Successful cardiopulmonary resuscitation after suspected mandibulocardiac reflex in a Jersey cow.

Prompt, structured CPR can achieve ROSC after mandibulocardiac reflex-induced cardiac arrest in cattle.

This case report describes a bradycardic cardiac arrest and successful cardiopulmonary resuscitation (CPR) in a 17-month-old female Jersey cow undergoing general anaesthesia for mandibular fracture osteosynthesis. The anaesthetic protocol included xylazine, butorphanol, meloxicam, amoxicillin, ketamine induction, isoflurane maintenance, a ketamine CRI, and a mandibular nerve block with lidocaine. Thirty-eight minutes post-induction and 18 minutes after regional anaesthesia, percutaneous needle placement along the mandibular fracture line precipitated sinoatrial block with ventricular escape rhythm, followed by sinus tachycardia with hypertension, and ultimately cardiac arrest. CPR consisted of external chest compressions, controlled ventilation, and IV administration of epinephrine (0.01 mg/kg) and atropine (0.01 mg/kg). Return of spontaneous circulation (ROSC) was achieved after three CPR cycles. Post-resuscitation ventricular tachycardia was successfully managed with IV lidocaine. Retrospective analysis of an arterial blood sample collected at the time of the initial cardiovascular event revealed marked hyperkalaemia (8.1 mmol/L). Recovery was uneventful with no postanaesthetic complications. The authors propose that activation of a mandibulocardiac reflex during mandibular manipulation—even under regional anaesthesia—combined with concurrent hyperkalaemia, likely contributed to cardiovascular collapse. This case highlights the importance of continuous cardiovascular monitoring, preparedness for CPR, and awareness of the mandibulocardiac reflex in bovine anaesthesia.

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