CPR for Dogs and Cats: The Current Protocol

Cardiopulmonary resuscitation in companion animals follows the RECOVER initiative guidelines, a veterinary-specific evidence base developed to standardise CPR the way human protocols have been standardised. Success depends on immediate recognition of arrest and correct compression technique matched to the animal's chest conformation.

Confirming Cardiopulmonary Arrest

Cardiac arrest removes blood flow to the brain and heart muscle itself, and chest compressions work by generating enough intrathoracic pressure change to circulate a fraction of normal cardiac output. This is why compression rate, depth and minimal interruption matter more than any single drug given during CPR.

For deep, narrow-chested dogs such as greyhounds, compressions over the widest point of the chest use the cardiac pump mechanism to directly squeeze the heart. For barrel-chested or round-chested dogs and cats, compressions over the highest point of the chest instead rely on the thoracic pump mechanism, driving overall pressure changes.

Compression Technique by Body Type

• No visible chest movement or breathing effort
• No palpable pulse on the inner thigh (femoral artery)
• Unresponsive to voice, touch or painful stimulus
• Pale, grey or blue gums with no capillary refill
• Fixed, dilated pupils that do not respond to light

Confirm arrest quickly by checking for breathing and a femoral pulse simultaneously for no more than ten seconds, since prolonged pulse-checking delays the start of compressions that are the single most important intervention.

Rescue Breathing and Compression Ratios

In the field, arrest is diagnosed clinically by absence of breathing, pulse and responsiveness; there is no time for equipment-based confirmation. At the clinic, ECG monitoring identifies the underlying rhythm, distinguishing asystole, pulseless electrical activity and ventricular fibrillation, each of which is managed differently.

Capnography, measuring exhaled carbon dioxide through an endotracheal tube, is used by veterinary teams during CPR to gauge compression effectiveness in real time and to detect return of spontaneous circulation.

Drugs and Defibrillation in Clinic

Basic life support should begin the moment arrest is confirmed, with compressions started before any attempt at rescue breathing.

• Chest compressions at 100 to 120 per minute, compressing one third to one half chest width
• Rescue breaths at 10 per minute if two rescuers are available, without pausing compressions
• Rotate compressors every two minutes to prevent fatigue-related decline in quality
• Epinephrine and atropine administered by veterinary staff based on ECG rhythm

Realistic Outcomes and When to Stop

Return of spontaneous circulation, if achieved, is followed by intensive post-arrest care including blood pressure support, oxygen therapy and monitoring for the underlying cause of arrest. Even with successful resuscitation, survival to hospital discharge in dogs and cats remains modest, reported in various studies at roughly 6 to 10 percent.

Owners who witness a home arrest should still attempt CPR while arranging transport, since even a low chance of success is better than none, but should also be prepared for a realistic conversation with their vet about prognosis if underlying disease is severe.

When to seek help urgently

• No breathing and no femoral pulse detected simultaneously
• Sudden collapse with grey or blue gums and no response
• Known cardiac disease with sudden unresponsiveness
• Any collapse during or after surgery or sedation

Begin compressions immediately if arrest is confirmed and have someone call ahead to the veterinary clinic so the team is ready on arrival, but discuss in advance with your own vet what outcomes are realistic given your pet's health history.