As we all know the RECOVER CPR guidelines updated at the end of June 2024 after much
awaited anticipation. The guidelines, developed by RECOVER initiative are designed to
enhance are every growing knowledge of all things veterinary CPR! The updates introduce
several key changes aimed at improving survival rates for our patients who require CPR.
So here we go…

• Previous Guidelines: Recommended a compression rate of 100-120
  compressions per minute for dogs and cats, with a compression depth of 1/3
  to 1/2 the width of the chest.
• New Guidelines: Maintain the compression rate at 100-120 cpm but now
  emphasise the importance of allowing full chest recoil between
  compressions. The compression depth remains the same, but the guidelines
  now stress the significance of using the correct hand placement and
  technique to ensure optimal results.
• Barrel chested patients (Brachycephalic breeds)– compression depth
  has now changed to ¼ of the width of the chest and patients are
  placed in dorsal recumbency as these provides the most effective
  compressions. However compressions may be started in lateral
  recumbency whilst intubating.

• Previous Guidelines: Suggested a ventilation rate of 10 breaths per minute
  during CPR.
• Previous Guidelines: Mouth to snout method if not intubated. Deliver 30
  compressions, pause and give 1-2 mouth to snout breaths with a 1 second
  inspiratory time
• New Guidelines: Adjust the ventilation rate to 6-10 breaths per minute, with
  a focus on avoiding hyperventilation. This change is based on evidence that
  lower ventilation rates can improve outcomes by preventing the negative
  effects of excessive ventilation, such as decreased cardiac output.
• New Guidelines: Mouth to snout ventilation is now not recommended due to
  risk of zoonosis or contamination from toxins or narcotics from patient to
  ventilator. It should only be used unless necessary. RECOVER now
  recommend using a tightly fitted face mask offering breaths in the same way.
• We should now be adjusting ETCO2 rates from 15mmHg to 18mmHg
  as evidence has shown this has been linked to higher return of
  spontaneous circulation (ROSC).
• We should look to trouble shoot if ETCO2 is not increasing or
  decreases as usually this is due to compression/ventilation rate or
  positioning of the patient or compressor.

• Previous Guidelines: Recommended the administration of drugs like
  epinephrine and atropine at specific intervals during CPR.
• Previous Guidelines: Recommended atropine every other cycle if needed.
• Previous Guidelines: Use of high and low dose adrenaline.
• New Guidelines: Stop the use of high dose adrenaline as this can cause
  neurological issues.
• New Guidelines: Only administer one dose of atropine due to the half life.
• New Guidelines: Introduce more precise dosing regimens and administration
  timings, based on the latest evidence. The guidelines now highlight the use of
  intraosseous access for drug delivery when intravenous access is not readily
  available.

• Previous Guidelines: Focused on immediate post-resuscitation support.
• New Guidelines: Provide detailed protocols for post-resuscitation care,
  including temperature management, monitoring for complications, and
  guidelines for gradually weaning off mechanical ventilation.

The new guidelines stress the importance of continuous monitoring and supportive
care to improve long-term outcomes.

The 2024 update to the RECOVER CPR guidelines represents a significant step forward in
veterinary emergency medicine and veterinary CPR. By incorporating the latest research
and clinical insights, these guidelines aim to improve the effectiveness of CPR and ultimately
save more animal lives.

We should familiarise ourselves with the new guidelines which can
be found here.

If your team would like a CPR refresh then please take a look at our In-House CPR training,
CPR pocket guides, crash box checklists and CPR monitor and debrief bundles.