Dog CPR: how to administer first aid properly

Can a member of the public resuscitate a collapsed dog?

The first question to answer is simple: is it possible for an untrained lay person to resuscitate a dog? The obvious answer is that it depends on what is wrong with the dog. If an animal has collapsed because of some other serious underlying disease (such as poisoning, or major trauma following a road accident), then resuscitation is unlikely to be successful. And it’s rare for an animal to collapse without a serious underlying condition. That said, there are instances where prompt actions can indeed be lifesaving.

Professional, prompt veterinary help is more likely to be lifesaving than home-made efforts to save an animal’s life, so make sure that someone phones the vet while you are getting busy on the animal, and be ready to transport the patient as rapidly as possible to wherever the vet wants you to go. The benefits of an emergency veterinary centre (with trained staff and high tech facilities) far outweigh anything that can be done in the field, other than the most short-term life saving efforts.

How do you know if a dog needs CPR?

Cardio-pulmonary arrest (CPA) is an important differential diagnosis for any animal that exhibits three key signs:

• Unconsciousness

• Lack of breathing

• Absence of a pulse or heart beat

It can be surprisingly difficult to evaluate these three signs, and the simplest way is to do three other rapid checks, based on the ABC acronym:

• Airway

• Breathing

• Circulation

It should take no more than 10 - 15 seconds to complete this assessment. If the airway is clear, breathing has ceased, and the colour of the dog’s gums is not a healthy pink colour (indicating that the circulation is not functioning normally), then it’s likely CPA has occurred, and immediate CPR is needed.

If the airway is not clear (check this by opening the dog’s mouth and peering to the back of the throat), then obviously you have to remove the obstruction (see below).

The main reason for CPR being started immediately in any suspected case is that if it’s done for a patient with CPA, it can be genuinely life saving, while if it’s done on an unresponsive patient that does not have CPA, the risk of causing harm is minimal.

How do you start giving CPR to an animal?

The basic principle of CPR goes back to the acronym used in the initial assessment: Airway, Breathing, Circulation (ABC), although circulation should be addressed first, rather than last. This means apply chest compressions as the first, most urgent action. Ventilation is a waste of time if there is no cardiac output, and studies have shown that the longer chest compressions are delayed, the worse the outcome.

How do you apply chest compressions to animals?

There are two goals of chest compressions in animals

• Getting blood flowing into the lungs to get oxygen into the blood and to eliminate carbon dioxide from the blood.

• Getting blood flowing to all vital organs to restore the cellular metabolism.

The above aims are achieved by chest compression in two ways;

1. By direct compression of the heart itself, causing its chambers to contract and expand

2. By stimulating blood flow around the chest via to the changed overall pressures inside the thorax via chest compressions

Chest compressions should be done with the animal  lying on their side, aiming to compress the chest to  1/3–½  of its width, at a rate of 100–120 compressions per minute. This basic rule applies to all species, and all sizes of animal, from dogs to cats to pigeons. The well-known tip of using the tempo of the BeeGees song  "Staying Alive" applies to animal CPR as much as to humans. It’s important to pull back after each press to let the chest rebound fully, rather than keeping the chest in the compressed position.

• In large dogs, significant force is needed for CPR to be effective: both hands should be used, with one on top of the other, the elbows should be locked, and you should lean over the animal, with your shoulders directly above your  hands.This allows the use of your own body weight and your abdominal core muscles, rather than just your arm muscles.

• For small dogs and cats (and for pigeons), the double handed method is possible, but a single-handed technique can also be used, putting your fingers underneath the chest, thumb on top, and squeezing firmly.

Airway and Breathing - Ventilation

Once regular chest compression is underway, the other two aspects of ABC can be addressed: airway and breathing, which together allow ventilation: the passage of air to and from the lungs, to improve oxygenation of the blood as well as allowing the removal of carbon dioxide.

The ideal way to achieve this is via an endotracheal tube, but this is impossible without the skills and equipment of a vet. The next best option is to carry out mouth-to-snout ventilation, (not the commonly-attempted but useless mouth-to-mouth version).

• The animal’s mouth should be firmly closed, by wrapping one hand around it

• The neck should be extended so that the muzzle follows the same line as the spine: this ensures maximal opening of the airways

• Place your mouth firmly over both nostrils, creating a seal, and blow hard so that the chest is inflated

• Look at the chest as you blow, keeping going until you see it rise as it inflates

• You should aim to keep the chest inflated for around one second

Combining chest compressions with ventilation

It’s obvious that you can’t ventilate an animal at the same time as carrying out chest compressions. The general rule is that you should carry out cycles of thirty chest compressions, then pause while you deliver two breaths. Ideally, you should keep doing this for two minutes, then let someone else take your place. It’s tiring carrying out this type of intensive procedure, and it’s important that the person doing it is fresh and focussed.

When to stop giving CPR

When you can feel a heart rate, and when the animal is breathing on its own, you can stop administering CPR. Even if the animal seems to make a full recovery, be sure to get them to the vet as soon as possible for follow up care.

How do you do CPR on a cat?

As with dogs, the chance of a cat having an emergency that is likely to be fixable via CPR is tiny: if a cat is unconscious, not breathing and lacking a pulse or heart beat, there’s a very high chance that there’s a life threatening underlying disorder. Even you manage to kick-start the cardiopulmonary system, the main issue is still likely to cause a recurrence of the crisis.

If you do wish to attempt CPR, the basic technique is identical to the procedure in a small dog: rather than compressing the chest with two hands, you use the fingers and thumb of one hand to squeeze the cat’s chest.

How do you do CPR on other animals?

The principles of CPR are identical across the species, with size being the biggest variable factor. CPR can be done on anything: from a goldfish to a mouse to an elephant. Repeated, rhythmic chest compression combined with intermittent ventilation can be adminstered to any species.

What do you do if a dog is choking?

As part of the initial ABC assessment, if the airway is obstructed, you need to remove the object that is in the way. You can normally do this by reaching in and grabbing it (e.g. a tennis ball), or if not, by pushing either side of the object through the skin, at the top of the neck/ back of the throat. In theory, the Heimlich manoeuvre can be used: this is done in a similar way to humans. With smaller dogs and cats, the animal can be suspended by the hind legs, using gravity and perhaps centrifugal force to dislodge an object.

What about first aid courses for pets?

If you want to have hands-on practice of doing CPR (on life-sized dog models), there are now many establishments offering First Aid courses for pets. Check carefully with online reviews or talk to your own vet before signing up for a course: the quality varies.