When and How to Perform CPR on a Dog (Cardiopulmonary Resuscitation)

CPR refers to cardiopulmonary resuscitation. This is a technique started after a dog goes into arrest, aiming to help them regain their ability to breathe, have a heartbeat, and cardiac output. That said, the most successful CPR is the one you manage to avoid needing in the first place.

Of course, this is a procedure only carried out in emergencies, while waiting for the vet to arrive or on the way to a clinic. It's worth noting that ideally, this should be done by a vet. Want to learn how to do CPR? We'll explain everything in detail.

General principles of CPR

The goal of this type of massage is to achieve proper tissue perfusion by manually replicating what the heart itself would do to pump blood — and therefore oxygen — to the organs, including the lungs. The goal, then, is to get blood circulating again.

As mentioned, the best CPR is the one you manage to avoid, since survival, even when done correctly, is low. In veterinary medicine (small animals), it's estimated that the survival rate is 6-7%, while in humans it's around 17%. This is because, with luck and a well-done massage, you'll manage to move around 25% of the blood a healthy heart would move at 100%.

It's important for us to know this, and for the vet to make it clear, in case we ever need to hospitalize our animal. These patients need intensive monitoring, with vital signs (oxygen saturation, blood pressure, heart rate, temperature...) repeatedly checked and reassessed, which is why they'll be in intensive care.

In this kind of emergency, the vet will follow a protocol to control vital signs known by the acronym ABC (Airway, Breathing, Circulation).

Factors that lead to needing CPR

The examples below are situations that can lead to needing resuscitation. This technique requires at least two people, though the outcome would improve with a bigger team, since medications, fluids, etc. need to be given. These are the situations:

• Sepsis and SIRS ("systemic inflammation").
• Poisoning.
• Clotting disorders and DIC (disseminated intravascular coagulation).
• Terminal cancer.
• Multiple trauma (head injury).
• Shock.
• Lung disease.
• Heart failure.

How to know if CPR is needed

The first thing to keep in mind is that owners usually aren't medical professionals. This means our first option should always be to contact the vet. Only if they're a considerable distance away should we act, and always following their guidance.

The clinical signs of respiratory arrest are: loss of consciousness and/or absence of spontaneous breathing, possibly along with no heart sounds or palpable pulse.

So we'll need to check whether the dog is breathing or not. To do this, we'll watch whether the chest rises and falls, or bring a hand close to the nose to feel for airflow. Then we'll check for a pulse. It can be found on the inner side of the thigh, where the femoral artery is.

For someone without training in this, this can be a tricky task, since the right amount of pressure (which is light) needs to be applied over the artery to feel the pulse. If you press too hard, you'll end up feeling your own pulse. It's also possible the pulse is so faint it can't be felt.

If there's neither pulse nor breathing, the technique of choice is CPR. CPR is done differently depending on whether we're dealing with a small or large dog, which we'll explain further below.

When in doubt, CPR should be started (ideally by a vet), since if you start it and the dog wasn't actually in arrest, it's been shown there's no downside to that. However, waiting too long to start it leads to a poor outcome.

How to perform CPR (cardiopulmonary resuscitation)

Doing CPR properly isn't easy, since it requires strength, coordination, and stamina. The person doing the compressions needs to keep their shoulders in line with their arms, with the arms kept straight. As for hand placement, the right hand goes on top of the left, gripping it. With elbows locked and the animal's spine facing us, we'll apply force to the chest using our hip movement.

We need to be at a height where we don't have to bend our elbows, so with them locked, we push our weight downward. Depending on our size and the animal's, we can do this with the dog on the floor and us kneeling, or by getting up on a raised surface. Otherwise, the compressions won't be done properly.

What we're doing here is creating pressure changes in the chest to try to mimic what the heart does. With each properly done compression, we push blood out through the aorta to the rest of the body, and with each release, it returns through the vena cava.

CPR depending on breed and age

Hand placement and the dog's positioning will differ depending on the patient in front of you. So we'll distinguish positioning for large breeds, brachycephalic breeds (Bulldogs, Pugs...), and puppies.

For large-breed dogs, the dog is placed on their side and both hands are used as described above. For wide-chested brachycephalic breeds, the animal should be placed on their back, with compressions done over the breastbone.

In puppies, we'll place the animal on their side, with the left hand over the spine and the right hand cupped around both sides of the chest, with the breastbone essentially in the middle of our hand. The thumb goes on one side and the rest of the fingers on the other. Compress the chest about 1/4 to 1/3 of its total width.

That said, the mechanics are the same for every patient. The dog needs to be laid on a flat surface, with uninterrupted two-minute cycles of compressions. The rate should be 100-120 compressions per minute (mimicking the heartbeat). It becomes effective after around 60 seconds.

It's important to compress between 1/2 and 1/3 of the chest's depth, and let the chest fully re-expand after each compression in the cycle.

Done correctly, this technique is very tiring, so we'll need someone to take over each two-minute cycle. It's worth noting that no full two-minute cycle should be interrupted. Between two-minute cycles, there's a ten-second break, during which the vet team will place an IV line and assess the patient.

The success of CPR

A well-done CPR technique will only move about 25% of normal blood flow, compared to 100% in healthy patients. It also requires a lot of staff to take turns and monitor the animal. It requires veterinary techniques and equipment, such as intubation, so this technique done at home has very slim chances of survival.

On the other hand, the handling involved in CPR sometimes has side effects. The most common are broken ribs and pneumothorax (collapsed lung). But it's still better to try, even if these occur. Even with the full veterinary team needed, it's difficult, so the best approach is to try to avoid reaching these situations in the first place, through regular vet check-ups for a critical patient.