Prevention & Preparedness and POCUS – Guidelines Consensus Input
What and When:
Welcome to the review and comment period for two sets of proposed RECOVER CPR Guidelines, scheduled to publish in the 4th quarter of 2026:
Prevention and Preparedness (update)
Point-of-Care Ultrasound use in CPR
The comment period will close on August 24, 2026, at 8 am PDT.
The Treatment Recommendation tables on this page contain the designator (e.g., PP-01 or POCUS-03), Population-Intervention-Comparator-Outcome (PICO) question with evaluated outcomes listed in order of descending priority, and the associated proposed Treatment Recommendation(s) for each question. The POCUS domain also has 5 best practice statements available for comment.
How to Comment: If you would like to comment on a proposed Treatment Recommendation or best practice statement, please click the link associated with that row, which will take you to the full Evidence Profile Worksheet for that PICO question, or to the best practice statement page. The Evidence Profile Worksheets include the consensus on science, treatment recommendation(s), and justification for each PICO, as well as Evidence Evaluator, Domain Chair, and Co-Chair notes about the evidence and a comprehensive list of sourced references. Final versions of the draft figures will appear in the Guidelines papers to accompany their associated topics. Comments with full names attached will be considered when finalizing the Treatment Recommendations. In order to comment, you must sign in with a Google account. If you don’t have a Google account, you can sign up for one for free here by clicking on “Create Account”. Please comment directly on the pdf by highlighting the section in question and clicking the “Comment” tool icon on the pdf so all stakeholders can view one another’s comments. When commenting, please include your full name at the start of the comment. Only comments with full names listed will be considered when finalizing the Treatment Recommendations. If we have questions about your feedback, we’ll contact you using your Google account.
How to Contact Us: You are welcome to email us at gu********@***************ve.org to provide your contact information, in case we have questions about your comments.
Prevention & Preparedness
| PICO # | PICO Question with Outcomes Listed from Most Critical to Important | Treatment Recommendation(s) | Link to consensus copy for comment |
| PP-01 | In learners taking CPR courses (P), does any other specific interval for update or retraining (I), compared with standard practice (24-month update or retraining) (C), result in improved outcomes (O)? 1. Survival to discharge 2. ROSC 3. Surrogate markers of perfusion 4. Skill performance in CPR simulations or actual resuscitation 5. Knowledge of the CPR algorithm | We recommend veterinary BLS and ALS refresher training more often than every 24 months (strong recommendation, very low quality of evidence). | PP-01 PDF for comment |
| We suggest short, hands-on BLS retraining with real-time feedback no less often than once a month for veterinary professionals that work in an environment with high probability of conducting CPR (weak recommendation, very low quality of evidence). | |||
| We suggest conducting hands-on ALS refresher training and knowledge assessment no less often than every 6 months (weak recommendation, expert opinion). | |||
| PP-02 | In rescuers who perform CPR (P), how does no debriefing (I) after a CPR attempt compare with debriefing (C) after a CPR attempt (O)? 1. Survival to discharge 2. ROSC 3. Surrogate markers of perfusion 4. Skill Performance in CPR simulations or actual resuscitation attempts 5. Knowledge of the CPR algorithm | We suggest debriefing following a CPR event (weak recommendation, very low quality of evidence). | PP-02 PDF for comment |
| PP-03 | In rescuers performing CPR in dogs and cats (P), does no use of cognitive aids (I), compared with the use of cognitive aids (checklists, algorithm charts, etc.) (C), result in improved outcomes (O)? 1. Survival to discharge 2. ROSC 3. Surrogate markers of perfusion 4. Skill performance in CPR simulations or actual resuscitation attempts 5. Knowledge of the CPR algorithm | We recommend that cognitive aids be available in clinical areas where cardiopulmonary arrest is more likely to occur (strong recommendation, low quality of evidence). | PP-03 PDF for comment |
| We recommend that cognitive aids be used during CPR (strong recommendation, low quality of evidence). | |||
| PP-04 | In dogs and cats undergoing CPR (P), how does use of an auditory metronome device to time chest compressions (I) compared to use of a non-auditory device (C ) affect … (O)? 1. Survival to discharge 2. ROSC 3. Surrogate markers of perfusion 4. Skill Performance in CPR simulations or actual resuscitation attempts [From Summary of Findings table: Chest compression quality (depth, rate)] 5. Knowledge of the CPR algorithm | We suggest the use of an auditory metronome device to guide chest compression rate during CPR (weak recommendation, high quality of evidence). | PP-04 PDF for comment |
| We suggest the use of an auditory metronome device to guide ventilation rates during CPR (weak recommendation, expert opinion). | |||
| PP-05 | In rescuers managing dogs and cats at risk of CPA (P) does use of Just-in-Time Training (JITT) measures (I) (e.g., pre-brief) compared to no JITT (C) improve patient outcome (O)? 1. Survival to discharge 2. ROSC 3. Surrogate markers of perfusion 4. Skill performance in CPR simulations or actual resuscitation attempts 5. Knowledge of the CPR algorithm | We suggest just-in-time training for rescuers managing dogs and cats at risk of CPA (weak recommendation, very low quality of evidence). | PP-05 PDF for comment |
| We suggest just-in-time training for rescuers managing dogs and cats at risk of CPA consist of a review of CPR guideline recommendations as well as hands-on practice with feedback (weak recommendation, expert opinion). | |||
| We suggest preparing a just-in-time training plan as part of institutional CPR training strategies (weak recommendation, expert opinion). | |||
| PP-06 | In learners taking in-person CPR courses (P) how does inclusion of specific pre-course preparation (e.g., e-learning, pretesting) (I) compare with no such preparation (C), … (O)? 1. Survival to discharge 2. ROSC 3. Surrogate markers of perfusion 4. Skill performance in CPR simulations or actual resuscitation attempts 5. Knowledge of the CPR algorithm | We suggest incorporating low-burden pre-course preparatory materials for learners taking in-person CPR courses (weak recommendation, very low quality of evidence). | PP-06 PDF for comment |
| PP-07 | In learners taking CPR courses (P) how does video or computer led self-instruction courses (I) compare with instructor led (C) courses (O)? 1. Survival to discharge 2. ROSC 3. Skill performance in CPR simulations or actual resuscitation attempts 4. Knowledge of the CPR algorithm | We suggest that self-directed video- or computer-based BLS instruction that includes skills demonstration accompanied by deliberate hands-on manikin practice and a skills assessment may be used as an alternative to instructor-led training (weak recommendation, very low quality of evidence). | PP-07 PDF for comment |
| We suggest against replacing instructor-led training with self-directed video- or computer-based BLS instruction if a manikin for deliberate hands-on practice is not available (weak recommendation, very low quality of evidence). | |||
| We suggest that ALS instruction include in-person, instructor-led training (weak recommendation, very low quality of evidence). | |||
| PP-08 | In dogs and cats at high risk of OHCA (P), does bystander CPR training (e.g., family, caregivers, or first responders) (I), compared with rapid transport to a veterinary hospital with no such bystander training (C), result in improved outcomes (O)? 1. Survival to discharge 2. ROSC | We recommend that owners, caregivers, and handlers of dogs and cats at high risk of CPA undergo species-specific CPR training.(strong recommendation, very low quality of evidence) | PP-08 PDF for comment |
| PP-09 | In rescuers who perform CPR (P), does no pre-stocked arrest station / crash cart (I), compared with the presence of a pre-stocked arrest station / crash cart (C), result in improved outcomes (O)? 1. Survival to discharge 2. ROSC 3. Skill performance in CPR simulations or actual resuscitation attempts 4. Knowledge of the CPR algorithm | We recommend providing a clearly organized arrest station or code cart that is pre-stocked with all supplies required to perform CPR in accordance with current RECOVER CPR guidelines (strong recommendation, low quality of evidence). | PP-09 PDF for comment |
| We recommend that arrest station(s) be located in any area where CPR is most likely to be performed (strong recommendation, expert opinion). | |||
| We recommend that all arrest stations used by a common resuscitation team be organized in the same, standardized layout (strong recommendation, very low quality of evidence). | |||
| We recommend initial orientation to the location, contents, and layout of the crash cart for all team members that may perform CPR (strong recommendation, expert opinion). | |||
| PP-10 | In learners taking ALS courses (P), does training with high fidelity simulators (e.g., with pulses, chest movement, heart and lung sounds) (I), compared with low-fidelity simulators (e.g., static mannequins with no physiologic feedback) (C) result in improved outcomes? 1. Survival to discharge 2. ROSC 3. Surrogate markers of perfusion 4. Skill performance in CPR simulations or actual resuscitation attempts 5. Chest compression quality and depth | We suggest that high-fidelity simulations be included in ALS training if the resources, infrastructure, and expertise to operate them are available (weak recommendation, very low quality of evidence). | PP-10 PDF for comment |
| If high-fidelity manikins are unavailable, we suggest that low-fidelity manikins can be used for ALS training (weak recommendation, very low quality of evidence). | |||
| PP-11 | In veterinary CPR teams (P), does a CPR team leader with more CPR training / experience (I), compared to a CPR team leader with more authority in the organization (C), result in improved (O)? 1. Survival to Discharge 2. ROSC 3. Surrogate markers of perfusion 4. Skill Performance in CPR simulations or actual resuscitation attempts | In veterinary CPR teams, we suggest against using team members’ levels of organizational authority (e.g., doctor vs non-doctor) to determine the team leader.(weak recommendation, very low quality of evidence) | PP-11 PDF for comment |
| In veterinary CPR teams, we suggest using team members’ training (in CPR, in leadership skills) and experience level (in CPR) to determine the team leader.(weak recommendation, very low quality of evidence) | |||
| PP-12 | In veterinary CPR teams (P), does standardized team training (I), compared with no team training (C), result in improved outcomes (O)? 1. Survival to discharge 2. ROSC 3. Surrogate markers of perfusion 4. Skill performance in CPR simulations or actual resuscitation attempts 5. Knowledge of the CPR algorithm | For veterinary teams, we recommend standardized CPR team training (strong recommendation, low quality of evidence). | PP-12 PDF for comment |
| PP-13 | In veterinary CPR attempts (BLS and ALS) (P), does a team size of 4 (I), compared with other team sizes (C), improve (O)? 1. Survival to discharge 2. ROSC 3. Surrogate markers of perfusion | We recommend that teams involved in CPR efforts for dogs and cats consist of a minimum of 4 rescuers (strong recommendation, very low quality of evidence). | PP-13 PDF for comment |
| We suggest that teams involved in routine, closed-chest CPR efforts for dogs and cats consist of no more than 8 rescuers (weak recommendation, very low quality of evidence). | |||
| PP-14 | In hospitals treating dogs and cats in CPA, does the presence of a hospital-wide CPR alert system (I) compared to no alert mechanism (C) improve patient outcome (O)? 1. Survival to discharge 2. ROSC 3. Surrogate markers of perfusion | In hospitals treating dogs and cats in CPA, we suggest the presence of a hospital-wide CPR alert system (weak recommendation, expert opinion). | PP-14 PDF for comment |
| In hospitals treating dogs and cats in CPA, we suggest a pre-organized, trained rapid response team to be alerted to perform CPR (weak recommendation, expert opinion). | |||
| PP-15 | [THERE IS NO P-15] | N/A | N/A |
| PP-16 | In cats and dogs in cardiac arrest (P) does any other communication strategy or tool (I) compared with closed-loop communication (C) improve (O)? 1. Survival to discharge 2. ROSC 3. Surrogate markers of perfusion 4. Skill performance in CPR simulations or actual resuscitation attempts | In veterinary CPR teams, we suggest using a standardized communication technique such as closed-loop communication (weak recommendation, very low quality of evidence). | PP-16 PDF for comment |
| PP-17 | In learners taking CPR courses (P), does hands on training in real-time with or without didactic training (I) compared to didactic training alone (C) result in improved outcomes (O)? 1. ROSC 2. Survival to discharge 3. Surrogate markers of perfusion 4. Skill performance 5. Knowledge of CPR algorithm | We recommend that CPR training programs include a hands-on practice component in addition to didactic instruction whenever feasible (strong recommendation, very low quality of evidence). | PP-17 PDF for comment |
POCUS
| PICO # | PICO Question with Outcomes Listed from Most Critical to Important | Treatment Recommendation(s) | Link to consensus copy for comment |
| POCUS-01 | In dogs and cats undergoing CPR (P), how does ultrasound of the cervical region (I) compared to waveform capnography (C) to confirm ET intubation affect (O)? 1. Accuracy in confirming ET intubation 2. Time to confirm correct ET intubation
| In dogs and cats undergoing CPR, we recommend against using cervical ultrasound as the sole method to confirm correct endotracheal intubation. (strong recommendation, very low quality of evidence) | POCUS-01 PDF for comment |
| POCUS-02 | In dogs and cats undergoing CPR (P), how does cardiac point-of-care ultrasound during the planned inter-cycle pause (I/E) compare with measurement of ETCO2 during chest compressions (C ) to predict (O)? 1. Favorable neurologic outcome 2. Survival to discharge 3. ROSC | In dogs and cats undergoing CPR, we suggest performing C-POCUS in the 10-second inter-cycle pause to assess for the presence or absence of cardiac motion, provided it does not interrupt high-quality CPR (weak recommendation, very low quality of evidence).
[identical recommendation associated with POCUS-04] |
|
| In dogs and cats undergoing CPR, we recommend against replacing ETCO2 measurement with C-POCUS to guide resuscitation efforts or to predict outcome (strong recommendation, very low quality of evidence). | |||
| In dogs and cats undergoing CPR, we recommend against using the finding of cardiac standstill on C-POCUS at a single timepoint to guide the decision to continue vs terminate CPR (strong recommendation, very low quality of evidence). | |||
| POCUS-03 | In dogs and cats undergoing CPR, during the planned inter-cycle pause (P), does subxiphoid cardiac POCUS (I) compared to transthoracic cardiac POCUS (C) affect time to obtain image of the left ventricle (O) or quality of the image of the left ventricle (O)? 1. Survival to discharge 2. ROSC 3. Time to obtain image of the left ventricle 4. Quality of left ventricular image | In dogs and cats undergoing CPR, when C-POCUS is used during the planned inter-cycle pause, we suggest that either the subxiphoid or transthoracic cardiac window may be used (weak recommendation, very low quality of evidence). |
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| In dogs and cats undergoing CPR, when C-POCUS is performed in the planned inter-cycle pause, we suggest pre-placement of the ultrasound probe during chest compressions to facilitate rapid image acquisition (weak recommendation, very low quality of evidence). | |||
| For rescuers planning to use C-POCUS in dogs and cats during CPR, we suggest CPR-specific C-POCUS training (weak recommendation, expert opinion). | |||
| POCUS-04 | In dogs and cats undergoing CPR, during the planned pause between chest compression cycles (P) how does supplementing ECG with cardiac POCUS (I) compared with ECG evaluation alone (C) affect (O)? 1. Survival to discharge 2. ROSC 3. Time to rhythm diagnosis 4. Accuracy of rhythm diagnosis | In dogs and cats undergoing CPR, we suggest performing C-POCUS in the 10-second inter-cycle pause to assess for the presence or absence of cardiac motion, provided it does not interrupt high-quality CPR (weak recommendation, very low quality of evidence).
[identical recommendation associated with POCUS-02] | POCUS-04 PDF for comment |
| In dogs and cats that undergo C-POCUS during the planned inter-cycle pause of CPR, we suggest against basing a defibrillation decision on ultrasonographic findings (weak recommendation, expert opinion). | |||
| POCUS-05 | In dogs and cats with pericardial effusion that are undergoing closed-chest CPR (P) how does cardiac POCUS (E), compared to no cardiac POCUS (C), affect (O)? 1. Favorable neurologic outcome 2. Survival to discharge 3. ROSC 4. Surrogate markers of perfusion 5. Time to open-chest CPR | In dogs and cats undergoing closed-chest CPR that are suspected to have pericardial effusion, we suggest performing cardiac POCUS as long as doing so does not impede delivery of high-quality CPR (weak recommendation, very low quality of evidence). | POCUS-05 PDF for comment |
| POCUS-06 | In dogs and cats with a reversible pleural space disease undergoing closed-chest CPR (P), how does pleural space and lung ultrasound (I) compared to no ultrasound (C) affect (O)? 1. Favorable neurologic outcome 2. Survival to discharge 3. ROSC 4. Surrogate markers of perfusion 5. Oxygenation 6. Time to open-chest CPR | In dogs and cats undergoing closed-chest CPR in which clinically relevant pleural space disease (pneumothorax, pleural effusion) is suspected, we suggest pleural space and lung ultrasound, provided doing so does not impede delivery of high-quality CPR (weak recommendation, very low quality of evidence). | POCUS-06 PDF for comment |
| POCUS-07 | In dogs and cats with hypovolemia that are undergoing CPR (P) does cardiac POCUS to assess volume status (E) compared to no cardiac POCUS (C ) affect (O)? 1. Favorable neurologic outcome 2. Survival to discharge 3. ROSC 4. Diagnosis of hypovolemia
| In dogs and cats with hypovolemia undergoing CPR, we suggest against use of cardiac point-of-care ultrasound to assess intravascular volume status (weak recommendation, very low quality of evidence).
| POCUS-07 PDF for comment |
| POCUS Best Practice Statements | |||
| POCUS-BPS-A | In dogs and cats undergoing CPR, we recommend against interrupting a 2-minute cycle of chest compressions to perform POCUS. | POCUS-Best-Practice-Statements | |
| POCUS-BPS-B | In dogs and cats undergoing CPR, we recommend against prolonging the planned, ≤10-second, inter-cycle pause for the purpose of performing POCUS. | POCUS-Best-Practice-Statements | |
| POCUS-BPS-C | In dogs and cats undergoing CPR in which POCUS is performed, we recommend against POCUS-related activity that interferes with delivery of high-quality CPR. | POCUS-Best-Practice-Statements | |
| POCUS-BPS-D | In dogs and cats undergoing CPR in which C-POCUS is performed in the planned, ≤10-second, inter-cycle pause, we recommend resuming chest compressions as soon as minimally diagnostic images are acquired. | POCUS-Best-Practice-Statements | |
| POCUS-BPS-E | In dogs and cats undergoing CPR in which C-POCUS is performed in the planned, ≤10-second, inter-cycle pause, we recommend recording cine loops or still images for interpretation during the next compression cycle. | POCUS-Best-Practice-Statements | |
| POCUS | Main POCUS Algorithm | POCUS – Main Algorithm PDF for comment | |
| POCUS | POCUS ETT Check Algorithm | POCUS – ETT Check Algorithm PDF for comment | |
