Suspected cardio‐biliary reflex in a dog undergoing exploratory laparotomy

The cardio‐biliary reflex is a type of vagal reflex associated with biliary disease. It was first described by Zachary Cope in 1970, and since then, it has only been reported in a small number of cases in human medicine. A 5‐year‐2‐month‐old miniature schnauzer presented for surgical revision following a cholecystectomy. Two episodes of cardio‐pulmonary arrest caused by a suspected cardio‐biliary reflex occurred during the anaesthetic. Each episode presented as asystole resulting in a sudden loss of cardiac output. The first episode occurred while the dog was undergoing surgical preparation, and the second episode occurred during the surgery. Return to spontaneous circulation was achieved by prompt cardiopulmonary resuscitation according to the basic Reassessment Campaign On Veterinary Resuscitation (RECOVER) guidelines. This case report describes a suspected cardio‐biliary reflex (Cope's sign) leading to two cardiopulmonary arrests and discusses the potential precipitating factors.