The field of veterinary medicine is constantly evolving, and the delivery of effective emergency care is a critical component of this ongoing progress. In 2012, the Reassessment Campaign on Veterinary Resuscitation (RECOVER) introduced groundbreaking guidelines for Basic Life Support (BLS), Advanced Life Support (ALS), and periarrest monitoring. Now, over a decade later, the RECOVER team has released an updated set of evidence-based consensus guidelines to further enhance the delivery of veterinary cardiopulmonary resuscitation (CPR).
How the updates were developed
The updated RECOVER CPR Guidelines were developed using a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. This comprehensive process involved the formulation of prioritized clinical questions in the Population, Intervention, Comparator, and Outcome (PICO) format, followed by systematic literature searches, evidence extraction, and quality assessment. The resulting recommendations were then reviewed by the RECOVER writing group and opened for feedback from veterinary professionals.
Key updates and changes
The new RECOVER CPR Guidelines feature several important updates and changes to the previous recommendations.
- High-dose epinephrine is no longer recommended, and atropine, if used, is only administered once. Additionally, when intubation is not possible, bagmask ventilation using a tight-fitting facemask with oxygen supplementation is recommended rather than mouth-to-nose ventilation. These revisions are based on the latest scientific evidence and aim to optimize the delivery of life-saving interventions.
- Regarding basic life support, these new treatment recommendations continue to emphasize the critical importance of high quality, uninterrupted chest compressions, with a modification suggested for the chest compression technique in wide-chested dogs. In the latter, lateral chest compressions focused over the widest part of the chest, until an endotracheal tube is placed and secured, are suggested. In wide-chested dogs that are positionally stable in dorsal recumbency, the guidelines recommend moving the dog to dorsal recumbency during an intercycle pause, and performing chest compressions over the sternum, directly over the heart, once an endotracheal tube is in place.
- For advanced life support, in animals with a shockable rhythm in which initial defibrillation was unsuccessful, the recommendation is to double the defibrillator dose once and give vasopressin (or epinephrine if vasopressin is not available), esmolol, lidocaine in dogs, and/or amiodarone in cats.
Improved algorithms and resources
Alongside the updated recommendations, the RECOVER CPR Guidelines also include an algorithm for initial assessment, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug dosing table. These supplementary resources are designed to provide veterinary professionals with clear and actionable guidance, streamlining the delivery of emergency care and improving patient outcomes.
Addressing evidence gaps
One of the key findings from the RECOVER CPR Guidelines update is the recognition of “indirectness of evidence” as the largest impediment to the certainty of the formulated guidelines. This underscores the urgent need for more studies focused on the target species of dogs and cats, to further strengthen the evidence base and inform future iterations of the guidelines.
Empowering veterinary professionals
The updated RECOVER CPR Guidelines represent a significant step forward in the field of veterinary emergency medicine. By incorporating the latest scientific evidence and providing clear, evidence-based recommendations, the guidelines aim to empower veterinary professionals to deliver the most effective and efficient resuscitation care possible. As the veterinary community continues to tackle the challenges of emergency situations, the RECOVER CPR Guidelines will serve as a valuable resource and guide for clinicians.
Conclusion
The updated RECOVER CPR Guidelines mark an important milestone in ongoing efforts to improve veterinary emergency care. The RECOVER team has demonstrated a steadfast commitment to advancing the field of veterinary resuscitation by introducing key changes, enhancing supporting resources, and highlighting areas for future research. As veterinary professionals, we must embrace these guidelines and strive to incorporate them into our daily practice, ultimately improving the lives of the animals we serve.
