How to perform basic CPR
read it before you need to do it
What is CPR?
CPR stands for cardiopulmonary resuscitation. Basic CPR is the sort done by bystanders at the scene of the arrest. It’s temporary treatment intended to provide enough blood and oxygen to the vital organs to support life until more advanced therapy can be started.
There are two parts to it:
rescue breathing – to keep the lungs supplied with oxygen
chest compressions – to manually pump the chest/heart and keep blood circulating
Advanced CPR is done by a team of trained professionals and includes medications.
It’s important to have realistic expectations when it comes to CPR. It’s not like what you see on TV – in real life, most patients cannot be saved when their hearts stop. In fact, only around 2% of pets who receive CPR are discharged from hospital and go home. It might surprise you to know that human statistics aren’t a whole lot better.
Poor statistics don’t mean it’s not worth trying – for those 2% who make it, it was the quick (and calm) action and skill of someone that was the difference between life and death.
What to do
Basic CPR is best done by two people – one does the breathing and one does the compressions. If only one person is available, then as long as the airway is open, focus on the chest compressions.
We’ll describe CPR for two people here. Remember ABC and stay calm:
A = airway
B = breathing
C = circulation
check for arrest/unconsciousness
Look for breathing by watching the chest.
Note that a gulping or gasping type breathing is not normal breathing (it’s called agonal breathing and it means the brain has become severely oxygen deprived). It can be difficult to check for a pulse in pets, so do not automatically assume the heart has stopped (arrested) because you can’t feel one.
Make sure your pet is definitely unconscious by attempting to wake/rouse him.
Talk to him, touch him and tap your finger on the inner part of one eyelid. If there is no response, proceed to the next step.
AIRWAY – ensure an open airway
For resuscitation to have any chance of working, there must be a way for oxygen to get into the lungs. You need to check for any obstruction of the mouth/throat.
Perform what’s called a finger sweep of the throat by:
opening the mouth (if you can, wide enough so you can see in)
gently pull the tongue forward – which allows better access to the back of the throat
with the other hand, run a finger along the inside of the back teeth down toward the throat
when your finger touches the back of the throat, gentle sweep it across the throat in a hooking like motion toward the centre of the tongue
remove any foreign material*
*Note: Many people feel the epiglottis or hyoid apparatus and think it’s a bone – if you can’t remove something with a sweep, it might not be supposed to come out, so don’t forcefully remove/grab at anything that you can’t see and recognise as a foreign object. Some objects are notoriously difficult to remove without advanced techniques and equipment (eg balls and big pieces of meat). Some obstructions cannot be removed (eg a swollen throat). In the hospital we may need to perform a tracheostomy to create an airway that buys us time to treat the obstruction.
BREATHING – MOUTH to NOSE breathing
If you have successfully removed a foreign object or did not find one, start rescue breathing:
extend the head and neck and gently pull the tongue forward – this opens the airway
look inside the mouth and remove saliva or vomit, if you can’t see, do another finger sweep
watch for breathing, if you don’t see a breath within 10 seconds, start rescue breathing
close your pet’s mouth (in larger dogs, keep the tongue pulled forward) and wrap one or both hands around the muzzle to create a seal
place your mouth over your pet’s nose and blow until you see your pet’s chest expand
remove your mouth and let the lungs deflate
repeat 2 more times and then watch for breathing again
if there is still no breathing within 10 seconds, start rescue breathing again and repeat every 6 seconds (push down on the stomach between breaths to help remove any air that’s gone in). Try to coordinate with chest compressions (below)
If there is no return to spontaneous breathing or the breaths are very shallow, continue rescue breathing while someone drives you to the nearest vet.
Circulation – chest compressions
Unless you can clearly see the heart beating through the chest or can easily find a pulse, start chest compressions.
For small dogs (<10 kg) and cats:
place one or both hands around the chest
squeeze the rib cage rhythmically (100–120 beats per minute, which is the same as human CPR)
In smaller pets, we’re actually aiming to pump the heart.
For larger dogs:
place one or both hands on the chest wall (at its widest part)
press down rhythmically, aiming to move the rib cage 3–10 cm depending on the size of the dog (rate is 100–120 beats per minute)
In larger pets, we’re using the whole chest as a pump rather than the heart itself – this is much less effective. In advanced CPR, we may need to do open chest compressions on larger dogs.
Coordinating and continuing
If you have two people, give breaths during the compressions:
6 breaths per minute
100–120 compressions per minute
If you’re by yourself:
give 2 breaths after every 30 compressions
Keep going until:
you’re exhausted and can’t (it is extremely tiring, especially with bigger patients)
you get your pet to a vet and can hand over for advanced CPR
breathing and heart beats return and are strong and regular (most of the time we need to keep breathing for a pet who’s heart has started beating again)
