Peer Reviewed

Cardiopulmonary
Resuscitation

The RECOVER
Guidelines
Noah Jones, RVT

Regional Emergency Animal Care Hospital of
Asheville, Asheville, North Carolina

Management of cardiopulmonary arrest (CPA)
requires rapid patient assessment, with immediate institution of cardiopulmonary resuscitation (CPR).
Despite amazing advances in veterinary medicine overthe last several years, over 90% of dogs and cats do not survive CPA.1 Human and veterinary CPA patients had similar
outcomes before the institution of evidence-based guidelines and mandatory comprehensive training of humanhealth care professionals.1 Now approximately 20% of humans survive in-hospital CPA.1
The improved outcomes in human survival are largely
considered to be a product of the guidelines and standardized training mentioned above. With this in mind,
the Reassessment Campaign on Veterinary Resuscitation(RECOVER) was developed. The RECOVER initiative had
2 goals:

RECOVER Classes & Levels
Each guideline was assigned a class andlevel based on the initiative’s findings(Table).1 For example, the recommendation
to perform chest compressions at 100 to
120 compressions per minute is a Class I,
Level A recommendation, which means:2,4• The benefit of performing chest
compressions at 100 to 120 compressions
per minute greatly outweighs the risk of
performing them at another rate (Class)• There are multiple, high-quality studies
in multiple populations that support thisrecommendation (Level).

24• Develop evidence-based guidelines for dogs and cats experiencing CPA• Identify knowledge gaps, or areas of CPA managementthat require further investigation.1
Both goals have the same ultimate objective: to improve
the quality and outcomes of veterinary resuscitation efforts.
The RECOVER initiative is an ongoing process, combining
evaluation of available evidence to develop current bestpractices and reevaluation in the future.1
This article provides an overview of the guidelines; however, readers are encouraged to read the original manuscript (see Read the RECOVER Guidelines).
RECOVER GUIDELINESThe RECOVER guidelines are divided into 5 major topics,
or domains, which provided structure for the development process:1

Table. Classes & Levels of RECOVER Guidelines1
Class IClass IIa
ClassClass IIb
Class III
Level A
Level

Today’s Veterinary Practice January/February 2014

Level B
Level C

Benefit greatly outweighs the risk, and theintervention should be performed.
Benefit outweighs the risk, and the intervention
is reasonable to perform.
Benefit is less clear, but unlikely to cause
harm, and intervention may be considered.
Risk outweighs the benefit, and theintervention should not be performed.
Multiple high quality studies in multiple
populations support recommendation.
Few or no high quality studies in limited
populations support recommendation.
Expert opinion or physiologic principle in very
limited populations.

Cardiopulmonary Resuscitation: The RECOVER Guidelines |1. Preparedness and prevention
2. Basic life support (BLS)
3. Advanced life support (ALS)
4. Monitoring
5. Post cardiac arrest (PCA) care.
A total of 101 clinical guidelines were developed andpublished, with the guidelines organized by domain.1,2 The
guidelines are further categorized by Class and Level (seeRECOVER Classes & Levels).
DOMAIN 1: PREVENTION & PREPAREDNESS
Equipment & Training
The prevention and preparedness guidelines are directed at improving CPA equipment availability, training, andteamwork, and include ensuring:• Staff are familiar with and utilize a standardized crashcart (Figure 1) or pre-stocked arrest stations (I-A)• Cognitive aids are available for review during a CPR
event (I-B)• Staff receive comprehensive multimodal training, including simulations, followed by structured assessment
to determine comprehension (I-A).2,3
Education & Leadership
Refresher training every 6 months is also recommended (I-A).2,3 The RECOVER authors developed a comprehensive, standardized online CPR course offered throughVeritas (veritasdvm.com) and endorsed by the Veterinary
Emergency and Critical Care Society and American College of Veterinary Emergency and Critical Care. ALS certification is currently in development.
Specific leadership training for those who may be leading a CPR (I-A) is recommended; both veterinarians andtechnicians are capable of leading such a team (IIb-B).2,3
Regular debriefing after a CPR event should take place todiscuss what went well or wrong (I-A).2,3
CPR & Anesthesia
Prompt, high quality CPR should be provided for anesthetic-related CPA patients due to their significantly higher survival rate of 47% (I-B).2,3 Planning ahead for “worst case scenario” situation—by calculating emergency drug dosages
and ensuring easy access to emergency equipment—before
the anesthetic procedure can shave off precious seconds, allowing more rapid diagnosis of CPA and initiation of CPR.

Read the RECOVER Guidelines

The RECOVER initiative’s evidence-based
guidelines were published in a special issue of the
Journal of Veterinary Emergency and Critical Carein 2012; these guidelines can be downloaded forfree at veccs.org.1
The RECOVER initiative also developed 3 posters
for use in clinical practice—CPR Emergency Drugs
and Doses, CPR Algorithm, and PCA Algorithm.1,2
These posters are available for purchase at veccs.
org. The Veterinary Emergency and Critical Care
Society kindly granted permission for adapted
versions of the CPR Emergency Drugs andDoses (page 32) and the CPR Algorithm (page 30)
to be published in this article.

Chest Compressions
Chest compressions should be (Figure 2, page 26):
• Initiated in lateral recumbency (I-B)• At a rate of 100 to 120 compressions per minute for bothdogs and cats (I-A)• Performed with chest compression depth being to ½ thewidth of the chest (IIa-A)• Performed without leaning on the patient, allowing for
full chest-wall recoil (I-A).2,4
CPR should be performed without interruption in 2-minute cycles to maximize coronary perfusion (I-A), with achange in compressor after each cycle in order to minimize fatigue (I-B).2,4
Ventilation & Airway Management
Regardless of compression technique, simultaneous ventilation should be provided via a cuffed endotracheal tube
(with cuff inflated) at a rate of 10 breaths per minute, witha tidal volume of 10 mL/kg and an inspiratory time of 1
second (I-A).2,4• Endotracheal intubation and ventilation should be performed simultaneously during chest compressions in lateral recumbency.2,4• A laryngoscope should always be used and tube placement confirmed by visualization (tube passing throughthe arytenoids), auscultation, observing chest wall movement, and capnometry.2,4

DOMAIN 2: BASIC LIFE SUPPORTThe BLS domain focused on the importance of providing
high-quality BLS to patients and, therefore, increasing the
likelihood of return of spontaneous circulation (ROSC).4
For the RECOVER guidelines, BLS includes:4• Recognition of CPA• Chest compressions• Ventilation• Airway management.
Recognition of CPA
If a patient is unresponsive and apneic, CPR should be initiated aggressively and immediately (I-B); wasting time for
confirmation of CPA by pulse palpation or ECG is not recommended (III-B).2,4,5

Figure 1. A stocked crash cart
January/February 2014 Today’s Veterinary Practice25

| Cardiopulmonary Resuscitation: The RECOVER Guidelines

Intratracheal Administration & Drugs
When administering drugs via the intratracheal route,
dilution with normal saline and use of a long catheter,
such as a red-rubber catheter placed through theendotracheal tube to the level of the carina, arerecommended (I-B).2,6,8
Use the mnemonic NAVEL to remember whichdrugs can be administered intratracheally:8

Naloxone Atropine Vasopressin Epinephrine Lidocaine
Figure 2. A CPR drill• Ventilation with 100% oxygen is reasonable (IIa-B); however, use of room air may also be considered (IIb-B).2,4
In single-rescuer CPR, or if endotracheal intubation isunavailable, mouth-to-snout ventilation is recommended,with 2 breaths delivered after every 30 compressions (IB).2,4 On the other hand, if sufficient trained personnel
are available, interposed abdominal compressions may increase venous return and should be considered (IIa-B).2,4
DOMAIN 3: ADVANCED LIFE SUPPORTThe ALS domain provides a larger number of recommendations due to the greater number of interventions that
may be required.6 The main tenets of the ALS recommendations pertain to:6
• Vasopressor therapy• Vagolytic therapy• Electrical cardioversion• Correction or reversal of condition(s) that led to arrest.
Vasopressor Therapy
Vasopressor therapy is directed atincreasing systemic vascular resistance in an effort to increase
coronary and cerebral blood

Specific hand placement for
CPR depends on patient sizeand breed:2,4• Larger dogs benefit from compressions over the widest portion of the thorax, using thethoracic pump theory (IIa-C)(Figure 3).
Figure 3. Large dog• Barrel-chested breeds, such as
hand placement (thobulldogs, may benefit from sterracic pump theory)
nal chest compressions in
dorsal recumbency (IIb-C).
• Smaller dogs, keel-chested dogs, and cats may
benefit from compressions
directly over the heart, employing the cardiac pumptheory (IIa-C) (Figure 4).
• Smaller dogs and catsalso benefit from circumferential compressions(IIb-C), although beneFigure 4. Small dog/cat handfits are less clear.
placement (cardiac pump theory)
26

Today’s Veterinary Practice January/February 2014

flow.6 Epinephrine, a nonselective adrenergic agonist, is themost commonly used vasopressor for CPR therapy; it affects
both alpha and beta adrenergic receptors. Alpha adrenergic
stimulation causes peripheral vasoconstriction. Beta adrenergic stimulation has positive inotropic and chronotropic effects, which increase myocardial oxygen demand and, therefore, may be detrimental in CPA patients.6
Epinephrine• Low-dose epinephrine (0.01 mg/kg) is recommended
for routine use every other BLS cycle (I-B) or every 3 to
5 minutes.2,6• High-dose epinephrine (0.1 mg/kg) may be consideredafter prolonged CPR (IIb-B).
Experimental data in dogs demonstrated no benefit or
reduced survival with use of high-dose epinephrine.2,6 Additionally, some research argues that high-dose epinephrine may resuscitate patients with irreversible, ischemic
damage, which leads to ethical questions regarding use ofhigh-dose epinephrine.6
Vasopressin
Unlike epinephrine, vasopressin does not affect heart rateor contractility and, therefore, does not increase myocardial oxygen demand. Vasopressin (0.8 U/kg) may be considered as a substitute or in combination with epinephrine (IIb-B) per the RECOVER guidelines.2,6 While vasopressin is advocated for use in CPR,2,6 research regarding
its benefits is mixed. The only prospective veterinary study
showed no benefit over epinephrine use.6,7
Vagolytic Therapy
During CPR, vagolytic therapy is usually provided by atropine.6 Limited data is available on atropine use in CPR,
with no high-quality data available for dogs or cats.6
Current best-evidence suggests that:• Atropine can be used in patients with CPA related to increased vagal tone and associated asystole or pulselesselectrical activity (IIb-B).
• Routine use of atropine may be considered (IIb-C).2,6
In experimental studies in dogs, high-dose atropine is associated with poor outcomes; therefore, doses above 0.04
mg/kg should be avoided.6
Electrical Cardioversion
Electrical defibrillation is indicated in patients sufferingfrom ventricular fibrillation (VF) (Figure 5) or pulseless ven-

Cardiopulmonary Resuscitation: The RECOVER Guidelines |Diagnosing CPA
tricular tachycardia (VT), and has been
Rapid identification of a patient requirshown to significantly improve ROSC
ing CPR allows more rapid institution
in these patients.6
of BLS and ALS, which increases the
RECOVER guidelines recommend:
chance of ROSC.
• Use of a biphasic defibrillator(I-A) has been shown to be more efPulse Palpation
fective than monophasic current2,6
Pulse palpation to diagnose CPA in un• Single-shock therapy versus
responsive, apneic patients is not recomstacked-shock therapy in order tomended (III-B) given that:2,5
minimize interruption of chest comFigure 5. Ventricular fibrillation• Lack of a palpable pulse does not alpressions (I-B) (However, evidence
ways indicate CPA
on stacked shocks versus single shocks
2,6•
Lengthoftime
ittakes to determine if a patient is pulsein dogs and cats is lacking. )less can delay initiation of CPR.
• Immediate defibrillation for pulseless VT/VF of less
Human research has shown that diagnosis of CPA bythan 4 minutes duration as there is minimal ischemia
pulse
palpation is not reliable, with only 2% of profession2,6
during this time (I-B)
alsdiagnosing
a pulseless patient in less than 10 seconds.5• Two-minute BLS cycle before defibrillation forpulseless VT/VF of greater than 4 minutes duration in For this reason, current human guidelines limit pulse palpation by health care professionals to less than 10 seconds
order to maximize coronary perfusion (I-B)2,6
5• Immediate defibrillation may be considered if VF or pulse- before BLS measures are initiated.
less VT is diagnosed during an intercycle pause (IIb-B).2,6
If defibrillation is unsuccessful, escalation of defibrilla- Electrocardiography & Blood Pressure Measurement
Electrocardiography (ECG) or Doppler blood pressuretion energy is reasonable (IIa-B).2,6 Readers with electricalmeasurement to diagdefibrillators should view the RECOVER drug dosage chart
nose CPA in unresponspecific to their defibrillator type for recommendations on
sive, apneic patientsenergy selection (see veccs.org).2
is not recommended(III-C) due to the reaAdditional ALS Therapies
sons listed above for
Medications
pulse palpation.2,5Routine use of IV fluids, magnesium, corticosteroids, orHowever, ECG or
calcium is not recommended (III-B, IIb-B, III-C, III-B, Doppler blood presrespectively), but these drugs may be beneficial in specific sure measurement
patient populations.2,6 Use of these drugs, as well as ami- to detect impending
odarone, lidocaine, sodium bicarbonate, reversal agents, CPA is reasonable toand impedance threshold devices are thoroughly covered perform in at-risk pa- Figure 6. PCA Monitoringin the RECOVER guidelines.2,6tients (IIa-C) (Figure
Of note, naloxone should be administered to CPA pa- 6). Evidence of an ECG
tients with suspected opioid toxicity (I-B), and may be con- rhythm does not always indicate a perfusing rhythm; absidered in all patients that recently received opioids (IIb- sence of a Doppler signal does not always indicate CPA.2,5
B).2,6 If IV access is unavailable, intraosseous access is obIn patients with VF, waveform analysis may provide prognostained; if intraosseous access is unavailable, intratracheal tic information, with coarse VF (high amplitude) associatedadministration may be performed (IIb-B) (see Intratra- with better outcomes than fine VF (low amplitude) (IIb-B).2,5
cheal Administration & Drugs).2,6
End-Tidal Carbon Dioxide Monitoring
Procedures
End-tidal carbon dioxide (EtCO2) monitoring is recommendOpen-chest CPR may be considered in cases of intratho- ed for intubated patients at risk of CPA (I-A).2,5 EtCO2 correracic disease if appropriate resources are available for the lates well with cardiac output and rapidly drops to zero at
intensive PCA care these patients will require (IIb-C).2,6
CPA onset.5,9 Additional reasons for rapid decreases include:9• Leaking anesthetic circuit
DOMAIN 4: CPR MONITORING• Airway obstruction
Proper monitoring plays a critical role in patients at risk • Massive pulmonary thromboembolism
for, suffering from, or recovering from CPA. Monitoring • Severe hypotension (may indicate impending CPA).
involves understanding the monitor’s limitations, and corEtCO2 readings should be interpreted cautiously and in
rectly interpreting the information obtained. Monitoring is conjunction with other monitoring parameters. Additionally, many arrests in dogs and cats are asphyxial in nature
further subdivided into:5• Diagnosing CPA and confirmation of endotracheal intubation (due to respiratory failure, hypoxemia, or hypercarbia),
which may cause elevated EtCO2 readings immediately fol• Monitoring during CPR
lowing endotracheal intubation and manual ventilation.2,5• PCA monitoring.
January/February 2014 Today’s Veterinary Practice27

| CARdIoPuLMonARy REsusCITATIon: ThE RECoVER GuIdELInEs

CPR Algorithm	  Unresponsive,	
  apneic	
  pa.ent	
  
CPR	
  (1	
  cycle	  =	
  2	
  minutes)	
  Compressions:	
  100-­‐120/min,	
  lateral,	
  1/3-­‐1/2	
  chest	
  width	  Ven.late:	
  10/min,	
  VT	
  =	
  10ml/kg,	
  I-­‐Time	
  =	
  1sec	  Ini.ate	  Monitoring:	
  ECG	
  and	  ETCO2	
  

ROSC	
  
Evaluate	
  Pa.ent	  Check	
  ECG	
  Vﬁb	
  Post-­‐CPA	
  Algorithm	  Asystole	
  /	
  PEA	  ¥ ConBnue	
  CPR	
  while	  charging	
  deﬁbrillator	
  ¥ Give	  1	
  shock	  ¥ Resume	  CPR	
  immediately	
  for	  1	  cycle	  ¥ Resume	  CPR	
  immediately	
  for	  1	  cycle	  ¥ Low	
  dose	  epinephrine	
  or	
  vasopressin	
  q	
  3-­‐5	
  mins	  ¥ Consider	
  atropine	
  if	
  é	
  vagal	
  tone	
  

ROSC	
  
Evaluate	
  Pa.ent	  Check	
  ECG	
  Vﬁb	
  ¥ ConBnue	
  CPR	
  while	  charging	
  deﬁbrillator	
  ¥ Give	  1	
  shock	  ¥ Resume	  CPR	
  immediately	
  for	  1	  cycle	  ¥ Give	  epinephrine	
  or	
  vasopressin	
  q	
  3-­‐5	
  mins	  ¥ Consider	
  amiodarone	  or	
  lidocaine	
  if	
  refractory	  Post-­‐CPA	
  Algorithm	  Asystole	
  /	
  PEA	
  ¥ Resume	  CPR	
  immediately	
  for	  1	  cycle	  ¥ Low	
  dose	  epinephrine	
  or	
  vasopressin	
  q	
  3-­‐5	
  mins	  ¥ Consider	
  high	  dose	  epinephrine	
  aKer	
  10	
  mins	  ¥ Consider	
  atropine	  Reprinted with permission from the Veterinary Emergency & Critical Care Society (veccs.org) RECOVER Initiative CPR Algorithm.

• Therefore, immediate post-intubation EtCO2 readings
should not be used to diagnose CPA because elevated values may lead to the incorrect conclusion that the patient is
not in CPA (III-B).2,5• Similarly, an EtCO2 reading may not be obtained (or a reading of zero may be obtained) immediately following endotracheal intubation in a patient suffering from CPA.5
Confirmation of Endotracheal Intubation
For the reasons stated above, use of EtCO2 alone to verify endotracheal intubation is not recommended (III-B).2,5 Verification shouldbe accomplished by all 3 of the following (IIa-B):2,5• Laryngoscopy• Bilateral lung sounds and chest movement• EtCO2 readings.
28

Today’s Veterinary Practice January/February 2014

Monitoring during CPR
Electrocardiography
ECG use during CPR is recommended for rhythm evaluation, but should (I-C):2,5• Only be evaluated during intercycle pauses• Not delay resumption of chest compressions.
End-Tidal Carbon Dioxide Monitoring
Since EtCO2 correlates well with cardiac output, EtCO2
monitoring during CPR to evaluate efficacy of chest
compressions is reasonable if minute ventilation isheld constant (IIa-B).2,5,9 Additionally, ROSC will causea sharp increase in EtCO2, and EtCO2 monitoringshould be used as an indicator of ROSC during CPR(I-A).2,5,9

| Cardiopulmonary Resuscitation: The RECOVER Guidelines

ing should detect impending
recurrence of CPA as well as
guide therapy to avoid its recurrence (I-C).2,5
Mimimum monitoring should
consist of (I-B):2,5• Continuous ECG• Arterial blood pressure
measurement• Body temperature• Oxygenation/ventilation
status.
Additional clinicopathologic
monitoring, which is dependent on patient comorbidities,
may include blood glucose
and lactate concentrations, although the benefit of monitoring these parameters in all PCA
patients is not clear (IIb-B).2,5
DOMAIN 5: POST
CARDIAC ARREST CARE
Excellent PCA care is required
Reprinted with permission from the Veterinary Emergency & Critical Care Society (veccs.org)
RECOVER Initiative CPR Emergency Drugs and Doses chart.
to minimize the likelihood of
CPA recurrence and maximize
the chance of a patient returnBlood Gas & Electrolyte Analysis
Blood gas and electrolyte analysis may be helpful in evalu- ing home with its owners. One study showed that over 50%
ating CPR effectiveness and identifying underlying causes.5 of dogs and cats will suffer another CPA event while in the• Mixed-venous or central-venous blood gas analysis may hospital, which correlates with human data on the subject.5
Patients with CPA who experience ROSC are likely tomore accurately reflect tissue acid–base status during
CPA; use of such values to evaluate CPR effectiveness have:10,11
may be considered (IIb-B).2,5 Increased PCO2, increasing • Some degree of hemodynamic instability related to vasopressor therapy during CPR or the underlying cause of CPA
lactate, or decreasing pH may indicate inadequate compression or ventilation technique; a change in technique • Cardiac ischemia• Systemic inflammatory response syndrome (hallmarked
should be considered.
by inflammatory system activation and excess circulat• Because CPA causes poor peripheral perfusion, periphing cytokines)
eral venous or arterial blood gas analysis is not recom• Anoxic brain injury.
mended to evaluate CPR effectiveness (III-A).2,5
CPA may be caused by significant electrolyte derangements.2,5,6 If underlying electrolyte derangements are sus- Fluid Therapy
pected or known, electrolyte analysis to guide therapy is When titrating IV fluids and vasopressors, the primary
recommended (I-C) and electrolyte monitoring during CPR endpoints of central venous oxygen saturation (> 70%)
and lactate (< 2.5 mmol/L) coupled with the following secmay be considered in all patients (IIb-B).2,5• In patients with documented hyperkalemia, treatment is ondary endpoints may be considered (IIb-B):2,10,11• Arterial blood pressure (systolic, 100–200 mm Hg; mean
recommended (I-B).2,6
arterial pressure, 80–120 mm Hg)• Treatment of documented hypokalemia may be consid• Central venous pressure (10 cm H2O)
ered but clear benefit has not been shown (IIb-C).2,6• Packed cell volume (> 25%)
• Arterial oxygen saturation (SpO2 94–98%; PaO2, 80–100
Real-Time CPR Feedback
mm Hg).
While widely used in human medicine but not in veterinary
However, routine large-volume IV fluid administration
medicine, real-time CPR feedback devices that improve CPR
is not recommended unless hypovolemia is strongly suseffectiveness may be useful in veterinary CPR (IIa-C).2
pected or documented (III-C).2,10
PCA Monitoring
While limited data is available regarding PCA monitor- Oxygen Supplementationing, the RECOVER authors recommend use of monitor- Oxygen supplementation should be titrated to produce
ing appropriate for a critically-ill patient.2,5 This monitor- normoxia (PaO2, 80–100 mmHg, or SpO2, 94%–98%), but
30

Today’s Veterinary Practice January/February 2014

| Cardiopulmonary Resuscitation: The RECOVER Guidelines

Early Goal Directed
Therapy

Most PCA care recommended by the RECOVER initiative
pertains to early goal-directed
therapy (EGDT).3,10 It has beenshown to improve outcomesin human patients, though veterinary data on the subject islacking.10,11
EGDT is directed at:•	Optimizing hemodynamics tomaximize perfusion to organs• Minimizing the likelihood ofmultiple-organ dysfunction
syndrome.

hyperoxia should be avoided (I-A).2,10
While routine, mechanical ventilationof all PCA patients is not recommended (III-B), mechanical ventilation ofhypoventilating CPA patients is reasonable (IIa-C).2,10
Referral to Specialty Center
Several human studies demonstrate
improved survival of patients treatedby highly-trained professionals withexperience in PCA care and in facilities with higher staff-to-patient ratios.10
Veterinary research on the subject
is lacking; however, research has indicated that patients were more likely
to survive when drugs, such as dopamine and vasopressin, were available
and more staff were involved in resuscitation efforts.10
For these reasons, it is reasonable
to refer a PCA patient to a facility with
(IIa-B):2,10• 24-hour care
• Higher staff-to-patient ratios• Advanced critical care capabilities.
Many facilities have critical caretransportation available. Contact yourlocal emergency/referral center for critical care transportation options.
Other Recommendations
The RECOVER guidelines outline several other recommendations for PCA
care, including:2,10• Therapeutic hypothermia• PCA hypertension• Corticosteroids• Seizure prophylaxis• Osmotic agents.
32

See Read the RECOVER Guidelines, page 25, to access more information on these recommendations.
In Summary
The RECOVER initiative created thefirst consensus guidelines on veterinary resuscitation, which provide an
in-depth look at the available evidence
on veterinary resuscitation.2 Readers
are encouraged to review these guidelines in their entirety as well as seek
standardized training in the area ofveterinary resuscitation. These consensus guidelines combined with standardized training allow veterinary
professionals to provide the best standard of care for CPA patients. n
FIGURE CREDITS
Figures 2 through 4 courtesy David Liss,
AS, BA, RVT, VTS (Emergency Critical Care & Small Animal Internal Medicine), CVPM
ALS = advanced life support;
BLS = basic life support; CPA =cardiopulmonary arrest; CPR =cardiopulmonary resuscitation; ECG= electrocardiography; EGDT =early goal-directed therapy; EtCO2= end-tidal carbon dioxide; ILCOR =International Liaison Committee on
Resuscitation; PCA = post cardiac
arrest; RECOVER = Reassessment
Campaign on Veterinary Resuscitation;
ROSC = return of spontaneous
circulation; VF = ventricular fibrillation;
VT = ventricular tachycardia
To view the references for this article,
go to todaysveterinarypractice.com/
resources.asp#resources.

Noah Jones,
RVT, is a veterinary technician inemergency andcritical care at Regional Emergency
Animal Care Hospital of Asheville, Asheville, North
Carolina. He has worked in private
emergency/referral practice as wellas in academia at the University ofCalifornia–Davis Veterinary Medical
Teaching Hospital.

Today’s Veterinary Practice January/February 2014

References
1. Boller M, Fletcher DJ. RECOVER evidence
and knowledge gap analysis on veterinary
CPR—Part 1: Evidence analysis andconsensus process: Collaborative path
toward small animal CPR guidelines. J Vet
Emerg Crit Care 2012; 22(S1):S4-S12.
2. Fletcher DJ, Boller M, Brainard BM, et al.
RECOVER evidence and knowledge gap
analysis on veterinary CPR—Part 7: Clinicalguidelines. J Vet Emerg Crit Care 2012;
22(S1):S102-S131.
3. McMichael MA, Herring J, Fletcher DJ, etal. RECOVER evidence and knowledge
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Preparedness and prevention. J Vet Emerg
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4. Hopper K, Epstein SE, Fletcher DJ, et al.
RECOVER evidence and knowledge gap
analysis on veterinary CPR—Part 3: Basiclife support. J Vet Emerg Crit Care 2012;
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5. Brainard BM, Fletcher DJ, Boler M, etal. RECOVER evidence and knowledge
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Monitoring. J Vet Emerg Crit Care 2012;
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6.	Rozanski EA, Rush JE, Buckley GJ, etal. RECOVER evidence and knowledge
gap analysis on veterinary CPR—Part 4:
Advanced life support. J Vet Emerg Crit Care,
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7. Buckley GJ, Rozanski EA, Rush JE.
Randomized, blinded comparison of
epinephrine and vasopressin for treatment of
naturally occurring cardiopulmonary arrest in
dogs. J Vet Intern Med 2011; 25(6):1334-1340.
8. Norkus CL. Cardiopulmonary cerebral
resuscitation. In CL Norkus (ed): VeterinaryTechnician’s Manual for Small Animal
Emergency and Critical Care. West Sussex,
UK: John Wiley & Sons, 2012, pp 83-97.
9. Barter LS. Capnography. In Burkitt JM, Davis
H (eds): Advanced Monitoring and Procedures
for Small Animal Emergency and Critical Care.
West Sussex, UK: John Wiley & Sons, 2012,
pp 340-348.
10. Smarick SD, Haskins SC, Boler M, et al.
(2012). RECOVER evidence and knowledge
gap analysis on veterinary CPR—Part 6: Postcardiac arrest care. J Vet Emerg Crit Care
2012; 22(S1):S85-S101.
11. Boller M. Post-resuscitation monitoring.
ACVECC Proc, 2011, pp 333-337.