Keeping a cool head in the event of a life-threatening injury may be the only thing that gives your pet a chance higher than zero to survive. The statistics are sadly pretty dismal. About 6% of pets that undergo cardiac arrest survive to leave the hospital. The aftercare of a successful resuscitation is incredibly important, which means that a pet MUST go to a critical care facility for intensive care after a resuscitation.
Six percent. Why bother? The blunt truth is that the reason for the arrest informs the likelihood of success. A patient that’s very sick with cancer or organ failure or heart disease isn’t likely to make it. A younger animal in a trauma case or some other accident has a better chance of surviving. I think it’s worth it if your pet is otherwise young and healthy. Even if it’s not, it’s important for you as an owner to feel that you’ve done everything you can. Trying CPR is one of the things that you can do wherever you are, including on your way to the hospital.
CPR (cardiopulmonary resuscitation) in pets is very similar to what is done in people. Recently, the human CPR guidelines/instructions were changed. Veterinarians have adopted the same recommendations for pets. I’ll briefly go through the steps here.
First, you need to determine if your pet is breathing and has a pulse.
Breathing can be assessed by the rise and fall of the chest, or the motion of air through the nose, which you can feel with your hand on most dogs. There is a breathing pattern called an “agonal breath” that is NOT actual breathing. This happens when an animal has undergone arrest. A pet may open its mouth wide and the chest may heave, but it’s not a normal breath. I promise that if you see this, you will not mistake it for a normal breath.
The pulse is best felt on the inside of the thigh. The videos below shows you where to feel for a pulse. It will take a bit of pressure to feel the femoral artery. My best tip for this is to find the thigh bone and move your fingers into the sort of groove formed by the muscles in front of and behind the bone. The pulse may be weak and just barely there, but that still counts. You can also put your ear against your pet’s chest, but there’s a caution with this strategy. Hearing a heart noise does NOT necessarily mean that the heart is generating a pulse and circulating blood.
If you don’t have breathing, but you do have a pulse, you can start rescue breathing. First, open the mouth and make sure there isn’t anything blocking the airway. If there is, get it out before you start rescue breathing. The next step is to close your pet’s mouth. Seal your mouth around the nose of the pet and gently breathe out. You only breathe out until you see your pet’s chest rise a little bit. It is entirely possible for you to overpressurize the lungs and cause severe damage. So, just enough breath to raise the chest a bit. You should repeat two breaths every 4-6 seconds. You can stop if your pet starts to breathe on its own.
If there is no breathing and no pulse, or just no pulse, you will need to start chest compressions. This is where the guidelines have changed. It was decided that chest compressions are more important than the breathing, so instead of airway-breathing-circulation, we have circulation-airway-breathing.
Compressions for most pets are accomplished with the pet on its side. For dogs, you’ll want to place your hands on the chest right where the elbow would touch the ribcage if you pulled the elbow up and back. It’s at the 4th-6th rib spaces. Compressions should be done with you on your knees and bent over your pet. Your elbows should be locked and you should have your hands placed one atop the other. You’ll push the chest down about 1/3 of its total thickness.
(Images credited to the Journal of Veterinary Emergency and Critical Care.)
The pace of the compressions should match the beat for one of these songs: Stayin’ Alive (Bee Gees), Another One Bites The Dust (Queen), or Cecilia (Paul Simon). Compressions continue for a total of 30 compressions before you then breathe for your pet. For very small dogs or cats, you can use one hand to perform compressions by slipping your fingers under the chest and “pinching” the chest between your thumb and fingers. You will need to brace your pet’s back so that you can keep your pet in place for effective compressions. For big round-chested dogs like bulldogs, you should position your pet on its back and compress the chest in that position, right over the breastbone, just like for people.
Compressions and breathing should continue for 2 minutes, after which you can reassess breathing and pulse. If there is another person with you that can continue compressions after the quick check, you should trade off. CPR is more exhausting than it seems, and it’s important that you don’t get too tired to perform effective compressions.
If, after 20 minutes, your pet has not had a heartbeat or breathing resume, it’s time to stop resuscitation. If you become too exhausted to continue, then you’ve done all you can, and stopping is OK.
If you’re one of the lucky 6% and your pet’s heartbeat and breathing come back, get to the emergency hospital as quickly as you can. Emergency-critical care is required because these pets need 24 hour monitoring and often fairly complex treatments.
Here are a few links to help review and show the CPR procedure. Keep in mind that the recommendations have changed to be C-A-B instead of A-B-C.
The video below is a live dog that they’re demonstrating on, so she was absolutely incredible through the procedure. The timing of the breaths and compressions here is NOT too accurate compared to current recommendations.
The next video is a practice dummy. This is an older video as well, but there are good examples of how to locate the heart and how to breathe for your pet.