CPR Can Save a Pet’s Life
March 14, 2014
If you have confirmed that your pet has no heartbeat and is non-responsive, or the normal pattern of breathing has stopped and gums have turned ashen grey blue, have someone call your veterinarian or the local emergency veterinary hospital for guidance while you begin rescue efforts. In death, if you gently touch the surface of the eyeball where it is clear, there is no blink reflex.
Cardiopulmonary resuscitation, or CPR, can be used to treat an animal that has stopped breathing and has no heartbeat. It is not useful for collapse/unresponsiveness from other causes such as a low sugar coma or fainting. Basic life support is the appropriate response to cardiopulmonary arrest. Basic resuscitation can be broken down into three steps, which are called the ABC's of CPR; Airway, Breathing, and Circulation.
Basic CPR step one is to confirm that the airway is open. How? The first step is to open the mouth, pull out the tongue, and examine the throat. Do not do this if there is agonal breathing since the mouth can clamp closed with great force, causing injury to your fingers. Agonal breathing is a slow deep gasping effort that can happen at the time of passing on and for a few minutes after. In long-nosed breeds of dogs, a small flashlight may be needed to visualize the throat area. Use your finger to check for and remove any foreign material from the mouth.
Breathing for the pet involves mouth-to-nose (snout) resuscitation. How? To protect fingers in case the pet starts to arouse during the examination, make sure the fingers are never placed in the path of the large teeth at all times. If the animal is becoming conscious, one must not put the fingers in the mouth at all because the pet may bite very hard due to reflex. For medium-to-large-sized animals, holding the muzzle closed with your hands should seal the mouth, providing opportunity for mouth-to-nose resuscitation. For cats and very small dogs, your mouth will seal the pet's whole snout when you perform CPR.
Placing your mouth over the animal's nose and exhaling directly into the nostrils begins resuscitation. Do not overinflate the chest or lung damage may occur. After four to five quick breaths, the breathing should be checked again and if no spontaneous breathing begin formal resuscitation cycles of 2 minutes each. If no equipment is available, 30 chest compressions should alternate with 2 quick breaths and the people should rotate roles every 2 minutes to reduce fatigue for chest compressions (see part 7, RECOVER 2012 for pictures). Check for return of breathing and pulse during the cycle changeover. If the animal does not start breathing after 15 minutes, it is not likely to revive.
To check whether enough air is being provided (or too much), watch the movement of the chest wall as you provide air. The chest wall should move up and out as if a large normal deep breath is occurring. If the wall moves very high, you are over-inflating the lungs, and a smaller, less vigorous breath should be used. If the chest wall does not move at all, it is quite possible that a blockage of the windpipe is present.
Cardiovascular (circulatory, heart and blood vessels). How? For small dogs, the pet should be lying on its right side. The palm of one hand should be placed over the ribs at the point where the elbow would touch the chest if he was lying down with back facing up, with forelegs tucked at side, while the other hand is placed beneath the right chest wall opposite it.
Compression rate should be about 100-120/minute, allowing time for the chest to spring back in between pressure application. If there are two people present, one person can perform the breathing, while the other compresses the chest then checks for a pulse in the femoral artery (running up the inside of the leg and felt ½ way down from the junction of leg and body wall to the knee joint).
For medium-to-large dogs, the hands must be cupped over each other on the top side behind the elbow on the chest wall where the elbow would naturally sit if the pet was lying down, with back facing up, with forelegs sitting normally, and the arms kept straight and elbows locked. The person needs to place their body squarely over their hands in order to get sufficient power to compress the chest properly. If there are two people present, one person can perform the breathing, while the other compresses then checks for a pulse every 2 minutes. A folded towel placed under the chest will help to keep the pet from shifting during the application of pressure.
Cats should be placed on their side, and one hand should be placed over the backbone near the shoulder blades, while the other hand is cupped around the underside of the chest where, if the cat was standing, just behind where the elbows would be. Flat fingers on the underside, and flat part of the thumb on topside are applied over this region of the heart.
Pulses can be checked by placing a finger over the mid portion of the inside rear limb about half way between the body wall and the stifle, or knee joint half way between the back and front margins of the limb. The femoral artery lies within a minor trough in the muscles here. A veterinarian can teach you how to find pulses during a routine annual examination. It is best to practice getting the pulse on a healthy, awake pet before any time of crisis.
Important: The chest should go down by about a third to half of the height as the animal lays on the side.
- Lay the pet with the body angled so the head is lower than the heart, and hind end is higher than the heart using blankets or pillows, or coats, if they are handy. This keeps more blood in the brain. This should not be done if there is trauma especially to the head.
- Do not attempt to drive and do CPR at the same time! Ideally enlist a friend or family member to assist with you promptly. At the veterinary clinic, they have important aids for resuscitation such as adrenalin and other key drugs, oxygen, intravenous access, breathing bags, and windpipe (tracheal) intubation to maximize effectiveness of CPR, so do not delay your trip to the clinic whatsoever.
- Note that once a pet has passed away, resuscitation with even the very best equipment and trained personnel there is only a success rate of 9% reported as of 2012, and of those animals that recover, some will have permanent brain damage and may not be themselves afterwards. However, this should not deter anyone from trying it in an emergency situation. To learn more about CPR, ask your veterinarian.
- The greatest chance of success is when there is an observed passing and immediate CPR begins. Presence of agonal breathing (heavy irregular gasps) does not mean the pet is still alive. These can continue to occur for a few minutes after death but do indicate very recent death (or is currently dying).
- If you see a return of heart beat and breathing, it is essential to still present the pet right away to the hospital since very important post-resuscitation support that must happen. It can happen that the animal re-arrests so it is not over until quite a while has passed, with the animal remaining stable. Brain swelling and other complications of recovery require a hospitalized stay so don’t delay.
RECOVER 2012 guidelines: http://acvecc-recover.org/