How to Perform CPR on a Cat

Kirsten McCarthy / Cats.com

Cardiopulmonary resuscitation (CPR) is a familiar term for most. But compared to humans, there are some differences in pets for when CPR is indicated, successful, and how to actually perform it. In this article, we will discuss CPR, include steps based on the most recent RECOVER guidelines for pets, and include resources where you can get personal first aid and CPR training for pets.

Note: This article is intended only for information and education, not for current emergent situations. If you have a pet currently experiencing cardiac arrest or other form of distress, you need to transport them immediately to the nearest veterinary hospital or emergency center.

About CPR

Cardiopulmonary resuscitation (CPR) as the name suggests, involves actions to stimulate both heart function and circulation (cardio) as well as breathing and oxygenation (pulmonary). Through providing rescue breaths and chest compressions, CPR is proven in the right circumstances to reverse cardiopulmonary arrest (CPA) where breathing and the heart have both stopped.

CPR has been around for a very long time, with early methods dating all the way back to the 1500s. Early methods focused primarily on providing breathing support. It wasn’t until the late 1800s that the importance of chest compressions was discovered.

Interestingly, Rudolph Boehm first discovered the potential importance of chest compressions in 1878 with cats, showing that external compressions provided adequate circulation. It was in 1891 that Dr. Friederich Maass first advocated chest compressions in people.

Modern CPR took a long time after that to develop. It wasn’t until 1960 that rescue breaths combined with chest compressions were advocated as a standard, with the American Heart Association formally adopting CPR 3 years later.

While we most often think about CPR for people, animals played a significant role in its development. In addition to work with cats proving that chest compressions provided circulation, studies on dogs were crucial to proving that chest compressions provided adequate blood circulation to the brain until defibrillation could restart the heart on its own.

CPR has developed further since then over the decades, as more studies and data became available. In humans, this resulted in a greater focus on chest compressions over rescue breathing, at least for basic life support (BLS), until trained professionals arrive.

For a long time, CPR in pets was based solely on CPR data in people. But given some core differences between animals in people, data in pets has had to be collected separately to provide the best recommendations for our furry friends. The reasons that cardiopulmonary arrest occurs in pets is often very different from the reasons in people. Dogs and cats also come in all shapes and sizes, requiring modification of techniques depending on the type and size of the animal.

A collection of veterinary emergency and critical care specialists spearheaded an initiative in 2010 called the Reassessment Campaign on Veterinary Resuscitation (RECOVER). The goal was to collect as much data as possible for pets and help standardize CPR protocols. RECOVER guidelines were first published in 2012 and most recently updated in June of 2024.

How Successful is CPR in Cats?

There are core differences between pets and people in terms of why they develop cardiopulmonary arrest (CPA). People can develop CPA quite suddenly for a variety of reasons, while in pets underlying causes often develop over time until they reach a point where CPA occurs.

Heart disease of various types is highly prevalent in humans, and is a leading collective cause for cardiac arrest in people. In contrast, while heart disease like hypertrophic cardiomyopathy (HCM) is common in cats, cardiac arrest is a rare complication on its own. Far more common are complications like congestive heart failure (CHF) and feline arterial thromboembolism (FATE).

According to RECOVER, the survival rate in people receiving CPR who survive to discharge from the hospital is over 20%. But in dogs this number is less than 6%. In cats, it’s less than 20%, but in studies this range is extremely wide with one finding survival was only about 1% with another as high as 19%.

There are a few reasons for a lower rate of success. One is the previously mentioned differences for why CPA occurs in pets vs. people. Cats especially can hide signs of illness that may develop for weeks. When signs of concern are finally apparent to a pet owner, a disease process affecting the ability to breathe may be at a critical stage with an imminent risk for CPA.

For example, any process that causes fluid build up in (pulmonary edema) or around (pleural effusion) the lungs can progress over days or weeks. Causes can vary but include heart failure, infection, severe asthma, or cancer. By the time breathing becomes critical and cardiac arrest occurs, CPR will be ineffective without addressing fluid build-up, severe inflammation, or cancer tissue that is present.

Timing from CPA to when CPR can be initiated is also a concerning factor. In people, CPR can be initiated to some degree by bystanders, followed up by EMTs in an ambulance, then taken over by a trained hospital team. Pets must be driven to wherever the nearest veterinary hospital offering emergency services is located. Starting CPR may then be delayed. Or, CPR may be started at home, but then stopped for transit while driving to a hospital. By the time a pet arrives at a hospital, several minutes or more may have passed by which time CPR has a very low likelihood of success.

The situations where CPR can be the most successful include veterinary anesthetic procedures where intravenous access and airway access are already in place and availability of resuscitation medications are readily available.

Choking events may also have a higher rate of success, as long as the foreign object can be quickly removed and CPR started immediately. For further information on dislodging a foreign object in the mouth or throat, see our article on the Heimlich maneuver for cats.

But we do know that a standard for CPR and training has also played a significant factor in CPR success in pets. One of the main purposes of RECOVER was to develop these standards for CPR based on science and evidence for what works best. And this isn’t just for veterinary professionals but also for anyone caring for pets from pet owners to pet sitters and everyone in between.

How is CPR for Cats Different from CPR for People?

There are a couple main differences between CPR for a human and CPR for pets.

First, while there has been a change in focus in human CPR on only chest compressions especially for bystanders acting in an emergency, providing rescue breaths in pets is still a core part of CPR according to RECOVER guidelines. An exception is if there is some reason where providing breaths is not considered safe or appropriate.

Providing breaths in pet CPR does NOT involve mouth to mouth like in people, where the nose is pinched off. Instead, the pet’s mouth should be closed and breaths administered through a pet’s nostrils, providing a seal with the caregiver’s mouth.

The third difference is how chest compressions are performed. In cats, full on compressions with two hands and straight arms is too intense and could introduce trauma. This is only appropriate for medium and large sized dogs.

In cats, compressions are done only with the hands and fingers, using one of three recommended techniques that will be covered below.

Interestingly, the chest compression rate for pets is similar to what is recommended for people, which is approximately 100-120 compressions per minute.

CPR Steps

The following steps are provided based on RECOVER guidelines, the standard for CPR in pets. You can find here the full RECOVER guidelines study, updated in 2024. Keep in mind these guidelines include a lot of additional details for dogs and protocols for trained veterinary professionals.

If you are by yourself and your cat is not responsive, starting CPR may be lifesaving. However, it can also delay other care that may be needed. The best scenario is to call for help, even from a friend or neighbor, so that one person can start CPR, while the other focuses on getting both the cat and rescuer in a vehicle and helping with transport to the closest veterinary hospital.

Note: Full CPR involves the addition of intubating the airway, gaining intravenous access to administer fluids or resuscitating medications, defibrillation if available, and evaluating for the underlying cause of cardiac arrest. CPR has a higher rate of success with these other components and a trained veterinary professional team. The steps below are intended for initial basic life support (BLS) until additional care can be provided. In the images below, Dr. Vanderhoof’s cat Annie was sedated for an imaging procedure when these photos were taken.

1. Before CPR is started, make attempts to rouse the cat. This includes shouting the cat’s name, and gently shaking them to see if they respond. If there is a response, transport the cat to the nearest veterinary hospital for further evaluation. Or, if there is concern for airway obstruction, see further details below. You may also view our article on the Heimlich maneuver in cats for further info on dislodging an airway obstruction. In an unresponsive cat, move to step 2.

For the further steps below, you need a firm surface for effective compressions (a bed or couch for example is too soft). Either move your cat to the floor or move them to a table or other flat, elevated surface that is no higher than waist height. A raised surface will also allow you to see the airway better and provide better positioning for breaths.

To ensure a cat has arrested and is non-responsive, first make attempts to rouse a cat with gentle shaking motions. Chris Vanderhoof / Cats.com

2. Check for breathing. After shaking and shouting, see if the chest rises and falls. If it does not, and you are by yourself, RECOVER recommends first checking for an airway obstruction before starting CPR. Gently open the mouth and with your finger in a hooked position, gently sweep across the back of the mouth to see if any kind of abnormal object is lodged. Be careful to use side to side sweeping motions (instead of poking motions) to avoid pushing an object further into the throat. Always be aware and careful of the risk of bite injury.

If an object is dislodged, or if no object is found but the cat is still not breathing or responsive, move to the next step of chest compressions.

RECOVER advises with single caretakers to start compressions immediately in a non-responsive, non-breathing cat before checking for pulse or heartbeat.

If you are not alone and another person is present, RECOVER advises one person immediately starting chest compressions while the second checks the airway. A heartbeat can be best checked for in a cat by wrapping your thumb and fingers over the chest where the elbow meets it. However, if you’re unsure of what you’re feeling, do not delay chest compressions.

An object lodged in the airway is one reason for cardiac arrest. Always make sure to check for something blocking the airway as CPR will be ineffective unless a lodged object is removed. Chris Vanderhoof / Cats.com

3. Chest compressions should be prioritized first over rescue breathing, and started immediately. The rate is 100-120 compressions per minute. One helpful tip is to do compressions while humming/singing a song that has the same beats per minute. An example is “Stayin’ Alive” by the Bee Gees, which has a BPM of 103. Here is a list of other songs supported by the American Red Cross to use to help time chest compressions. You can even pull up the song quickly on your phone while performing CPR if necessary.

Your goal is to compress the chest by at least ⅓ of the chest width, but no more than ½ of the chest width.

4. Chest compressions in cats can include 1 of 3 techniques. In all cases, the cat is on their side. A cat’s heart is positioned approximately where the elbow meets the chest.

To identify where to perform chest compressions, flex the cat’s arm back to a 90 degree angle. Where the elbow meets the chest is where compressions should be performed. Chris Vanderhoof / Cats.com

The three technique descriptions follow.

a. Both hands are wrapped around the circumference of the cat’s chest with both thumbs on top next to each other over the heart. Compress with both thumbs with support from fingers beneath. This technique is appropriate for a majority of cats.

For the first CPR compressions technique, both hands are wrapped around the cat’s chest with both thumbs on top. Compressions are performed only by the thumbs with the other fingers providing support. Chris Vanderhoof / Cats.com

b. One hand is positioned wrapped around the sternum with the thumb on top and other four fingers on the bottom. Compressions are performed between the flat portions of the thumb and fingers. This technique is ideal for small cats and kittens or when you need a free hand (i.e. to use your phone, etc).

For the second CPR compressions technique, only one hand is wrapped around the chest with one thumb on top. Compressions are performed only by the thumb with the other fingers providing support. Chris Vanderhoof / Cats.com

c. The heel of your dominant hand is placed over the region of the heart, compressing ⅓ to ½ of the chest width. Your non-dominant hand supports the top of the chest and back to prevent the cat from sliding back during compressions. This technique is ideal for larger-bodied cats and overweight or obese cats where wrapping the fingers around the chest is not feasible or does not provide the needed compression.

For the third CPR compressions technique, the heel of the dominant hand is used for compressions while the non-dominant hand provides stabilizing support from behind. Chris Vanderhoof / Cats.com

5. When doing compressions, make sure to allow the chest to fully rise after the compression. Only passive recoil of the chest is advised in pet CPR. Lifting the chest after compression (active compression-decompression CPR) is not recommended in pets.

6. The ratio of compressions to breaths should be 30 chest compressions followed by 2 breaths.

7. For breaths, close the cat’s mouth, and place your mouth over the cat’s nose, creating a seal over the nostrils. Provide two exhales, watching for the chest rising and falling each time. Make sure to minimize or prevent elevating the cat’s neck to provide breaths.  Exceptions to using mouth to snout rescue breaths include if a tight-fitting facemask is available for such purpose or if a disease transmission risk poses a health risk to the rescuer.

When doing CPR at home, give breaths through the cat’s nose (not mouth). Make sure to stay as flat and in line with the cat as possible (not not lift or bend the neck). Chris Vanderhoof / Cats.com

8. Repeat the cycles of 30 chest compressions followed by 2 breaths. Continue until the cat shows some signs of recovery or until you reach further professional care.

When CPR Is Not Successful and When to Stop CPR

If obtaining further care is not possible, such as in remote locations where there is no veterinary care nearby, the decision to stop CPR may be difficult. In a professional setting, we have guidelines for when to recheck for the presence of a heart beat and breathing, about every 2 minutes. And how many cycles to continue if these are not found. This also includes cycles of administering resuscitation medications.

If you’re by yourself performing CPR in a non-responsive cat, it is not unreasonable to continue attempts for up to 10 minutes. This would include approximately 15 cycles of 30 compressions and 2 breaths. CPR can be tiring. In a professional setting, we only expect one team member to provide compressions for up to 2 minutes. If someone else is available you can switch off with, this can keep the compressions consistently at the correct rate.

After doing 3-4 cycles of 30 compressions and 2 breaths (approximately 2 minutes), you can check for a heart beat by placing your fingers over the heart where the elbow meets the chest. You can also try to check for a femoral pulse by gently pressing 2-3 of your fingers into the inner thigh/groin. If you can’t detect any beat or pulse, continue for at least one more set of 3-4 cycles.

If a cat is still non-responsive, take heart that you have done your best with your circumstances and resources. In my experience, the likelihood of success of CPR in pets declines significantly after 10 minutes of continued effort. This is even in the case of more advanced techniques like airway ventilation and medications. In humans, CPR may be continued for much longer and still be successful. However, this is not the case in pets. CPR is commonly discontinued within 10-15 minutes, even in a veterinary setting.

CPR Training

This article includes guidelines based on the best evidence-based techniques provided by RECOVER. But more formal training should always be considered by any pet owner, pet sitter, or anyone who may be in a caregiver position.

RECOVER is not only for veterinary professionals. Video-based training is also provided for the general public. Better awareness and training for all can lead to better outcomes.

RECOVER offers online courses for only $35. Follow this link to register for a RECOVER CPR course for pets.

The American Red Cross also offers a Pet First Aid course for only $25, which includes information about CPR (along with other very useful first aid information). Follow this link for the American Red Cross Cat and Dog First Aid Online course.