RECOVER’s 2024 CPR guidance puts immediate, uninterrupted basic life support first: chest compressions at 100–120 per minute, ventilation every six seconds, and two minutes of CPR before a brief rhythm-and-pulse check. Advanced life support then uses the arrest rhythm and monitoring to guide defibrillation, medication, and other treatment. These are veterinary resuscitation recommendations; drug and electrical interventions require a clinical team, and the guidance is not a guarantee of survival.
What the RECOVER CPR guidelines cover
The 2024 RECOVER update addresses basic life support (BLS), advanced life support (ALS), and monitoring during cardiopulmonary arrest (CPA) in dogs and cats. BLS means external chest compressions and intermittent positive-pressure ventilation for a pulseless, apneic patient. Trained responders can provide BLS outside a hospital, but ALS relies on clinical equipment and expertise for ECG and capnography monitoring, defibrillation, vascular access, and medication. See the RECOVER 2024 Veterinary CPR Guidelines and the peer-reviewed 2024 treatment recommendations.
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This guidance is not the same as RECOVER’s separate newborn-resuscitation recommendations or its 2026 first-aid guidance for emergencies before veterinary treatment is available. The CPR recommendations discussed here concern resuscitation of dogs and cats in CPA, especially in veterinary clinical care.
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The update was developed using GRADE methods, including systematic reviews and assessment of evidence quality. Its authors report 40 worksheets and 90 treatment recommendations across BLS, ALS, and monitoring. Evidence is often indirect, and target-species outcome studies remain limited; recommendations should be understood as guidance for clinical decisions, not as proof that a particular intervention will produce a specific outcome.
What happens first: uninterrupted basic life support
RECOVER’s algorithm begins with two full minutes of CPR without pauses. During this period, the target is 100–120 chest compressions per minute, with a ventilation breath every six seconds. The algorithm then calls for a brief pause of under 10 seconds to assess rhythm and palpate for a pulse before the team continues along the appropriate rhythm pathway. The RECOVER CPR algorithm poster is a cognitive aid, not a replacement for detailed training or clinical judgment.
For an apneic, unresponsive dog or cat, RECOVER recommends beginning BLS without first delaying to palpate femoral or apex pulses. Technique varies with the animal’s size, chest shape, and position. Chest compressions should allow the chest wall to recoil fully between compressions; incomplete recoil is not the recommended technique.
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Compression position, depth, and technique
For non-wide-chested dogs, the recommendation is lateral recumbency, with hand placement adjusted to chest conformation. For a patient in lateral recumbency, compression depth is one-third to one-half of the lateral chest diameter. In dorsal recumbency, the recommended depth is one-quarter of the anterior-posterior diameter. These depth recommendations are not a single measurement that fits every animal.
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Ventilation and rescuer safety
For a nonintubated dog or cat, RECOVER prioritizes ventilation through a tight-fitting face mask attached to a manual resuscitator, with supplemental oxygen if available. If that equipment is unavailable, mouth-to-nose breaths are suggested only when rescuer risk is low. If risk is high or unknown—for example, because of possible zoonotic disease or narcotics exposure—and suitable mask equipment is unavailable, the recommendation is compression-only CPR to reduce rescuer risk. This is a trained-responder recommendation, not a substitute for assessing the situation or obtaining veterinary help.
The guideline notes that ventilation may be particularly important in dogs and cats because many arrests are believed to be asphyxial. That rationale does not override rescuer safety: the recommended ventilation approach depends on available equipment and the risk to the person providing care.
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How monitoring guides clinical resuscitation
During ALS, RECOVER’s algorithm adds ECG and end-tidal carbon dioxide (ETCO₂) monitoring, IV access, and treatment of reversible causes. Monitoring is used to assess perfusion and help guide resuscitation, rather than being an afterthought. A sudden rise in ETCO₂ together with an arterial pulse distinct from compressions may indicate return of spontaneous circulation (ROSC); a single signal alone should not be treated as conclusive.
Teams use a brief rhythm check to decide which pathway to follow. The distinction matters because ventricular fibrillation and pulseless ventricular tachycardia are shockable rhythms, while asystole and pulseless electrical activity are nonshockable. CPR continues while the team applies the relevant interventions and reassesses the patient.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.How ALS changes with the arrest rhythm
| Rhythm or situation | RECOVER-guided clinical approach |
|---|---|
| Nonshockable: asystole or pulseless electrical activity | Continue CPR and treat reversible causes. The algorithm lists epinephrine or vasopressin every other CPR cycle; atropine may be considered once, early. |
| Shockable: ventricular fibrillation or pulseless ventricular tachycardia | Defibrillation is part of the pathway. If the initial standard-energy shock is unsuccessful, the guideline recommends doubling the initial energy for the second and later shocks. |
| Refractory shockable rhythm after two or more shocks | The algorithm lists vasopressin or epinephrine every other cycle and an antiarrhythmic: amiodarone for cats, lidocaine for dogs, with esmolol as a consideration. |
| Prolonged CPR, over 15 minutes | The algorithm suggests bicarbonate, especially when pH is below 7.0. |
The table summarizes algorithm branches, not a stand-alone protocol. Cycle timing, exact drug choice, electrical settings, and patient-specific decisions belong to the trained clinical team using the current detailed guideline and dosing chart. The ALS evidence review and recommendations are available in 2024 RECOVER Guidelines: Advanced Life Support.
Medication recommendations: what changed and what not to infer
The 2024 update recommends standard-dose epinephrine when epinephrine is used; routine high-dose epinephrine at 0.1 mg/kg is no longer recommended. If atropine is used, it is a one-time early dose rather than a medication repeated throughout resuscitation. These points describe the guideline’s recommendation, not a dosing instruction for an individual animal.
RECOVER’s algorithm expresses medication timing in CPR cycles, while the detailed clinical decisions depend on the patient, rhythm, and response. The algorithm poster should not be used to infer exact doses or formulations. Clinicians should consult the current RECOVER dosing chart and apply their judgment; this article does not provide patient-specific drug dosing.
What survival figures do—and do not—say
RECOVER’s official guideline page reports that fewer than 6% of dogs and fewer than 20% of cats with CPA survive to hospital discharge; the page does not give that statistic a publication year. Separately, the 2024 peer-reviewed guideline article describes survival figures of 5%–7% in dogs and 1%–19% in cats from single emergency or referral hospital studies. These figures have different source framing and should not be combined into one estimate or treated as a controlled comparison. They also do not predict an individual patient’s outcome.
How CPR differs from RECOVER’s first-aid guidance
RECOVER announced its first evidence- and consensus-based First Aid Guidelines for dogs and cats on August 27, 2026. That guidance addresses prehospital support before veterinary treatment is available, including problems such as heatstroke, choking, burns, noncaustic toxin ingestion, hypoglycemia, and severe extremity bleeding. It is intended to help caregivers recognize emergencies, provide appropriate immediate support, and move animals toward veterinary care; RECOVER says it does not replace veterinary diagnosis or treatment. It is a distinct guidance stream from the 2024 clinical CPR algorithm. Details are in RECOVER’s 2026 first-aid announcement.
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