Adrenaline in CPR: low dose and frequency
12 kg Beagle in asystole. It is intubated, good-quality compressions are being given and a peripheral venous line is in place.
Which adrenaline protocol is appropriate?
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A. Low dose (0.01 mg/kg) IV, repeated every 3–5 minutes (every other cycle)
Correct. Adrenaline increases coronary and cerebral perfusion pressure through its alpha vasoconstrictor effect. The low dose is repeated every 3–5 minutes, that is, every other 2-minute cycle.
B. High dose (0.1 mg/kg) IV from the start to maximise vasoconstriction
High doses do not improve survival to discharge and increase adverse effects after return of circulation (arrhythmias, myocardial oxygen demand). They are not recommended routinely.
C. A single dose at the start, not repeated, because of the risk of arrhythmias
Adrenaline has a short half-life; if arrest persists, it must be repeated every 3–5 minutes.
D. Intracardiac adrenaline, because it is the fastest route
The intracardiac route requires interrupting compressions and can damage coronary vessels or lung. IV or intraosseous routes are preferred; intratracheal is an alternative if there is no vascular access.
lightbulb Key takeaway
Low-dose adrenaline (0.01 mg/kg IV/IO) every 3–5 minutes, on alternate cycles. If there is no vascular access, it can be given intratracheally at a higher, diluted dose. Record the time of each dose on the CPR record.
References: RECOVER clinical guidelines for veterinary CPR (2012)
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.