Contributed by: Tammy McCarty, LVT, VTS (ECC), Emergency & Critical Care Specialty Technician
To improve survival outcomes in dogs and cats that undergo cardiopulmonary arrest (CPA), the American College of Veterinary Emergency and Critical Care and the Veterinary Emergency and Critical Care Society established the Reassessment Campaign on Veterinary Resuscitation (RECOVER) initiative. The RECOVER initiative was a project involving over 100 board certified specialists that reviewed and researched data to develop a series of cardiopulmonary resuscitation (CPR) guidelines for dogs and cats. Training in how to perform CPR according to these guidelines can double our survival rate of dogs and cats that suffer cardiopulmonary arrest (meaning that they survive to leave the hospital). Currently, overall average survival rate in a hospital setting is 6-7 %, but with the correct training of these guidelines in basic and advanced life support, those numbers could increase to 20% depending on the cause of the arrest. If the cause is reversible such as an anesthetic or drug overdose the survival rate is much higher at almost 50%. Unfortunately, if it is a progressive disease that caused the arrest, such as heart disease or cancer, the chances of survival are lower than 6%.
If your pet undergoes cardiopulmonary arrest it is most important to seek professional care by those who can administer basic and advanced life support. Only be reversing the cause of the arrest will your pet have a chance of survival. You can increase the chances of survival by administering basic life support while seeking professional help. The following is how to recognize if your pet is in need of basic life support and how to administer it according to the most current RECOVER guidelines.
The ABC Assessment
The ABC assessment should take no longer than 15 seconds as any delay in starting basic life support will lower chances of survival.
It is important to rule out an airway obstruction. An obstruction will prevent effective respirations and basic life support will not be successful. The assessment should take no more than 5 seconds, although if a foreign object is obstructing the airway you may need to clear or remove the object.
- Open the mouth and pull out the tongue so you can see into the oral cavity, if your pet responds stop immediately to avoid being bit. Response indicates basic life support is not needed.
- If there is any debris or a foreign object, gently clear it, being very careful to not push it in further.
- A careful sweep of the oral cavity may reveal foreign object, masses or swellings.
If the airway if clear, the next step is to determine if the pet is breathing.
- Look at the chest and watch for the rise and fall of breathing.
- Lightly touch the chest and feel for movement.
- Place a mirror or cotton in front of the nostrils and look for fogging or movement.
Due to the low likelihood of significant injury from basic life support, current veterinary and human CPR guidelines do not recommend checking for a pulse before starting basic life support in patients that are unresponsive and not breathing. Even if the pet has a heartbeat but is not breathing, it is highly likely that it will soon progress to full cardiopulmonary arrest from lack of oxygen to the heart.
Basic Life Support
The most important part of basic life support is to re-establish blood flow. This is achieved through high quality chest compressions.
Thoracic pump theory- uses compression to push blood from the aorta in the chest to the tissues and elastic recoil pulls blood back into the pulmonary vessels of the chest. Compression is directed over the widest part of the chest. This method is best in medium to large barrel chested dogs (most dogs). Cardiac pump theory- uses direct compression of the heart to provide blood flow to the lungs and tissues, elastic recoil of the chest between compressions creates negative pressure allowing filling of the heart before the next compression. Compression is directed over the heart. To find the heart pull the elbow back and place hands over 1/3 of the distance from the bottom of the chest to the spine. This method works best in small dogs, cats and narrow keel- chested dogs like sight hounds.
- Pet positioning — Most pets should be in placed on their side. Flat chested dogs such as Bulldogs or Pugs should be placed on their back and use the thoracic pump method.
- Compression depth — 1/3 to 1/2 the width of the chest.
- Compression rate — 100 to 120 compressions per minute. Singing a song with the correct tempo such as the Bee Gees’ “Staying Alive” can help. You can download a playlist of songs with the correct tempo from the Hands Only CPR website at https://nyp.org/cpr.
- Recoil — Allow full recoil of the chest between each compression to allow for blood to return to the chest or heart.
- Cycle — 30 compressions to 2 breaths.
- Compressor rotation — After 2 minutes of compressions, if possible a new compressor should take over to reduce fatigue and lower quality of compressions.
- Compressor Posture
- One hand on top of the other with the fingers interlaced. The heel of the hand comes in to contact with the chest.
- Elbows locked.
- Shoulders directly above hands.
- Use core muscles rather that bending the elbows to reduce fatigue.
- One-handed method can be used for small cats and dogs by pulling the thumb against the palm of the hand and compressing the heart.
The next step in basic life support is to breath for the pet by using the mouth to snout method.
This training can help improve the chance of survival in a pet that has suffered cardiopulmonary arrest. Other factors that can help include knowing first aid, where to take your pet in case of an emergency and how to get there. I encourage pet owners to have advanced directives in place before an emergency happens. Unfortunately, some pets will not have a good chance of surviving CPR depending on what caused the arrest. These pets may be at the end of their life, have multiple illnesses or severely injured. We can help them die pain free and with dignity. Columbia River Veterinary Specialists is here to support you and your pets in any way we can. For more information on the RECOVER initiative go to https://recoverinitiative.org