18 Feb, 2025
Cardiorespiratory arrest in cats and dogs is an emergency with a bleak prognosis. In fact, less than one in ten animals are fortunate enough to survive.1 The survival rate is partly influenced by patient care, which is why effective cardiac massage is of crucial importance. For optimal cardiac massage:
If you suspect an animal is having a cardiorespiratory, an ABC (Airway – Breathing – Circulation) assessment of up to 10–15 seconds will allow you to quickly direct your diagnosis. If cardiorespiratory arrest cannot be ruled out, resuscitation should begin as soon as possible.
Even if short, a delay in starting a cardiac massage reduces the survival rate
Starting cardiopulmonary resuscitation on an animal that is not having an arrest poses very few risks.2-3 This is why it is recommended not to delay starting resuscitation if there an arrest is strongly suspected.
A perfectly executed massage in the heart actually provides only 30% of the original cardiac output.4 So it is clear why producing effective and animal-friendly chest compressions is essential. Height and thoracic conformation are two determining factors in the choice of massage.
Chest pump massage
This massage is for medium to large dogs with a “round” chest such as the labrador retriever, rottweiler or German shepherd. The hands are positioned on the widest part of the chest to exert compressions. The purpose of this massage is to increase intrathoracic pressure and allow blood to be ejected from the aorta to the vital organs.
Cardiac pump massage
This massage is for various types of dogs. For medium to large dogs with a deep chest (greyhound type) as well as small dogs and cats, the massage is performed in the lateral decubitus position. The hands are positioned on the heart and the compressions are directly exerted on it in order to reproduce its movements.For dogs with a large bulldog-type chest, the animal is placed in the dorsal decubitus position and compressions are performed on the sternum close to the heart.
The massage rhythm should be performed at a rate of 100 to 120 compressions per minute depending on the size of the animal.4 An experimental study has demonstrated that at a higher rate, net myocardial blood flow decreases and therefore exceeding these values is strongly discouraged.5
To ensure a good heart compression rate, you can follow the Bee Gee’s Staying Alive tempo
The force must be adapted to perform a compression of a depth of 1/3 to 1/2 of the width of the chest.4 Complete release between each compression is essential. It is therefore advisable to remove the hands from the chest between the heart compressions. Indeed, keeping your hands pressed on the chest prevents the elastic rebound of the chest and thus reduces cardiac filling.
The cardiac massage must be performed without interruption for a 2-minute cycle. Leave a rest period of 2-5 seconds between cycles.4
As important as it is, cardiac massage cannot guarantee good cardiorespiratory resuscitation on its own. The choice of injectables and their doses, ventilation, monitoring and post cardiorespiratory arrest care are all intrinsic and essential to the success of animal management.
1. Hofmeister EH, Brainard BM, Egger CM, et al: Prognostic indicators for dogs and cats with cardiopulmonary arrest treated by cardiopulmonary cerebral resuscitation at a university teaching hospital, J Am Vet Med Assoc 235(1):50-57, 2009.
2. Rittenberger JC, Menegazzi JJ, Callaway CW: Association of delay to first intervention with return of spontaneous circulation in a swine model of cardiac arrest, Resuscitation 73(1):154-160, 2007.
3. Dick WF, Eberle B, Wisser G, et al: The carotid pulse check revisited: what if there is no pulse? Criti Care Med 28(11 Suppl):N183-185, 2000.
4. Deborah C. Silverstein, Kate Hopper : Small Animal Critical Care Medecine 2nd Edition, Elsevier, 2015
5. Wolfe JA, Maier GW, Newton JR, et al: Physiologic determinants of coronary blood flow during external cardiac massage, J Thorac Cardiovasc Surg 95(3):523-532, 1988.
