RECOVER CPR Guidelines for Dogs

The evidence-based standard for CPR in dogs is the RECOVER guidelines (Reassessment Campaign on Veterinary Resuscitation), published in 2012 as 101 consensus clinical guidelines spanning five domains: preparedness and prevention, basic life support (BLS), advanced life support (ALS), monitoring, and post-cardiac arrest care. The 2012 set also includes a CPR algorithm, a resuscitation drug-dosing scheme, and a post-cardiac arrest care algorithm. The most recent update is the 2024 RECOVER Guidelines (J Vet Emerg Crit Care 34 Suppl 1), the first veterinary application of GRADE methodology, which produced 90 treatment recommendations for BLS, ALS, and periarrest monitoring. The core BLS targets from the 2012 guidelines are chest compressions at a rate of at least 100/min at a depth of one-third to half the width of the chest, with minimal pauses, and early ventilation at 8-10 breaths/min in intubated patients (30:2 compression-to-ventilation ratio when the patient is not intubated); the 2024 update reiterated the priority of high-quality, uninterrupted compressions and left the majority of BLS and ALS recommendations unchanged. Drug therapy is anchored by standard-dose epinephrine (0.01 mg/kg), for which the 2012 evidence review found strong support, alongside early electrical defibrillation for ventricular fibrillation or pulseless ventricular tachycardia, preferentially biphasic. The 2024 changes most relevant to daily practice: high-dose epinephrine is no longer recommended (even after prolonged CPR), atropine is limited to a single dose when indicated, bag-mask ventilation is prioritized over mouth-to-nose in nonintubated patients, and an initial-assessment algorithm, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug-dosing table were issued.

Basic life support: compressions and ventilation

• The 2012 BLS recommendations called for chest compressions at a rate of at least 100/min, at a depth of one-third to half the width of the chest, with minimal pauses, with early identification of cardiopulmonary arrest and immediate initiation of BLS as the major conclusions of the evidence review.
• Ventilation: 8-10 breaths/min in intubated patients; a 30:2 compression-to-ventilation ratio in nonintubated patients.
• The 2024 BLS domain examined 20 questions on animal position, compression point and technique, ventilation strategies, CPR cycle duration, and compression pauses, and formulated 32 treatment recommendations (25 on chest compressions, 7 on ventilation).
• The 2024 recommendations continue to emphasize high-quality, uninterrupted chest compressions and advise ventilation for all animals, with a modification suggested for the chest compression technique in wide-chested dogs.
• When intubation is not possible, the 2024 guidelines recommend bag-mask ventilation with a tight-fitting facemask and oxygen supplementation rather than mouth-to-nose ventilation.

Advanced life support: drug therapy and defibrillation

• The 2012 ALS evidence review found strong evidence supporting standard-dose (0.01 mg/kg) epinephrine and early electrical defibrillation for CPA due to ventricular fibrillation or pulseless ventricular tachycardia, preferentially using a biphasic defibrillator; for certain causes of arrest with advanced postcardiac arrest support available, open-chest CPR is preferred.
• The 2024 ALS domain reviewed 17 questions on vascular access, vasopressors in shockable and nonshockable rhythms, anticholinergics, defibrillation, antiarrhythmics, adjunct drug therapy, and open-chest CPR, and formulated 33 treatment recommendations (6 for nonshockable rhythms, 10 for shockable rhythms, 6 on open-chest CPR).
• Key 2024 positions: recommend against high-dose epinephrine even after prolonged CPR; atropine, when indicated, used only once; and for a shockable rhythm in which initial defibrillation was unsuccessful, double the defibrillator dose once and consider vasopressin (or epinephrine if vasopressin is not available), esmolol, lidocaine in dogs, and/or amiodarone in cats.

Monitoring during and after arrest

• The 2024 Monitoring domain examined 13 questions on hemodynamic, respiratory, and metabolic monitoring for identifying cardiopulmonary arrest, gauging CPR quality, and guiding postcardiac arrest care, and formulated 24 treatment recommendations, 5 of them on end-tidal CO2 (ETco2).
• The Monitoring authors continue to support initiating chest compressions without pulse palpation.
• Multimodal monitoring is recommended for patients at risk of cardiopulmonary arrest, at risk of re-arrest, or under general anesthesia.
• ETco2 is highlighted to verify correct intubation, identify return of spontaneous circulation, evaluate quality of CPR, and guide basic life support measures; intra-arrest evaluation of electrolytes (potassium and calcium) is suggested, as results may inform outcome-relevant interventions.

Post-cardiac arrest care

• Current post-arrest guidance derives from the 2012 RECOVER post-cardiac arrest care domain: supportive statements for mild therapeutic hypothermia and controlled reoxygenation, and neutral statements for mannitol administration and seizure prophylaxis, with a postcardiac arrest care algorithm included in the 2012 guideline set.
• The 2024 update covered BLS, ALS, and periarrest monitoring only. It did not re-issue post-cardiac arrest care recommendations, and no updated RECOVER post-cardiac-arrest guideline paper was identified in PubMed through September 2026. The 2024 methods paper lists post-cardiac arrest care among the domains the broader RECOVER initiative is re-evaluating.

What changed in the 2024 update

• Process: the update used GRADE methodology (its first veterinary application), information-specialist-driven systematic searches, more than 200 evidence evaluators, and 135 PICO questions across the broader initiative; the CPR update itself comprises 40 worksheets and 90 treatment recommendations across BLS, ALS, and monitoring.
• Clinical changes: high-dose epinephrine is no longer recommended (even after prolonged CPR); atropine is limited to a single dose; bag-mask ventilation is prioritized over mouth-to-nose ventilation in nonintubated animals; the approach to refractory shockable rhythms was clarified (double the defibrillator dose once, then vasopressin or epinephrine, esmolol, lidocaine in dogs, and/or amiodarone in cats); and an algorithm for initial assessment, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug-dosing table were provided.
• The 2024 authors state that the majority of BLS and ALS recommendations remain unchanged, with noteworthy changes driven by evidence that emerged over the prior decade.

Clinical context and limitations

The 2024 domain authors describe the underlying evidence as founded predominantly on very low quality evidence and expert opinion, and note that indirectness of evidence (the near-absence of clinical data in dogs and cats) remains the largest impediment to certainty, underscoring an urgent need for studies in the target species. The 2012 BLS evidence review noted that although veterinary clinical trials are lacking, much of the experimental literature on BLS utilized canine models. The guidelines are written for dogs and cats jointly, and some recommendations are species-specific (for example, lidocaine in dogs versus amiodarone in cats for refractory shockable rhythms). Knowledge gaps persist, including the optimal hand placement and technique for chest compressions.

Doses beyond standard-dose epinephrine, defibrillation energies, the specifics of the wide-chested-dog technique modification, numeric ETco2 thresholds, and post-arrest targets are in the full texts of the cited papers.

Ask Vetinuity

For follow-up questions about the 2024 changes, the drug-dosing table, or the recommendations that differ between dogs and cats, ask the Vetinuity clinical assistant.