Cardiopulmonary Resuscitation in Exotic Animals

Key Points

• The basic principles of cardiopulmonary resuscitation are the same for all animals. Guidelines and drug doses in non-traditional species are extrapolated from dogs and cats, however there are differences related to patient temperament, anatomy, physiology, and size.
• Preparation is essential. A “crash cart” with emergency supplies should be readily available, as well as a dosing chart for resuscitation drugs. Calculate drug doses, particularly for tiny patients that will require dilution for safe and accurate delivery. Emergency and reversal drugs can be drawn up ahead of time.
• Atropine may not be effective in the rabbit due to the presence of atropinase or high doses may be required.
• Endotracheal intubation of rabbits and many rodents is challenging. Ideally, the veterinary professional should be proficient in multiple techniques prior to presentation of the patient, however forced mask high flow oxygen ventilation may be the most successful technique in some small herbivores.
• Lower levels of oxygen or even room air delivered via a bag valve mask can be preferable in the reptile patient to stimulate respiration.
• Due to the presence of the sternal plate or keel, direct compression of the heart is impossible in birds, however sternal compression does serve to push air through the bellows-like air sac system.
• Birds and reptiles lack a diaphragm, therefore closed-chest compressions cannot utilize the thoracic pump mechanism to increase negative intrathoracic pressure.
• Small patient size means that supplemental heat and warmed fluids are required during resuscitation. Hypoglycemia is also a concern.