor Fitcha, certified veterinary technicians at the Oregon State University Carlson College of Veterinary Medicine.  

The Odd Thing About Otto
Otto’s not actually a real dog. He’s an incredibly lifelike canine manikin used for RECOVER CPR training. This training exercise is Otto’s first day on the job. “Otto breathes, has heart and lung sounds, has femoral pulses and communicates with our software on a laptop to reflect the patient's status on a monitor that is projected onto a large screen for everyone to see,” Warren said. “It provides real-life simulation scenarios in a safe, low-stress learning environment.” 

The RECOVER Initiative is the industry standard veterinary CPR training recognized by the American College of Veterinary Emergency Critical Care and the Veterinary Emergency and Critical Care Society. “The certification is essentially the equivalent of human doctors and nurses obtaining their Advanced Life Support CPR certification,” Warren said. 

Both she and Fitcha are certified RECOVER Instructors. In the nearly three years since their instructor certification, they’ve trained almost 80 faculty, staff, house officers and students in veterinary CPR through a full eight-hour lab that results in a RECOVER Rescuer Certification. (Today’s training exercise with the third-year students is an abbreviated lab to give them some exposure to veterinary CPR without the full certification.)  “Certification prepares practitioners by helping to expedite recognition of an arrest while organizing a team to perform high-quality CPR,” Fitcha said. “Ultimately this improves patient outcomes and centers our approach on one that highlights use of the latest evidence toward implementing best practices for patient care.” 

Otto was purchased through a grant from the Coit Family Foundation, which “makes grants to nonprofit organizations in the western United States that have demonstrated their commitment to the care and stewardship of the natural world, scientific education, animal welfare, the education of children, the arts and the delivery of social services to disadvantaged people,” according to its website.

Otto vastly improves on the previous manikin that Warren and Fitcha used in previous trainings. “We used a static manikin that required a lot of pretending and acting on the lab participants’ parts to make the practice scenarios feel realistic to them. Often times they relied on asking us questions to determine what next steps they needed to take with their patient, which often distracted them from focusing on their patient,” Warren said. “Now, there isn’t as much pretending, and there are more opportunities for participants to become fully immersed in the scenario. They can keep their focus on the patient by putting what they have learned to use, such as palpating for femoral pulses, listening to various heart and lung sounds, as well as assessing for chest movement indicating that their patient is alive and breathing in that moment.” 

Third-year student Maria Axenoff does chest compressions on Otto while classmate Clarissa Crothal provides breaths via the cuffed endotracheal tube.

Certified Veterinary Technicians and RECOVER Instructors Trevor Fitcha and Kimmie Warren demonstrate how to use a defibrillator on Otto.

Third-year student Nicole Gee points to Otto's vital signs on the projection screen while classmates Emily Eckart and Payton Hunt provide CPR to Otto. 

Certified Skills 
The training exercise for third-year students is vitally important. “Having the ability to practice CPR in the third year of veterinary school allows students to be better prepared and respond swiftly if a patient experiences cardiopulmonary arrest during their clinical rotations [fourth year],” Fitcha said. “The experience with the RECOVER simulator is often the first exposure to CPR for many of our students. Having the opportunity to practice in a supported and fun environment helps learners integrate their knowledge before being in an emergency setting.” 

Through Otto’s software, a variety of different scenarios can be run, giving students and other trainees a nearly unlimited variety of practice. And if the proper protocols aren’t followed and implemented correctly, Otto won’t make it. “She [Warren] told us, ‘He'll die if you guys aren't doing things right. He will die and he won't come back.’ So that's how you know you did everything right,” said Axenoff. “So that made me feel better, like I actually did my chest compressions right. Because I was wondering, ‘Am I actually doing this hard enough?’” 

As Warren’s own experience as a veterinary caregiver attests, this varied practice pays off in real situations. “I can specifically remember a busy Friday night where we had two very critical patients go into cardiopulmonary arrest within a couple hours of each other. Both cases were very similar to each other prior to their arrest, but during their arrest event they responded very differently,” Warren said. “We performed CPR on both of them according to RECOVER standards, which allowed us to focus more on each patient as an individual and utilize our knowledge and critical thinking skills to provide them with the best care.”  

Team by team, each group of students is run through the paces. Putting their knowledge gained from their RECOVER bookwork earlier in the academic term into practice. In one scenario, Otto’s been hit by a car and rushed to the ER. In another, he’s been sick with vomiting and diarrhea for more than 12 hours before being brought in for a checkup. And so on. For each scenario, the software adjusts his vitals and Otto responds accordingly as the students work. 

“Watching each group of students problem solve, communicate with each other, and celebrate their successes left me with a sense of fulfillment and gratitude. Having the opportunity to be able to teach such an important skill and make such an impact on this class of students is something that I am grateful for to those who helped us get to this point,” Warren said. 

Adds Fitcha: “Working with Kimmie to promote RECOVER CPR at the veterinary teaching hospital has been a highlight of my career and has helped remind me of the reason I became an instructor in the first place – to guide our veterinary students as we work collaboratively to improve patient outcomes.”