Resuscitating Foals

Cardiopulmonary cerebral resuscitation (CPCR, previously called CPR) is the restoration of spontaneous circulation (a heart beat) with the preservation of neurologic (brain) function. The most common and immediate problem requiring CPCR is an asphyxiated foal (one with inadequate oxygenation of tissues prior to and during foaling). Clinical signs that resuscitation is needed for a newborn foal include the absence of breathing; irregular gasping; respiratory rate less than 10 breaths/minute; irregular or absent heart rate, or one less than 40 beats/
minute; muscle flaccidity; and no responsiveness to tactile stimulation. Foals delivered by cesarean section often need CPCR.

The concept of the ABCs is important: A--airway; B--breathing; C--circulation.

Airway--The first step is to clear the airway and remove membranes and mucus from the nose. If this does not work, the airway can be suctioned with a bulb syringe (like a turkey baster) or a 60-mL syringe and rubber tubing. Don't worry about suctioning the mouth because horses are obligate nasal breathers (they do not breathe through their mouths). Vigorous rubbing with dry towels can provide tactile stimulation and initiate breathing. Slapping, shaking, spanking, and holding the foal upside down are strongly advised against in horses (and humans). If the umbilicus is still actively bleeding, hemostats should be clamped to it. If the bleeding is slight or is decreasing, clamping should be avoided.

Breathing--If spontaneous breathing and a normal heart rate have not been established in the first 30 seconds after birth, the foal should be placed on his side on a hard surface with adequate access to the head and thorax (chest). Until your veterinarian can arrive, use either mouth-to-nose resuscitation or a pump and mask resuscitator for ventilation. With mouth-to-nose ventilation, the neck should be extended, the nostrils cleared, the nostril facing down covered, and a breath delivered to the nostril facing up approximately 20-30 times per minute (every two to three seconds). The size of the breaths should be sufficient to cause the foal's chest to visibly expand. The pump and mask resuscitator carries a significant risk of inflating the stomach with air; ask your veterinarian to show you how to avoid this.

Check for spontaneous breathing and heart rate every 30-60 seconds, but do not stop CPCR for longer than 10 seconds to assess the foal. Ventilation can be stopped when the heart rate is above 80 beats/minute and spontaneous respiration is well established.

Circulation--Chest compressions are indicated if the heart rate is below 40 beats/minute and should be instituted in foals only after the initial 15-30 seconds of ventilation and reassessment of heart rate. The foal's ribs should be checked for fractures before starting ventilation. Feel over the chest with your hands while applying gentle pressure. If there's a marked indentation or a displacement of the ribs, then at least one is most likely fractured. If fractures were noted over the heart, then thoracic compressions could make the situation worse.

The individual performing compressions should kneel with his/her shoulders over the foal. The heel of one hand should be placed directly behind the triceps mass (behind and just above the elbow) at the level of the foal's shoulders with the other hand placed on top of the first hand. A rate of 100-120 compressions per minute (1.7-2 times per second) should be attempted. It's not necessary to coordinate chest compressions with breathing. Rib fractures are the most common complication, followed by lung and heart bruising. Monitor a central pulse, heart rate, and pupil size every two to three minutes during compressions. (A dilated pupil is indicative of severe oxygen deprivation and circulation collapse.)

With CPCR in humans, the success rate is between 10-15%; in veterinary medicine, the success is less than 10%. Resuscitation is only the beginning. Owners must realize that the initial event causing respiratory or cardiac arrest as well as hypoxia (reduction of oxygen supply to tissues) that occurs during arrest can cause more problems for the foal. It is thus appropriate to refer a resuscitated foal to an intensive care facility for further evaluation.

About the Author

Nathan M. Slovis, DVM, Dipl. ACVIM, CHT

Nathan M. Slovis DVM, Dipl. ACVIM, CHT, received his DVM from Purdue University. He is board certified in large animal internal medicine and he is currently the Director of the McGee Medical Center at Hagyard Equine Medical Institute in Lexington, Ky. His special interests are in neonatology, infectious diseases, and hyperbaric medicine (in which he is certfied as a hyperbaric technologist).

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