The 2024 RECOVER guidelines recommend initiating CPR with immediate chest compressions at 100–120 compressions per minute, a compression-to-ventilation ratio of 30:2, and cycles of 2 minutes of uninterrupted CPR before pausing to assess rhythm or administer drugs.Journal of Vete…+1
Basic Life Support: compressions are the priority. Compressions should be delivered at 100–120/min with the patient in lateral recumbency; conformation-specific technique modifications are recommended for wide-chested dogs.Journal of Vete… When intubation is not possible, bag-mask ventilation using a tight-fitting facemask with oxygen supplementation is recommended over mouth-to-nose ventilation.Journal of Vete…+1 Chest compression pauses should be minimized, and high-quality, uninterrupted compressions remain the single most important intervention.Journal of Vete…
Vasopressors are the cornerstone of Advanced Life Support (ALS) pharmacotherapy. Epinephrine at 0.01 mg/kg IV is recommended for nonshockable rhythms (asystole, pulseless electrical activity); high-dose epinephrine (0.1 mg/kg) is no longer recommended under any circumstance, including prolonged CPR.Journal of Vete…+1 Vasopressin is the preferred vasopressor in shockable rhythms refractory to initial defibrillation, with epinephrine as the alternative if vasopressin is unavailable.Journal of Vete… Atropine, when indicated, is administered once only — repeat dosing is no longer recommended.Journal of Vete…+1
Defibrillation is the definitive treatment for ventricular fibrillation and pulseless ventricular tachycardia. If initial defibrillation is unsuccessful, the defibrillator dose should be doubled once.Journal of Vete… In animals with refractory shockable rhythms, esmolol and antiarrhythmics are added: lidocaine is recommended in dogs, and amiodarone is recommended in cats.Journal of Vete… Lidocaine and amiodarone are not interchangeable between species per these guidelines.
End-tidal CO₂ (ETco₂) monitoring is the recommended method for assessing CPR quality and detecting return of spontaneous circulation (ROSC). The 2024 guidelines raise the target ETco₂ to 18 mmHg during CPR as a marker of adequate perfusion; a sudden rise in ETco₂ indicates ROSC.Journal of Vete… Multimodal monitoring is recommended for all patients at risk of cardiopulmonary arrest, under general anesthesia, or at risk of re-arrest.Journal of Vete…
IV fluid therapy during CPR is indicated only for specific indications. Fluids are appropriate when hypovolemia or distributive shock (e.g., anaphylaxis, sepsis) contributed to arrest; routine fluid boluses in euvolemic patients reduce perfusion pressures and decrease oxygen delivery to myocardial and cerebral tissues.AAHA Clinical G… Synthetic colloids should be avoided.AAHA Clinical G…
Post-cardiac arrest outcomes support continued aggressive resuscitation. Return of spontaneous circulation is achieved in 44% of dogs and 55% of cats; survival to hospital discharge is 7% in dogs and 19% in cats.Frontiers in Ve… Neurological improvement may take 48–72 hours post-ROSC, and early discouraging findings should not prompt discontinuation of post-arrest care.Journal of Vete… Median survival time in animals discharged from hospital is 455 days, and all owners in one cohort reported good quality of life.Journal of Vete…
| Parameter | 2024 RECOVER Recommendation | Key Change from 2012 |
|---|---|---|
| Compression rate | 100–120/min | Unchanged |
| Compression:ventilation ratio | 30:2 | Unchanged |
| CPR cycle duration | 2 min uninterrupted | Unchanged |
| Epinephrine (nonshockable) | 0.01 mg/kg IV | High-dose (0.1 mg/kg) no longer recommended |
| Atropine | Single dose only | Repeat dosing eliminated |
| Antiarrhythmic — dogs | Lidocaine | Unchanged |
| Antiarrhythmic — cats | Amiodarone | Clarified species preference |
| Defibrillation escalation | Double dose once if initial fails | Clarified |
| ETco₂ target during CPR | 18 mmHg | Raised from prior target |
| Ventilation (nonintubated) | Bag-mask preferred | Mouth-to-nose no longer preferred |
| IV fluids | Hypovolemia/distributive shock only | Unchanged |
Would you like the specific drug doses and defibrillation energy settings from the 2024 RECOVER drug dosing table?