The big changes to come out of the RECOVER 2024 Guidelines by a VetMed CPR Trainer
Last summer the proposed RECOVER 2.0 guidelines were the talk of VetMed. They were flaunted at EVECCs and after a year of us eagerly awaiting them the proposed guidelines they were finally published in June. It takes years of hard work for guidelines to be created and they were eagerly received.
Whilst there are many changes to come out of the new RECOVER 2.0 guidelines there are a few that warrant a headline discussion.
1. Barrel Chested guidance
Compression depth with a barrel-chested patient is ¼. For the majority of our patient’s, we compress them at a depth of 1/3 to ½ of the depth of the chest. However, with our barrel-chested patients we compress a little less. Not forgetting that these patients are also compressed on their back. This suits their body shape much more than in lateral and provides more effective compressions. That said there is a little more guidance on these patients, and starting compressions in lateral is a reasonable approach whilst intubating. After the first cycle we then place them onto their back and compress to a depth of a ¼ of the chest.
2. ETCO2- keep it up!
ETCO2 has increased from 15mmHg to 18mmHg. The higher ETCO2 has been linked to higher returns of spontaneous circulation (ROSC) Noting that 18mmHg is considered the minimum we aim for, and we should always be trying to get the ETCO2 as high as we can. If the ETCO2 fails to reach 18mmHg we need to trouble shoot both the compressions and also the ventilation. Perhaps the position of the person compressing needs to be adjusted, maybe the patient would benefit from being on the floor or maybe the cuff on the endotracheal tube wasn’t inflated sufficiently.
3. Goodbye high dose adrenaline
It’s goodbye high dose adrenaline in the RECOVER 2.0 Guidelines. Not a huge surprise as there’s been lots of emerging evidence around the use of high dose. In summary whilst there is a higher return of spontaneous circulation the patients were neurologically worse off. The Paramedic2 study is an interesting read for those that want to know more. This changes the ALS part of CPR for us, rather than ‘low’ dose for 5 cycles before moving onto ‘high’ but now it’s one dose for the entire CPR. Much simpler.
4. Atropine, once and done
Finally, atropine frequency has also changed. Very often the practices I visit will alternate adrenaline and atropine but according to the new guidelines and based on the drugs half-life we should only be administering one dose of atropine. Atropine has particular value in the patients where vagal tone is considered a cause of CPA.
You can access guidelines here and download the algorithm here.
