RECOVER Guidelines: Everything you need to know about evidence-based CPR

Author(s)Kelsey Gustafson, Associate Editor

Discover the nuts and bolts of these comprehensive guidelines established nearly a decade ago to offer a wide array of optimized protocols and evidence-based treatment methods for CPR in animal patients.

Although there are notable physiologic and anatomic variances between human and veterinary patients, possessing a clear and refined veterinary cardiopulmonary resuscitation (CPR) treatment strategy can help promote a successful outcome. Since June of 2012, the Reassessment Campaign on Veterinary Resuscitation (RECOVER) has published the first evidence-based guidelines for CPR after considering the difference in survival rates of CPR between human (20%) and veterinary (6-7%) settings—having formulated evidence-based guidelines through the American Heart Association (AHA).¹

During his lecture at the 2021 New York Vet Show in New York, New York, Kenichiro Yagi, MS, RVT, VTS (ECC, SAIM), chief veterinary nursing officer at Veterinary Emergency Group headquartered in Valhalla, New York, delved into the benefits of these comprehensive guidelines, spotlighting the importance of implementing adequate staff training modules within CPR and the changes it has instilled within the veterinary sector.

What are the 5 different domains of CPR questions?

According to Yagi, the 5 different “domains” of clinical questions asked include:

Preparedness and prevention

Basic life support

Advanced life support

Monitoring

Post-cardiac arrest care

He noted that these questions were “answered to disprove existing beliefs, provide new knowledge, and allow us to identify gaps in the knowledge available to come to definitive answers,” adding that the guidelines illustrate the necessity of early initiation of CPR as a key component to ensuring a successful outcome.

Training recommendations for evidence-based CPR

Yagi shared with attendees that in-depth training of the team in both didactic (knowledge) and psychomotor (physical) aspects of CPR can help promote prompt intervention with patients undergoing cardiac arrest. CPR drills that simulate the arrest and response enable team members to better understand the sequence of events and complications that may arise. Refresher training sessions every 6 months are recommended, as this can maximize efficiency and help keep everyone updated on these vital techniques and protocols. “Preparation of the facility through the setup of a crash cart in a central location, which is regularly checked for stock with a detailed checklist, will allow for easy access to supplies and equipment required for CPR,” explained Yagi, advising that the emergency area be filled with cognitive aids comprised of the CPR algorithm, drug dosage charts, and a CPR priority checklist.

For patients suspected of cardiopulmonary arrest (CPA), Yagi elucidated the importance of professionals quickly recognizing this ailment and performing CPR as soon as possible. The patient should also undergo the airway, breathing, and circulation (ABC) assessment for CPR, said Yagi, adding that this should be performed in no more than 10-15 seconds through a standardized approach. Any delay to a patient with hallmark signs of CPA can drastically reduce the chances of success, so it is imperative that if suspected, chest compressions be immediately initiated.

How is the RECOVER advancing the profession?

The RECOVER CPR Certification has instilled a new standard within veterinary medicine, providing a comprehensive and refined guideline of CPR protocols. Since the guidelines were published, evidence-based veterinary medicine (EBVM) has garnered significant traction, demonstrating the weight this initiative adds to the relevance and vitality of EBVM. Additionally, Yagi mentioned that through accreditation by the American College of Veterinary Emergency and Critical Care, the RECOVER initiative has begun issuing BLS and ALS Rescuer (Individuals who perform CPR) and Instructor (Individuals who teach CPR) certifications to elevate the standardizing of veterinary CPR approaches within EBVM.²

At the end of the day, the RECOVER initiative harbors 3 main goals: formulating evidence-based guidelines for CPR, offering education for veterinary CPR, and conducting research to fill knowledge roadblocks on the subject. “Advancement in the field of veterinary emergency and critical care has been accelerated by due to the RECOVER initiative,” concluded Yagi.

References

Hoehne SN, Hopper K, Epstein SE. Prospective evaluation of cardiopulmonary resuscitation performed in dogs and cats according to the RECOVER guidelines. Part 2: Patient outcomes and CPR practice since guideline implementation. Front Vet Sci. 2019;6:439.
RECOVER initiative – advancing the science of veterinary resuscitation. Recoverinitiative.org. Accessed November 4, 2021. https://recoverinitiative.org