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This month, we spoke to Jamie Burkitt, DVM, DACVECC, an associate professor at UC Davis. Dr. Burkitt is also a co-chair of the Executive Committee for the Reassessment Campaign on Veterinary Resuscitation (RECOVER) Initiative.
The RECOVER Initiative was established in 2010 by a group of veterinary emergency and critical care specialists. Over the past 5 years, the RECOVER Initiative has been working to update the CPR guidelines originally published in the Journal of Veterinary Emergency and Critical Care in 2012. Their objective: create and communicate the first evidence-based veterinary cardiopulmonary resuscitation (CPR) guidelines. More than 100 veterinary specialists collaborated and contributed to this update. These new CPR guidelines for Basic Life Support (BLS), Advanced Life Support (ALS), and periarrest monitoring were published in the Journal of Veterinary Emergency and Critical Care on June 26, 2024.
Jumping off from the 2012 RECOVER CPR Guidelines, what surprised you the most about the study’s findings?
Dr. Burkitt: We were somewhat surprised by the number of treatment recommendation updates the CPR evidence supported, particularly in the areas of Advanced Life Support and Monitoring. While the RECOVER co-chairs knew it was time for an update on veterinary CPR, we were surprised for instance by the strength of the evidence to increase the minimum end-tidal CO2 target to 18 mmHg and to eliminate high-dose epinephrine from the CPR algorithm. Some of the updates felt dramatic, and we wanted to be sure they were well justified.
What is the most important takeaway from this study?
Dr. Burkitt: Considering the volume of evidence evaluated and the complexity of decisions and tasks involved in a CPR effort, it’s difficult to identify the single most important takeaway in the treatment recommendations themselves. I think the co-chairs’ main hope for the veterinary community as pertains to CPR is that people familiarize themselves with the CPR algorithm for dogs and cats and take the time to pursue hands-on practice for the sake of their patients and their teams. CPR is the only practical method shown to achieve a return of spontaneous circulation in the clinical veterinary setting for dogs and cats that experience cardiopulmonary arrest, and so high-quality CPR is imperative in the treatment of patients with reversible causes of arrest.
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Do you recommend any physical changes to a veterinarian’s emergency treatment area to be better prepared to provide BLS and ALS?
Dr. Burkitt: This is a great question, and alludes to our Prevention and Preparedness domain, for which we expect a Guidelines update in the next 2 years. Evidence consistently shows that education and hands-on experience are vital for performing high-quality CPR. Additionally, the use of cognitive aids during a resuscitation effort improves team performance. The RECOVER Initiative thus recommends that veterinary hospitals have a pre-stocked, regularly audited CPR kit (“crash cart”) immediately available in areas of the hospital where cardiopulmonary arrest is more common, such as the triage or intake area and spaces used for anesthetic induction and recovery. Also, we recommend the use of cognitive aids such as the CPR Algorithm for Dogs and Cats and a CPR Dosage Chart. Such resources can be downloaded for free directly from www.recoverinitiative.org for printing or ordered in poster size for a fee from the Veterinary Emergency and Critical Care Society at www.veccs.org in the RECOVER Store area.
What remains the biggest deficit in the body of research on CPR in dogs and cats?
Dr. Burkitt: The biggest deficit in the evidence regarding CPR in veterinary medicine is the lack of clinical research in the target species. Most of the evidence available currently is from clinical human medicine and research performed in non-target species such as pigs and rats.
The Study:
2024 RECOVER Guidelines: updated treatment recommendations for CPR in dogs and cats.
Burkitt-Creedon JM, Boller M, Fletcher DJ, et al. J Vet Emerg Crit Care. doi.org/10.1111/vec.13391