2024 RECOVER Guidelines: Updated treatment recommendations for CPR in dogs and cats.

OBJECTIVE: After the 2012 Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR Guidelines, this is an update of evidence-based consensus guidelines for Basic Life Support (BLS), advanced life support (ALS), and periarrest monitoring. DESIGN: These RECOVER CPR Guidelines were generated using a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for evidence evaluation and translation of this evidence into clear and actionable clinical instructions. Prioritized clinical questions in the Population, Intervention, Comparator, and Outcome (PICO) format were used as the basis to conduct systematic literature searches by information specialists, to extract information from relevant publications, to assess this evidence for quality, and finally to translate the findings into treatment recommendations. These recommendations were reviewed by the RECOVER writing group and opened for comment by veterinary professionals for 4 weeks. SETTING: Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS: A total of 40 worksheets were prepared to evaluate questions across the 3 domains of BLS, ALS and Monitoring, resulting in 90 individual treatment recommendations. High-dose epinephrine is no longer recommended, and atropine, if used, is only administered once. Bag-mask ventilation is prioritized over mouth-to-nose ventilation in nonintubated animals. In addition, an algorithm for initial assessment, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug dosing table are provided. CONCLUSIONS: While the majority of the BLS and ALS recommendations remain unchanged, some noteworthy changes were made due to new evidence that emerged over the past 10 years. Indirectness of evidence remains the largest impediment to the certainty of guidelines formulation and underscores an urgent need for more studies in the target species of dogs and cats.

2024 RECOVER Guidelines: Basic Life Support. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR.

OBJECTIVE: To systematically review evidence and devise treatment recommendations for basic life support (BLS) in dogs and cats and to identify critical knowledge gaps. DESIGN: Standardized, systematic evaluation of literature pertinent to BLS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by 2 Evidence Evaluators, and findings were reconciled by BLS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk to benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization. SETTING: Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS: Twenty questions regarding animal position, chest compression point and technique, ventilation strategies, as well as the duration of CPR cycles and chest compression pauses were examined, and 32 treatment recommendations were formulated. Out of these, 25 addressed chest compressions and 7 informed ventilation during CPR. The recommendations were founded predominantly on very low quality of evidence and expert opinion. These new treatment recommendations continue to emphasize the critical importance of high-quality, uninterrupted chest compressions, with a modification suggested for the chest compression technique in wide-chested dogs. When intubation is not possible, bag-mask ventilation using a tight-fitting facemask with oxygen supplementation is recommended rather than mouth-to-nose ventilation. CONCLUSIONS: These updated RECOVER BLS treatment recommendations emphasize continuous chest compressions, conformation-specific chest compression techniques, and ventilation for all animals. Very low quality of evidence due to absence of clinical data in dogs and cats consistently compromised the certainty of recommendations, emphasizing the need for more veterinary research in this area.

2024 RECOVER Guidelines: Advanced Life Support. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR.

OBJECTIVE: To systematically review the evidence and devise clinical recommendations on advanced life support (ALS) in dogs and cats and to identify critical knowledge gaps. DESIGN: Standardized, systematic evaluation of literature pertinent to ALS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by ALS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk:benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization. SETTING: Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS: Seventeen questions pertaining to vascular access, vasopressors in shockable and nonshockable rhythms, anticholinergics, defibrillation, antiarrhythmics, and adjunct drug therapy as well as open-chest CPR were reviewed. Of the 33 treatment recommendations formulated, 6 recommendations addressed the management of patients with nonshockable arrest rhythms, 10 addressed shockable rhythms, and 6 provided guidance on open-chest CPR. We recommend against high-dose epinephrine even after prolonged CPR and suggest that atropine, when indicated, is used only once. In animals with a shockable rhythm in which initial defibrillation was unsuccessful, we recommend doubling the defibrillator dose once and suggest vasopressin (or epinephrine if vasopressin is not available), esmolol, lidocaine in dogs, and/or amiodarone in cats. CONCLUSIONS: These updated RECOVER ALS guidelines clarify the approach to refractory shockable rhythms and prolonged CPR. Very low quality of evidence due to absence of clinical data in dogs and cats continues to compromise the certainty with which recommendations can be made.

2024 RECOVER Guidelines: Methods, evidence identification, evaluation, and consensus process for development of treatment recommendations.

OBJECTIVE: To describe the methodology used by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) to re-evaluate the scientific evidence relevant to CPR in small and large animals, to newborn resuscitation, and to first aid and to formulate the respective consensus-based clinical guidelines. DESIGN: This report describes the evidence-to-guidelines process employed by RECOVER that is based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and includes Information Specialist-driven systematic literature search, evidence evaluation conducted by more than 200 veterinary professionals, and provision of clinical guidelines in the domains of Preparedness and Prevention, Basic Life Support, Advanced Life Support, Post-cardiac Arrest Care, Newborn Resuscitation, First Aid, and Large Animal CPR. SETTING: Transdisciplinary, international collaboration in academia, referral practice, and general practice. RESULTS: For this update to the RECOVER 2012 CPR guidelines, we answered 135 Population, Intervention, Comparator, and Outcome (PICO) questions with the help of a team of Domain Chairs, Information Specialists, and more than 200 Evidence Evaluators. Most primary contributors were veterinary specialists or veterinary technician specialists. The RECOVER 2024 Guidelines represent the first veterinary application of the GRADE approach to clinical guideline development. We employed an iterative process that follows a predefined sequence of steps designed to reduce bias of Evidence Evaluators and to increase the repeatability of the quality of evidence assessments and ultimately the treatment recommendations. The process also allowed numerous important knowledge gaps to emerge that form the foundation for prioritizing research efforts in veterinary resuscitation science. CONCLUSIONS: Large collaborative, volunteer-based development of evidence- and consensus-based clinical guidelines is challenging and complex but feasible. The experience gained will help refine the process for future veterinary guidelines initiatives.

2024 RECOVER Guidelines: Monitoring. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR.

OBJECTIVE: To systematically review evidence on and devise treatment recommendations for patient monitoring before, during, and following CPR in dogs and cats, and to identify critical knowledge gaps. DESIGN: Standardized, systematic evaluation of literature pertinent to peri-CPR monitoring following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by Monitoring Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk:benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization. SETTING: Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS: Thirteen questions pertaining to hemodynamic, respiratory, and metabolic monitoring practices for identification of cardiopulmonary arrest, quality of CPR, and postcardiac arrest care were examined, and 24 treatment recommendations were formulated. Of these, 5 recommendations pertained to aspects of end-tidal CO2 (ETco2) measurement. The recommendations were founded predominantly on very low quality of evidence, with some based on expert opinion. CONCLUSIONS: The Monitoring Domain authors continue to support initiation of chest compressions without pulse palpation. We recommend multimodal monitoring of patients at risk of cardiopulmonary arrest, at risk of re-arrest, or under general anesthesia. This report highlights the utility of ETco2 monitoring to verify correct intubation, identify return of spontaneous circulation, evaluate quality of CPR, and guide basic life support measures. Treatment recommendations further suggest intra-arrest evaluation of electrolytes (ie, potassium and calcium), as these may inform outcome-relevant interventions.

Recognition and Assessment of Pain-Related Behaviors in Avian Species: An Integrative Review.

The appropriate recognition and assessment of pain in animals is an essential tool that can be used by veterinary professionals, rehabilitators, household caregivers, and others to provide supportive care and analgesia to patients. Although the use of behavioral, postural, and facial changes to recognize pain have been studied in popular domestic species such as dogs (Canis lupus familiaris), cats (Felis catus), and rabbits (Oryctolagus cuniculus), very little is known relative to avian species. The purpose of this article is to provide a literature review comprising structured searches on the topic of avian pain recognition. The emphasis of the searches were based on the behavioral and postural alterations that have thus far been explored. The literature review was performed in the months of August-September 2020 over 5 online databases: MEDLINE/ PubMed, CAB Direct, Biosis, Zoological Record, and Scopus. Additional "snowballing" was incorporated by looking at the references and articles that cited the 126 articles from the initial abstract and full-text screening. Of the 194 full-text articles reviewed, 132 sources of literature were included in the final analysis. From these 132 sources of literature, 31.8% were general review articles in which avian pain behaviors were described irrespective of species, with others being specific to a particular species (chickens 47.8%, turkeys 7.6%, parrots 3.8%, pigeons [Columba livia] 3%, raptors 3%, and "other" 3%-2 on ducks, 1 on emus [Dromaius novaehollandiae], and 1 on Eurasian blue tits [Cyanistes caeruleus]). Pain stimulus varied depending on species, although the vast majority of the pain stimuli involved welfare issues such as beak trimming, limb abnormalities, and keel bone fractures in chickens. Although information regarding this topic remains limited for many avian species, this review provides a more thorough understanding of behavioral indicators of pain in species such as chickens, turkeys, psittacines, pigeons, raptors, and select others. It is the hope that this review will motivate further interest and future analgesia research for the improvement of avian welfare.

Vaccination for the Prevention of Neonatal Calf Diarrhea in Cow-Calf Operations: A Scoping Review.

Neonatal calf diarrhea (NCD), also known as scours, is an important disease of preweaned calves that affects the production and welfare of beef herds. While hygiene and nutrition are important in reducing the incidence of NCD, vaccination of dams or calves is often employed for the prevention of NCD. The present scoping review summarizes the available peer-reviewed scientific English literature on vaccination of dams or calves for the prevention of NCD over the past decades. The online databases Medline, CAB Abstracts, and Biosis were searched for articles on the topic published between 1950 and 2020. Online software was used to systematically evaluate 2807 citations for inclusion through pre-determined criteria in a 2-step process. In the 113 articles included in the review, vaccines tested targeted the pathogens E. coli (n = 43), bovine rotavirus (BRV, n = 38), Salmonella (n = 29), bovine coronavirus (BCV, n = 14), bovine viral diarrhea virus (n= 7), and other pathogens (n = 8). Field trials for commercial vaccines have been published for the most important pathogens, and results on efficacy are variable for such vaccines targeting BRV, BCV, and E. coli. Meta-analyses exploring efficacy of these vaccines would be helpful to practitioners and producers. No field studies on commercial products have shown efficacy for Salmonella vaccines so that a meta-analysis would unlikely come to a different conclusion. Further research is needed on vaccines for protozoal pathogens like Cryptosporidium parvum as well as on the importance of several emerging enteric viruses in calves.

Scoping Review on Risk Factors and Methods for the Prevention of Bovine Respiratory Disease Applicable to Cow-Calf Operations.

The presented scoping review summarizes the available research evidence and identifies gaps in knowledge for bovine respiratory disease (BRD) prevention. Published literature on BRD from 1990 to April 2021 was searched in online databases, including Medline, CAB Abstracts, Scopus, Biosis, and Searchable Proceedings of Animal Conferences. Citations were systematically evaluated in a three-stage approach using commercial software and summarized in a scoping review format. A total of 265 publications were included in this review with herd/farm management (27.9%) as the most prevalent factors studied, followed by metaphylaxis (24.5%), vaccinations (24.1%), diet formulations, and nutritional supplementations (17.7%), animal characteristics (10.2%), and less common interventions and risk factors (6.4%). A high proportion of studies under herd/farm management (73%), metaphylaxis (86%), vaccinations (70%), animal characteristics (78%), and less common interventions and risk factors (59%) showed either significant effects on reducing BRD morbidity or significant differences of BRD between treatments. However, diet and nutritional supplementations reduced BRD only in 30% of research publications. Most studies on BRD were performed in feedlot populations, and more studies in cow-calf populations are needed. We further suggest meta-analyses on the use of yeast and trace mineral supplementation, and nitric oxide-releasing solution for BRD prevention.

A Mapping Study of Veterinary Literature on Perceptions and Attitudes of Female Canine Spaying.

This is a mapping study conducted to evaluate the characteristics of where content that engages in perspectives or attitudes on female dog spaying is published. Three databases, CAB Direct, PubMed, and Scopus, were systematically searched. There were 84 out of 642 papers identified and screened for relevance on attitudes or perceptions on female canine spaying. These 84 articles were then examined for recurring authors, institutional representation, and publisher information. Additionally, information regarding the population being addressed, veterinarian or client, was noted with most literature addressing the veterinary perspective. Many important articles were published in a wide array of journals from many countries, which suggests the importance of not only browsing journals but also searching for relevant literature in databases like CAB Abstracts and MEDLINE.

Effective Multidisciplinary Search Strategies for Assistance Animals: A Librarian's Perspective.

Successful search strategies are based on good background knowledge and a focused clinical research question. Due to the multidisciplinary nature of research involving assistance animals means there is no one universal database to answer all research questions. The topic of assistance animals can yield better results when creating subheadings based on discipline focus. Subheadings have been divided into ethicolegal, sociocultural, psychobehavioral, and medical/veterinary. Each subheading, or discipline, has their own specific databases that will yield higher relevant content than others. Contacting local academic librarians and utilizing search guides created by those librarians can lead to successful search strategies. The goal of this article is to create a template for successful search strategies in assistance animals. Eighty-nine subject guides curated by academic librarians are reviewed to identify strong databases for each topic of ethicolegal, sociocultural, pscyhobehavioral, and medical/veterinary topics in relationship to assistance animals. A live subject guide has been created and maintained at https://www.library.ucdavis.edu/guide/assistance-animals/.