RECOVER 2.0 Guideline Drafts
Listed below are the drafts of the new RECOVER 2.0 CPR guidelines and the draft of the new BLS and ALS algorithm. The drafts will be open for public comment until August 14, 2023.
Click on the plus sign to the left of the domain name to see the individual PICO questions, the treatment recommendations, and a link to view a copy of the Evidence Evaluation Worksheet, on which you can enter comments and feedback. The Evidence Evaluation Worksheet contains a thorough consensus on science and justification for the treatment recommendation(s) as well as a list of knowledge gaps. You will need to enter a valid email address to add comments to the documents so that we can reach out if we have questions about your feedback.
Please be aware that this consensus process seeks to finalize a set of clinical guidelines that stakeholders can “live with.” As you contemplate commenting on a guideline, please be aware that our goal is to achieve broad consensus, and that these draft guidelines were the result of an extensive literature review process using the GRADE approach, during which 2 independent evidence evaluators read all of the relevant literature our information specialists could identify. The Domain Chairs and RECOVER Co-Chairs then debated the treatment recommendations until consensus was reached. If you feel changes are warranted, please provide a thorough justification for your proposed change and include complete references to any literature you used to reach your conclusion so that the committee can fully consider your suggestion.
If you have questions or problems, or if you find any errors on this page or the linked documents (there are many questions!), please send an email to recoverguidelines@gmail.com. Thanks for participating in this process!
| PICO ID | PICO Question | Treatment Recommendations | Link to Comment |
|---|---|---|---|
| BLS‑01 | In cats and dogs in CPA (P), does incomplete chest wall recoil (I) compared to allowing complete chest wall recoil (via 50:50 duty cycle, decreasing fatigue and leaning) (C), improve outcome? | We recommend allowing full chest wall recoil between chest compressions in dogs and cats undergoing CPR (strong recommendation, moderate quality of evidence). We recommend targeting a duty cycle of 50:50 for compression : non-compression during CPR in dogs and cats (strong recommendation, moderate quality of evidence). | Comment |
| BLS‑02 | In medium- and large-sized, round-chested dogs in CPA (P), does placing hands over the heart for chest compressions (I), compared to placing hands over the widest point of the thorax for chest compressions (C), improve outcome? | We suggest performing chest compressions with hand placement over the widest part of the thorax in medium- to large-sized, round-chested dogs (weak recommendation, very low quality of evidence). | Comment |
| BLS‑03 | In medium- and large-sized, keel-chested dogs in CPA (P), does placing hands over the widest point of the thorax (I), compared to placing hands over the heart for chest compressions (C), improve outcome? | We recommend performing chest compressions with hand placement over the heart in medium- to large-sized, keel-chested dogs (strong recommendation, very low quality of evidence). | Comment |
| BLS‑04 | In non-wide-chested dogs and in cats in CPA (P), does performing chest compressions with the animal in dorsal recumbency (I) compared to lateral recumbency (C), improve outcome? | We recommend performing chest compressions in lateral recumbency in non-wide-chested dogs (strong recommendation, very low quality of evidence). | Comment |
| BLS‑05 | In wide-chested dogs in CPA (P), does performing chest compressions with the dog in lateral recumbency (I) compared to dorsal recumbency (C), improve outcome? | In wide chested dogs that are positionally stable in dorsal recumbency, we suggest performing chest compressions in dorsal recumbency during CPR. (weak recommendation, expert opinion) In wide chested dogs that are not positionally stable in dorsal recumbency (e.g., whose bodies lie naturally in lateral recumbency), we suggest performing chest compressions in lateral recumbency during CPR. (weak recommendation, expert opinion) | Comment |
| BLS‑06 | In cats and dogs in CPA (P), does active compression-decompression (I) compared to active compression / passive decompression chest compressions (C), improve outcome? | We recommend against the use of active compression-decompression CPR in dogs and cats (strong recommendation, expert opinion). | Comment |
| BLS‑07 | In cats or dogs in CPA (P), does the use of any other specific rate for external chest compressions (I) compared to external chest compression rate of 100-120 / minute (C), improve | We recommend using a chest compression rate of 100-120 compressions per minute during CPR in dogs and cats. (strong recommendation, very low quality of evidence). | Comment |
| BLS‑08 | In cats and dogs in CPA (P), does the use of any other specific timing for interruptions to chest compressions to diagnose the heart rhythm (I), compared to ECG check every 2 minutes (C), improve outcome? | In intubated dogs and cats undergoing CPR, we recommend delivering CPR in 2-minute cycles of continuous high-quality chest compressions. (strong recommendation, expert opinion) | Comment |
| BLS‑09 | In non-intubated cats and dogs in CPA or during single-rescuer CPR in cats and dogs (P), does the use of another specific compression:ventilation (C:V) ratio (I), compared with a C:V ratio of 30:2 (C), improve outcome? | We recommend a compression : ventilation ratio of 30 chest compressions : 2 breaths (30:2) in non-intubated dogs and cats undergoing CPR (strong recommendation, very low quality of evidence). | Comment |
| BLS‑10 | In non-intubated cats and dogs in CPA or during single-rescuer CPR in cats and dogs (P), does chest compression only CPR (I) when compared to conventional CPR (C) improve outcome? | In non-intubated dogs and cats undergoing CPR or during single-rescuer CPR, we recommend provision of rescue breaths (strong recommendation, very low quality of evidence). In non-intubated dogs and cats undergoing CPR or during single-rescuer CPR including rescue breaths, we recommend provision of these rescue breaths via the mouth-to-nose (mouth-to-snout) technique (strong recommendation, expert opinion). | Comment |
| BLS‑11 | In non-intubated cats and dogs in CPA (P), does the use of ventilation first (ABC) CPR (I) compared with compressions first (CAB) CPR (C), improve outcome? | For multi-rescuer CPR in dogs and cats, we recommend that chest compressions be initiated without delay to assess airway and gain airway access.(strong recommendation, very low quality of evidence) For multi-rescuer CPR in dogs and cats, we recommend that the airway be evaluated and the animal endotracheally intubated as soon as possible after initiation of chest compressions .(strong recommendation, expert opinion) For single-rescuer CPR in dogs and cats, prior to initiation of chest compressions, we recommend that an airway evaluation be performed during the initial patient assessment (shake & shout) prior to initiation of chest compressions.(strong recommendation, expert opinion) | Comment |
| BLS‑12 | In cats and small dogs in CPA (P), do 2-handed circumferential ("2-thumb technique") chest compressions (I), compared to lateral chest compressions (C), improve outcome? | We recommend that chest compressions in cats and small dogs be performed using 1 of the following 3 methods, based on a combination of compressor preference and real-time markers of perfusion (e.g., EtCO2, direct blood pressure monitoring): a) using a circumferential 2-thumb chest compression technique with the animal in lateral recumbency and both of the thumbs directly over the heart.(strong recommendation, very low quality of evidence) b) using a 1-handed technique with the dominant hand wrapped around the sternum at the level of the heart performing compressions between the flat portion of the fingers and the flat portion of the thumb.(strong recommendation, expert opinion) c) using a 1-handed technique with heel of the dominant hand compressing 1/3 to 1/2 the chest width over the area of the heart with the animal in lateral recumbency while the non-dominant hand supports the dorsal thorax.(strong recommendation, expert opinion) | Comment |
| BLS‑13 | In cats and dogs in CPA (P), does providing ventilation with other inspiratory times and tidal volumes (I), compared with with a 1-second inspiratory time and tidal volume of about 10 mL/kg (C), improve outcome? | We recommend administering positive pressure ventilation at a tidal volume of 10 mL/kg and a 1-second inspiratory time during CPR in intubated dogs and cats.(strong recommendation, very low quality of evidence) | Comment |
| BLS‑14 | In cats and dogs in CPA (P), does any other ventilation rate (I), as opposed to a ventilation rate of 10 breaths per minute (C), improve | In intubated dogs and cats undergoing CPR, we recommend a respiratory rate of 10 breaths per minute.(very low quality of evidence, expert opinion) | Comment |
| BLS‑15 | In cats and dogs in CPA (P), does performing chest compression cycles for an extended period of time (e.g. 5 minutes) (I), compared to 2 minute cycles (C), improve outcomes? | We recommend the cycles of chest compressions delivered by an individual rescuer not extend beyond 2 minutes in intubated dogs and cats undergoing CPR.(strong recommendation, low quality of evidence) We recommend that if a rescuer perceives they are becoming fatigued, or if other rescuers perceive inadequate chest compression quality, it is reasonable to change compressors during a cycle while minimizing interruption in chest compressions (< 1 second).(strong recommendation, expert opinion) | Comment |
| BLS‑16 | In cats and dogs in CPA (P), does taking a longer pause (e.g., 30 seconds) (I), compared to minimizing pauses between compression cycles (e.g., < 10 seconds) (C), improve outcome? | We recommend minimizing pauses between compression cycles (< 10 seconds) in dogs and cats during CPR.(strong recommendation, low quality of evidence) | Comment |
| BLS‑17 | In cats and dogs in CPA (P), does interrupting a 2-minute cycle of chest compressions if ROSC is suspected (I), compared to not interrupting the 2-minute cycle (C), improve outcome? | We suggest interrupting a 2-minute CC cycle only when ROSC is suspected based on a combination of 1) a sudden and persistent increase in ETCO2 of great magnitude (e.g., by ≥ 10 mmHg to reach a value that is ≥ 35 mmHg) and 2) evidence of an arterial pulse distinct from chest compressions.(weak recommendation, expert opinion) In the absence of capnography data, we recommend against interruption of a 2-minute CC cycle even if ROSC is suspected.(strong recommendation, expert opinion) | Comment |
| BLS‑18 | In cats and dogs in CPA (P), does any other specific compression depth (I) as opposed to 1/3 - 1/2 the width of the thorax (C), improve outcome? | In dogs and cats that are positioned in lateral recumbency, we recommend providing chest compressions to a depth of one-third to one-half of the lateral diameter of the chest at the compression point.(strong recommendation, very low quality of evidence) In dogs and cats that are positioned in dorsal recumbency, we recommend providing chest compressions to a depth of one-quarter the anterior-posterior diameter of the chest at the compression point.(strong recommendation, very low quality of evidence) | Comment |
| BLS‑19 | In cats and dogs in CPA (P), does the use of any other specific peak inspiratory pressure (PIP) (I), compared to 40 cm H2O PIP (C), improve outcome? | We recommend that a peak inspiratory pressure be applied that creates visible but not excessive chest rise.(strong recommendation, expert opinion) We recommend against use of a peak inspiratory pressure that exceeds 40 cmH2O when providing manual ventilation.(strong recommendation, expert opinion) We recommend against use of a peak inspiratory pressure that exceeds 60 cmH2O when the patient is undergoing mechanical ventilation during CPR.(strong recommendation, expert opinion) | Comment |
| BLS‑20 | In cats and dogs in CPA already on a mechanical ventilator (P), does continuing mechanical ventilation (I) compared to switching to manual ventilation (C) improve outcome? | In dogs and cats that experience CPA while undergoing mechanical ventilation, we suggest switching to manual ventilation.(weak recommendation, expert opinion) If delivering breaths by mechanical ventilator during CPR in dogs and cats, ventilator settings should be adjusted to assure breaths are delivered (e.g., volume control mode; TV 10 mL/kg; RR 10 / minute; PEEP 0 cmH2O; pressure limit 60 cmH2O; and a trigger sensitivity least likely to detect a breath [e.g., -10 cmH20]).(strong recommendation, very low quality of evidence) | Comment |
| PICO ID | PICO Question | Treatment Recommendations | Link to Comment |
|---|---|---|---|
| ALS‑02 | In cats and dogs with a shockable rhythm that are being defibrillated (P), does the use of lidocaine (I) compared to not using lidocaine (C) result in improved outcome? | We suggest that intravenous lidocaine be administered to dogs (2 mg/kg) with refractory pulseless ventricular tachycardia or ventricular fibrillation after the initial shock has been unsuccessful (weak recommendation, moderate quality of evidence). We suggest that intravenous lidocaine not be administered in cats with refractory pulseless ventricular tachycardia or ventricular fibrillation after the initial shock has been unsuccessful (weak recommendation, moderate quality of evidence). | Comment |
| ALS‑02 | In cats and dogs with a shockable rhythm that are being defibrillated (P), does the use of amiodarone (I) compared to not using amiodarone (C) improve outcome? | If lidocaine is unavailable, we suggest that amiodarone may be administered intravenously (5 mg/kg) during CPR for PVT or VF refractory to the first shock in dogs (weak recommendation, very low quality of evidence). We suggest that amiodarone may be administered intravenously (5 mg/kg) during CPR for PVT or VF refractory to the first shock in cats (weak recommendation, very low quality of evidence). We recommend against the use of amiodarone formulations containing polysorbate-80 in dogs due to the adverse hemodynamic side effects of these formulations that have been documented (strong recommendation, moderate quality of evidence). | Comment |
| ALS‑03 | In cats and dogs with a shockable rhythm (P), does the use of beta blockers (I) compared to not using beta blockers (C) improve outcome? | We suggest using 1-blocker therapy in dogs and cats with shockable rhythms that do not convert after the first defibrillation (weak recommendation, very low quality of evidence). | Comment |
| ALS‑04 | In cats and dogs in CPA (P), does glucocorticoid use during CPR (I) versus not using glucocorticoids (C) improve outcome (O)? | We suggest against the routine administration of glucocorticoids during CPR (weak recommendation, very low quality of evidence). In dogs and cats with vasopressor resistant hypotension at the time of CPA or with known or suspected hypoadrenocorticism, we suggest intravenous administration of glucocorticoids during CPR (weak recommendation, expert opinion). | Comment |
| ALS‑05 | In dogs with CPA (P) does closed-chest CPR (I) compared to open chest CPR (C) improve outcome (O)? | We recommend open-chest CPR (OCCPR) in dogs and cats with abdominal organs or substantial accumulations of fluid or air in the pleural or pericardial spaces (strong recommendation, expert opinion). We recommend direct cardiac massage in dogs and cats undergoing abdominal or thoracic surgery (strong recommendation, low quality of evidence). We suggest OCCPR in dogs and cats with penetrating thoracic trauma or rib fractures at or near the chest compression point (weak recommendation, very low quality of evidence). In medium and large-breed round-chested and wide-chested dogs in which OCCPR is feasible and clients are amenable to the procedure, we recommend that CCCPR be started immediately and OCCPR be started as soon as possible (strong recommendation, low quality of evidence) We suggest not attempting OCCPR in cats and small dogs (< 15kg) that do not have pleural or pericardial disease, penetrating thoracic trauma or are not undergoing abdominal or thoracic surgery (weak recommendation, expert opinion) We recommend discussing the pros and cons of OCCPR in any dog at risk of CPA and obtaining a “CPR code” at the time of hospitalization if OCCPR is offered by the practice and is indicated. (strong recommendation, expert opinion) | Comment |
| ALS‑06 | In cats and dogs with CPA and non-shockable arrest rhythms (P) does administration of no epinephrine (I) compared to administration of epinephrine (C) improve outcome (O)? | We recommend the use of epinephrine for non-shockable rhythms during CPR in dogs and cats (strong recommendation, low quality of evidence).Comment | Comment |
| ALS‑07 | In cats and dogs with CPA (P) does administration of epinephrine at any other time interval (I) compared to administration of epinephrine every 3-5 minutes (C) improve outcome (O)? | We suggest against changing the standard epinephrine dosing interval from every 3 – 5 minutes to any other dosing interval (weak recommendation, very low quality of evidence) | Comment |
| ALS‑08 | In cats and dogs with CPA (P) does the use of high dose epinephrine (0.1mg/kg IV) (I) compared to standard dose epinephrine (0.01mg/kg IV) (C) improve outcome (O)? | We recommend against the routine use of high-dose epinephrine during CPR in dogs and cats (strong recommendation, low quality of evidence). | Comment |
| ALS‑09 | In cats and dogs with CPA associated with high vagal tone (P) does not using atropine (I) compared with using atropine (C) improve outcome (O)? | We suggest that atropine (0.04 mg/kg IV) may be administered once during CPR for dogs and cats with non-shockable arrest rhythms (weak recommendation, low quality of evidence). We recommend that if atropine is used, it is given as early as possible in the CPR effort (strong recommendation, very low quality of evidence). We recommend against administering repeated doses of atropine during CPR for dogs and cats with non-shockable arrest rhythms (strong recommendation, very low quality of evidence). We recommend the use of atropine (0.04 mg/kg IV) in dogs and cats with bradycardia causing hemodynamic compromise to attempt to prevent progression to CPA (strong recommendation, expert opinion). | Comment |
| ALS‑10 | In euvolemic cats and dogs with CPA (P) does the use of an intravenous fluid bolus (I) compared to not using an intravenous fluid bolus (C) improve outcome (O)? | We recommend against the use of intravenous fluid boluses in euvolemic dogs and cats during CPR (strong recommendation, very low quality of evidence). We recommend the use of intravenous fluid boluses in dogs (20 ml/kg isotonic crystalloid or equivalent) and cats (10-15 ml.kg isotonic crystalloid or equivalent) with known or suspected hypovolemia during CPR (strong recommendation, expert opinion). | Comment |
| ALS‑11 | In cats and dogs with CPA due to a shockable rhythm (P) does the use of a monophasic defibrillator (I) compared to a biphasic defibrillator (C) improve outcome (O)? | We recommend using a biphasic defibrillator over a monophasic defibrillator in dogs and cats with shockable rhythms (strong recommendation, very low quality of evidence). | Comment |
| ALS‑12 | In cats and dogs with CPA due to a shockable rhythm (P) does the use of standard dose fixed energy shocks (I) compared with escalating energy shocks (C) improve outcome (O)? | We recommend that for dogs and cats with shockable arrest rhythms, if an initial standard dose (2 J/kg) electrical defibrillation is unsuccessful the second and subsequent shocks be delivered at a dose of 2x the initial dose (4 J/kg). (strong recommendation, low quality of evidence). | Comment |
| ALS‑13 | In cats and dogs with CPA after recently administered opioid drugs (P) does not administering naloxone (I) compared to naloxone administration (C) improve outcome (O)? | In cats and dogs with CPA after recently administered opioid drugs, we recommend that once BLS and other high priority ALS interventions have been initiated, naloxone should be administered (0.04 mg/kg IV). (strong recommendation, very low quality of evidence) We recommend immediate administration of naloxone (0.04 mg/kg IV) in dogs and cats not in CPA that are bradycardic and/or unresponsive after administration of an opioid. (strong recommendation, very low quality of evidence) | Comment |
| ALS‑14 | In cats and dogs with CPA (P) does intraosseous administration of drugs (I) compared with intravenous drug administration (C) improve outcome (O)? | We recommend that CPR drugs be administered preferentially via an IV catheter rather than via an IO catheter (strong recommendation, very low quality of evidence). If attempts at IV access are not successful within 2 minutes, we suggest that rescuers pursue IO catheter placement and to concurrently attempt to secure IV and IO access if adequate personnel are available (weak recommendation, very low quality of evidence). | Comment |
| ALS‑15 | In cats and dogs with CPA associated with hyperkalemia (P) does the use of no calcium during CPR (I) compared with calcium administration (C) improve outcome (O)? | We recommend against the routine administration of calcium in dogs and cats in CPA regardless of the arrest rhythm. (strong recommendation, very low quality of evidence) We recommend administration of a single dose of 10% calcium gluconate (50 mg/kg IV over 2-5 minutes) or 10% calcium chloride (15 mg/kg IV over 2-5 minutes) in patients with documented hyperkalemia (> 6.5 mmol/L) prior to or during CPA. (strong recommendation, very low quality of evidence) We recommend administration of sodium bicarbonate (1 mEq/kg IV) in patients with documented hyperkalemia (> 6.5 mEq/L) and pH < 7.2 prior to or during CPA. (strong recommendation, very low quality of evidence) | Comment |
| ALS‑16 | In cats and dogs with CPA and shockable arrest rhythms (P), how does administration of epinephrine (I) compared with no administration of epinephrine(C) affect outcome(O)? | We recommend against the use of epinephrine in shockable rhythms in dogs and cats before the first defibrillation attempt.(strong recommendation, very low quality of evidence) We suggest the use of vasopressin (0.8 U/kg, or epinephrine 0.01 mg/kg if vasopressin is not available) in shockable rhythms in dogs and cats in which the shockable rhythm persists beyond the 1st shock.(weak recommendation, expert opinion) | Comment |
| ALS‑19 | In cats and dogs with any cause of CPA (P) does any other atropine dosing interval (I) compared with atropine every 3-5 minutes (C) improve outcome (O)? | We suggest against administering multiple doses of atropine (weak recommendation, very low quality of evidence). | Comment |
| PICO ID | PICO Question | Treatment Recommendations | Link to Comment |
|---|---|---|---|
| MON‑01 | In cats and dogs in respiratory or cardiac arrest (P) following attempted endotracheal intubation, does CO2 detection (capnometer or colorimetric CO2 detector) (I) compared to standard clinical assessment (laryngeal visualization, cervical palpation) (C) affect outcome (O)? | In dogs and cats in CPA, detection of ETCO2 using a waveform capnograph attached to the breathing circuit is adequate to confirm proper ETT placement if a waveform is present and CO2 is consistently detected.(strong recommendation, very low quality of evidence) In dogs and cats in CPA with a CO2 detection device in place, an ETCO2 ≥ 12 mmHg likely indicates proper ETT placement, while an ETCO2 < 12 mmHg should lead the rescuer to confirm tracheal intubation by other means.(strong recommendation, very low quality of evidence) In intubated dogs and cats undergoing CPR that are instrumented with any CO2 detection device, when ETCO2 is 0 or very low (e.g., < 5 mmHg) despite high quality chest compressions, we recommend confirmation of tracheal intubation by other means (e.g., direct visualization of the tube passing through the arytenoid cartilages, lung auscultation during the pause between CC cycles) and reintubation if indicated.(strong recommendation, very low quality of evidence) | Comment |
| MON‑02 | In cats and dogs that have experienced ROSC after CPA (P), does serial plasma lactate measurement (lactate clearance) (I) as opposed to single time-point plasma lactate measurement (C), improve outcome(O)? | We recommend serial measurement of lactate in the PCA period. (strong recommendation, very low quality of evidence) We recommend that serial lactate measurements be used to guide and evaluate response to treatment in dogs and cats in the PCA period. (strong recommendation, expert opinion) | Comment |
| MON‑03A | In cats and dogs that have experienced ROSC after CPA (P), does measurement of glucose (I) as opposed to non-measurement (C), improve outcome(O)? | We suggest measuring blood glucose in all dogs and cats as early as possible after return of spontaneous circulation (weak recommendation, very low quality of evidence). We recommend measuring blood glucose in dogs and cats after ROSC in which hypoglycemia or hyperglycemia are known or suspected (strong recommendation, expert opinion). | Comment |
| MON‑03B | In cats and dogs that have experienced ROSC after CPA (P), does measurement of creatinine (I) as opposed to non-measurement (C), improve outcome(O)? | We recommend measuring serum creatinine concentrations, as an indicator of AKI, as soon as feasible in the PCA period, and subsequently no less often than every 24 hours during hospitalization in dogs and cats that achieve ROSC. (strong recommendation, very low quality of evidence) | Comment |
| MON‑04 | In dogs and cats at risk of CPA (e.g., under anesthesia, in shock, in respiratory distress, post-ROSC) (P), does blood pressure monitoring (I) compared to no blood pressure monitoring (C) improve outcome (O)? | We recommend frequent or continuous blood pressure monitoring in patients at risk of CPA, including patients under anesthesia, in shock, and in the PCA period. (strong recommendation, very low quality of evidence) We suggest the use of continuous, direct arterial blood pressure monitoring if feasible in patients at risk of CPA. (weak recommendation, very low quality of evidence) | Comment |
| MON‑05 | In dogs and cats at risk of CPA (e.g., under anesthesia, in shock, in respiratory distress, post-ROSC) (P), does pulse oximetry monitoring (I) compared to no pulse oximetry monitoring (C) improve outcome(O)? | In dogs and cats at risk of CPA (e.g., under anesthesia, in shock, in respiratory distress, post-ROSC), we recommend against monitoring only with a pulse oximeter.(strong recommendation, very low quality of evidence) In dogs and cats at risk of CPA (e.g., under anesthesia, in shock, in respiratory distress, post-ROSC), we suggest continuous pulse oximetry monitoring in conjunction with continuous or frequent monitoring of other vital parameters such as respiratory rate, heart rate and rhythm, and arterial blood pressure.(weak recommendation, very low quality of evidence) In cats under general anesthesia, we recommend continuous monitoring of pulse oximetry or pulse quality.(strong recommendation, very low quality of evidence) In dogs and cats in which a pulse oximetry reading cannot be obtained and patient movement and non-patient factors are ruled out as the cause, we recommend assessment of perfusion status by other means (eg, pulse palpation, blood pressure measurement, ECG monitoring, apnea monitoring, plasma lactate concentration measurement, point-of-care cardiac ultrasound).(strong recommendation, expert opinion) | Comment |
| MON‑06 | In dogs and cats at risk of CPA (e.g., under anesthesia, in shock, in respiratory distress, post-ROSC) (P), does ECG monitoring (I) compared to no ECG monitoring (C) improve outcome(O)? | We recommend continuous ECG monitoring in dogs and cats at risk of CPA (e.g., under anesthesia, in shock, in respiratory distress, post-ROSC, aspiration risk). (strong recommendation, very low quality of evidence) | Comment |
| MON‑07 | For cats and dogs in CPA undergoing CPR (P), does no EtCO2 monitoring (I) compared with continuous EtCO2 monitoring (C), improve outcome(O)? | We recommend continuous measurement of ETCO2 to guide chest compression quality during CPR in dogs and cats.(strong recommendation, very low quality of evidence) | Comment |
| MON‑08 | In cats and dogs in CPA (P), does the identification and treatment of (arterial or venous) Na+ or K+ disorders during CPR (I) compared to not addressing Na+ and K+ disorders (C) improve outcome (O)? | We suggest measuring potassium concentrations in all dogs and cats during CPR (weak recommendation, very low quality of evidence). We recommend measuring potassium concentrations as early as possible in dogs and cats during CPR in which severe potassium abnormalities are suspected (strong recommendation, expert opinion). | Comment |
| MON‑09 | In cats and dogs in CPA (P), does the identification and treatment of (arterial or venous) calcium disorders during CPR (I) compared to not addressing calcium disorders (C) improve outcome (O)? | In dogs and cats in CPA, we suggest monitoring of plasma ionized calcium during CPR. (weak recommendation, expert opinion) In dogs and cats in CPA with documented hypocalcemia (ionized calcium < 0.8 mmol/L), we suggest administration of 10% calcium gluconate (50 mg/kg IV over 2-5 minutes) or 10% calcium chloride (15 mg/kg IV over 2-5 minutes). (weak recommendation, expert opinion) In dogs and cats in CPA, we recommend against routine administration of calcium in patients in the absence of documented hypocalcemia or other specific indications (eg, calcium channel blocker overdose). (strong recommendation, very low quality of evidence) | Comment |
| MON‑10 | In cats and dogs with CPA (P), does achieving any other specific ETCO2 during CPR (I), compared to achieving ETCO2 ≥ 15 mm Hg (C), improve outcome (O)? | We recommend optimizing CPR to maximize ETCO2 to no less than 18 mmHg in dogs and cats undergoing CPR. (strong recommendation, very low quality of evidence) | Comment |
| MON‑11 | In cats and dogs suspected to be in CPA (P), does the addition of femoral pulse or cardiac apex palpation (I) compared to assessment of only mental responsiveness and attempts to breathe (C) improve outcome (O)? | In apneic, unresponsive dogs and cats, we recommend that BLS be started without attempting to palpate femoral or apex pulses. (strong recommendation, very low quality of evidence) | Comment |
| MON‑12 | In cats and dogs in CPA undergoing CPR (P), does direct arterial blood pressure monitoring to titrate BLS and ALS interventions (I) compared to no direct arterial blood pressure monitoring (C) improve outcome (O)? | In dogs and cats in CPA with an arterial catheter in place, we recommend optimizing BLS and ALS interventions to maximize DBP to no less than 30 mmHg. (strong recommendation, very low quality of evidence) | Comment |
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