Foal CPR: How To Resuscitate a Newborn Foal in an Emergency

What to do in the first critical minutes when a foal isn’t breathing and how to give it the best chance of survival.

By Dr Duncan Houston

When a newborn foal isn’t breathing, this is a race against time.

The first few minutes after birth determine whether a foal survives, suffers complications, or dies. Most foals that fail at birth are not dying because of a primary heart problem. They are dying because they are not getting enough oxygen.

That distinction matters, because it completely changes how you should respond.

This guide explains exactly what is happening, when to act, and how to perform CPR correctly with real clinical reasoning behind each step.

Quick Answer

If a newborn foal is not breathing or only gasping, immediately clear the airway, stimulate breathing, and begin rescue breaths at about 10 breaths per minute. If the heart rate is below 60 beats per minute, add chest compressions. Call a veterinarian immediately and continue CPR until the foal stabilises or help arrives.

Why Foal CPR Is Different From Adult Horses

Foals can be resuscitated effectively, but only if you focus on the right priority first.

Foals are small enough that external chest compressions can work. Their chest wall is more flexible, and their size allows meaningful circulation to be generated with manual compression.

But the key clinical point is this:

In practice, most foals don’t start with a heart problem.
They start with a breathing problem that leads to a heart problem.

The typical sequence is:

• Failure to breathe properly

• Falling oxygen levels

• Brain depression

• Slowing heart rate

• Collapse

This is why ventilation is the priority.

When Should You Start CPR?

Do not wait for certainty. Early intervention is what saves foals.

Start immediately if you see:

• No breathing

• Gasping or irregular breathing

• Heart rate below 60 bpm

• Pale, grey, or blue gums

• Limp or poorly responsive foal

• Weak or absent suckle reflex

Decision checkpoint

• Breathing well and becoming alert → monitor closely

• Weak, gasping, or not breathing → act immediately

Waiting is one of the most common causes of poor outcomes.

What Is Happening Inside the Foal’s Body

Understanding the physiology helps you prioritise the right actions.

Before birth, oxygen comes from the placenta. After birth, the foal must rapidly switch to lung breathing.

If that transition fails:

• The lungs do not inflate properly

• Oxygen levels drop quickly

• Carbon dioxide rises

• The brain becomes suppressed

• The heart slows due to lack of oxygen

The foal is not just “weak”
It is failing to oxygenate

That is why breathing support is the first priority.

The First 60 Seconds: What Actually Saves the Foal

Speed and correct sequencing matter more than anything else.

1. Dry and Stimulate the Foal

Drying is not passive, it actively stimulates breathing.

Rub the foal vigorously with clean towels.

This helps:

• stimulate the nervous system

• trigger breathing

• improve circulation

• reduce heat loss

2. Clear the Airway

Air must be able to reach the lungs before anything else works.

• Wipe fluid from nostrils and mouth

• Extend the head and neck naturally

• Use suction if needed for obvious obstruction

Critical mistake

Do NOT hang the foal upside down

This can compress the lungs and make breathing worse.

3. Umbilical Cord Management

Only intervene if there is a real problem.

Only clamp the cord if there is active bleeding.
Otherwise, leave it intact briefly as it continues to provide blood transfer.

Artificial Respiration: The Most Important Step

If you get this right, you give the foal the best chance of survival.

What you are doing

You are delivering oxygen into the lungs to prevent brain and organ damage.

How to perform rescue breathing

• Extend the neck

• Seal over one nostril

• Deliver a breath until chest rises

• Repeat at about 10 breaths per minute

Clinical checkpoint

• Chest rises → correct

• Abdomen inflates → incorrect positioning

Reposition immediately if airflow is not effective.

Alternative methods

• Ambu bag with mask

• Oxygen supplementation if available

• Endotracheal tube (vet only)

When To Start Chest Compressions

Only start compressions when oxygen alone is not enough.

Start compressions if:

• Heart rate remains below 60 bpm

• No detectable heartbeat

• Foal remains collapsed despite ventilation

Why this matters

The heart is often slowed due to lack of oxygen.
If you don’t fix breathing, compressions alone will not solve the problem.

How To Perform Chest Compressions

Correct positioning and rhythm determine effectiveness.

• Place foal on its side

• Hands just behind the elbow

• Compress about 5 cm deep

• Rate: 80 to 100 per minute

Use a 30:2 ratio with breaths.

Reassessment rule

Check every 2 minutes:

• Heart rate

• Breathing

• Gum colour

How To Tell If CPR Is Working

Small improvements matter and should guide your next steps.

Look for:

• Spontaneous breathing

• Increasing heart rate

• Pinker gums

• Movement or reflexes

• Return of suckle reflex

Even partial improvement is a positive sign.

Severity Framework

This helps you quickly judge how urgent the situation is.

Mild

• Breathing present

• Responsive

• Heart rate adequate

Monitor closely

Moderate

• Weak breathing

• Reduced responsiveness

• Poor suckle

Support and call vet

Severe

• Gasping

• HR < 60

• Grey or blue gums

Immediate CPR

Critical

• No breathing

• No heartbeat

• Collapse

Full emergency response

When Is This an Emergency?

There is no safe delay when oxygen is compromised.

This is immediately urgent if:

• No breathing within seconds after birth

• Gasping only

• Weak or absent heartbeat

• Limp, unresponsive foal

• No improvement within minutes

What To Do Right Now

Clear, simple steps to follow under pressure.

1. Call your veterinarian

2. Dry and stimulate

3. Clear airway

4. Start rescue breathing

5. Add compressions if needed

6. Reassess every 2 minutes

7. Keep the foal warm

Post-CPR Care: The Part Most People Underestimate

Survival is only the first step. Recovery is the next challenge.

Even if the foal improves, oxygen deprivation can affect:

• brain function

• nursing ability

• organ systems

• infection risk

Monitor for 24 to 48 hours

Watch for:

• normal breathing

• strong suckle

• ability to stand

• alert behaviour

• stable temperature

Any deterioration requires immediate veterinary care.

Common Mistakes

These are the errors that most often lead to poor outcomes.

• Waiting too long to intervene

• Focusing on compressions instead of breathing

• Poor airway positioning

• Hanging the foal upside down

• Stopping CPR too early

• Not calling a vet promptly

Preparation Before Foaling

Preparation is one of the strongest predictors of survival.

Essential kit

• Towels

• Gloves

• Suction device

• Ambu bag or mask

• Stethoscope

• Warm blankets

Practical preparation

• Train your team

• Identify high-risk pregnancies

• Have vet contact ready

Frequently Asked Questions

Can CPR save a foal?

Yes, especially when started early and performed correctly.

Is breathing more important than compressions?

In most foals, yes. Oxygen delivery is the primary issue.

How long should CPR continue?

Until the foal improves, a vet takes over, or there is no response after sustained effort.

Should every foal be checked after CPR?

Yes. Post-resuscitation complications are common.

Can I perform intubation myself?

Only if trained. Focus on breathing and compressions otherwise.

Final Thoughts

The difference between survival and loss often comes down to the first few minutes.

Foal CPR is not complicated, but it is time-critical.

Focus on:

• recognising the problem early

• restoring breathing first

• acting decisively

That is what saves lives.

If you are ever unsure whether a foal is breathing normally or needs intervention, ASK A VET™ can help guide you in real time so you can act quickly and confidently.