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What would you do if your pet suddenly collapsed and stopped breathing? You may know about Cardio Pulmonary Resuscitation (CPR) for people and even have training, but what about for pets?
The American College of Veterinary Emergency and Critical Care (ACVECC) recently addressed this question through an initiative called Reassessment Campaign on Veterinary Resuscitation (RECOVER).1 Experts in veterinary resuscitation collaborated with professionals from other disciplines to identify CPR methods and techniques that are optimal for animals. New guidelines were created to help veterinary professionals achieve the best possible results through prevention and preparedness, basic and advanced life support, monitoring and post-resuscitation care.
Before outlining the guidelines, it’s important to define the term CPR. It describes all efforts employed in reviving an animal in cardiac arresta sudden, sometimes temporary, cessation of function of the heart. It may begin with external chest compressions and breathing support until the animal is transferred to a veterinary facility. Hands-on training in CPR is the best way to be prepared. Veterinary professionals as well as community colleges and animal organizations offer training classes.
Below are key points for CPR for most pets:
Ensure your own safety first. Do not get bitten or scratched in the process of helping an animal. If it is resisting your efforts, it is probably not in arrest.
Watch and feel the chest for breathing. Pluck a hair and hold it at its nostrils to check for air movement.
ABC is now CAB: The previous pneumonic device ABC (Airway-Breathing-Compressions) has changed to CAB (Compressions-Airway-Breathing).2 Chest compressions are prioritized before administering breaths. This is because there is still oxygen in the blood and lungs, and immediate circulation is beneficial. Administering compressions (reestablishing blood flow) first is more likely to benefit patients compared to delaying compressions while getting control of the airway for ventilations.
Ideally, the patient should be lying on his or her right side to allow the best compression of the left side of the heart. The recommended compression rate is 100 to 120 compressions per minute (which is about two compression per second). Some human CPR instructors teach compressions at the rate of the beat to the song “Stayin’ Alive” from the movie “Saturday Night Fever.” Compressions are applied a short distance behind the forelimb on the lower part of the chest—the exact spot depends on the size and breed of dog. Depress the chest one-half to two inches per compression, again depending on the size of the dog.
Breathing may be performed mouth-to-snout (don’t get bitten!) at a ratio of two breaths for every 30 compressions.
If two people are performing CPR, they should switch roles (compressions or breathing) in two-minute cycles.
The endpoint for CPR is one of the following: a health care team takes over, the CPR provider(s) is/are exhausted or the underlying cause of arrest or concurrent problems makes survival and quality of life impossible.
In a situation in which a pet requires CPR, a trained person can perform it without the need for special equipment. However, veterinary clinic monitoring equipment, diagnostic tools and experienced medical professionals enhance the level of care. Care in the veterinary hospital may include continuing previous efforts plus tracheal (airway) intubation for ventilating, intravenous fluid support, monitoring, oxygen supplementation, diagnostic testing, etc. Veterinary professionals often use the term Cardio Pulmonary CerebralResuscitation (CPCR) to indicate the importance of cerebralof the cerebrum of the brain support and a goal of preventing cerebral consequences.
Medical dramas on television often don’t show that successful CPR is usually followed by significant aftercare or brain injury from lack of oxygen or that the majority of CPR efforts fail. When people experience cardiopulmonary arrest out of the hospital, there’s a 12 percent chance of survival.3 There are no solid figures for veterinary success rates, but they are presumed to be lower.
Fortunately, cardiac arrest is rare in pets, especially those without underlying heart disease. Dogs and cats commonly do not suffer from atherosclerosisa disease of the arteries characterized by the deposition of plaques of fatty material on their inner walls, coronary artery diseaseDamage or disease in the heart's major blood vessels, high cholesterol, high blood pressure, heart attacks and strokes by the same mechanisms prevalent in people. Primary cardiac arrest is fairly common in people as more than 350,000 people experience it annually in the U.S.<sup>4</sup>
These updated veterinary CPR guidelines offer the best chances of helping a companion animal survive cardiac arrest. One should have realistic expectations for outcomes and be aware that the underlying cause of arrest will probably require further medical care.
References:
1. http://www.acvecc-recover.org/
2. https://www.mayoclinic.org/first-aid/first-aid-cpr/basics/art-20056600 CPR-Facts-and-Stats.jsp
3. http://cpr.heart.org/AHAECC/CPRAndECC/General/UCM_477263_Cardiac-Arrest-Statistics.jsp
4. http://cpr.heart.org/AHAECC/CPRAndECC/General/UCM_477263_Cardiac-Arrest-Statistics.jsp
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