Newborn Foal CPR: How to Resuscitate a Foal That Is Not Breathing

By Dr Duncan Houston

Most compromised newborn foals do not begin with primary cardiac arrest.

They fail to establish effective breathing, oxygen levels fall, and the heart rate then becomes dangerously slow. This matters because the first treatment for most non-breathing foals is assisted ventilation, not immediate chest compressions.

A foal that is limp, gasping or not breathing needs intervention within seconds. Drying and stimulation may be enough for a mildly depressed foal, but persistent gasping is not normal breathing and should not be watched for several minutes while hoping it improves.

Quick Answer

If a newborn foal is not breathing normally, remove any membrane from the nose, position the head and neck to open the airway, clear visible obstruction, rub the foal firmly with dry towels and call your veterinarian immediately.

If the foal has a heartbeat but is not breathing, begin assisted ventilation. Add chest compressions if there is no effective heartbeat, the heart rate is below approximately 40 beats per minute, or it remains below 60 and is not increasing after about 30 seconds of effective ventilation. Compressions should be delivered at 80 to 120 per minute while ventilation continues. (Merck Veterinary Manual)

Foal CPR Decision Guide

Foal’s condition	Immediate action
Regular breathing, heart rate above 60 and rising	Dry, monitor and allow mare-foal bonding
Not breathing or persistent gasping, heart rate above 60	Begin assisted ventilation
Heart rate 40 to 60 and increasing with ventilation	Continue ventilation and reassess frequently
Heart rate remains below 60 despite effective ventilation	Add chest compressions
Heart rate below approximately 40	Begin ventilation and chest compressions
No heartbeat or no effective pulse	Begin full CPR immediately

A heart rate below 40 may briefly occur during strong uterine contractions, but it should rapidly increase once the foal’s chest has cleared the birth canal. Persistent bradycardia after delivery requires rapid intervention. (Merck Veterinary Manual)

When Is This an Emergency?

A newborn foal requires immediate veterinary assistance if it:

• Does not begin breathing within seconds

• Continues gasping for more than approximately 30 seconds

• Has fewer than approximately 10 breaths per minute

• Has a heart rate below 60 that is not increasing

• Has no detectable heartbeat or pulse

• Is limp or unresponsive

• Has blue, grey or severely pale gums

• Does not respond to firm towel stimulation

• Was delivered following dystocia

• Was born during a red bag delivery

• Is heavily stained with meconium

• Has obvious airway, facial or chest abnormalities

• Begins breathing but remains profoundly weak

• Develops irregular, interrupted or increasingly difficult breathing

Persistent gasping is not adequate ventilation. One person should call the veterinarian while another starts the resuscitation sequence. (IVIS)

What Does a Healthy Newborn Foal Look Like?

A healthy foal may initially appear wet, awkward and mildly disoriented, but it should make rapid, continuous progress.

Time after delivery	Expected progress
Within seconds	Movement and spontaneous breathing begin
Within approximately 30 seconds	A regular breathing pattern develops
After the first minute	Heart rate is above 60 and rising
First 30 minutes	Respiratory rate may be approximately 60 to 80 per minute
Within approximately 10 minutes	A strong suckle reflex is present
Within approximately 20 minutes	Attempts to rise begin
By 1 hour	Foal should usually stand
By 2 hours	Foal should nurse effectively

Heart rate is generally closer to 80 to 130 beats per minute during the first hour after the initial transition. Respiratory rate commonly falls toward approximately 30 to 40 breaths per minute during the following hours. (IVIS)

The phrase “less than one breath or heartbeat per second” is therefore too crude to guide resuscitation. What matters is whether breathing is regular and effective, whether the chest is moving, whether the heartbeat is perfusing the foal, and whether those measurements are improving.

Not Every Non-Breathing Foal Needs Chest Compressions

This is the most important distinction in newborn foal resuscitation.

A foal can have:

• Respiratory arrest with a strong heartbeat

• Respiratory arrest with severe bradycardia

• Complete cardiopulmonary arrest

Most compromised newborn foals are initially in respiratory arrest rather than true cardiac arrest. Without ventilation, their oxygen level falls and their heart rate progressively slows.

For a foal with a heartbeat but no breathing, ventilation is the immediate priority. Almost 90% of newborn foals requiring resuscitation reportedly respond to ventilation alone without requiring compressions or advanced drugs. (Merck Veterinary Manual)

If the foal has no effective pulse, however, chest compressions should begin immediately while someone else establishes the airway and provides ventilation. High-quality compressions become the priority once true cardiac arrest has occurred. (PubMed)

Why Might a Newborn Foal Need Resuscitation?

Dystocia

A prolonged or difficult delivery can reduce oxygen delivery through:

• Umbilical cord compression

• Premature placental separation

• Prolonged uterine contractions

• Delayed delivery after placental separation

• Trauma to the foal

• Maternal exhaustion or illness

Because the equine placenta can separate rapidly during second-stage labour, a trapped foal can deteriorate quickly.

Red Bag Delivery

In a normal delivery, the first visible membrane should be thin, translucent and whitish.

A red bag delivery produces a thick, velvety red membrane because the placenta has detached before the foal has been delivered. The foal is no longer receiving adequate oxygen through the placenta.

The red membrane must be opened immediately and the foal delivered as quickly as possible while veterinary help is summoned. Delay can cause severe hypoxia, neonatal encephalopathy or death. (Merck Veterinary Manual)

Placentitis or Placental Insufficiency

Placental disease can impair oxygen and nutrient delivery before labour begins. A foal may therefore be compromised before the mare shows obvious signs of delivery.

Meconium Aspiration

A stressed fetus may pass meconium before birth and make gasping respiratory movements while still inside the uterus.

Meconium-contaminated fluid can then enter the airways, causing obstruction, inflammation and impaired oxygen exchange.

Prematurity or Dysmaturity

Premature and dysmature foals may have:

• Weak respiratory muscles

• Immature lungs

• Poor cardiovascular adaptation

• Poor temperature regulation

• Weak suckle and swallowing reflexes

• Incomplete musculoskeletal development

Caesarean Delivery or Maternal Medication

Foals delivered by caesarean section may be affected by maternal anaesthetic and sedative drugs. Some require ventilation, cardiovascular support, warming or veterinarian-administered reversal medication.

Congenital Disease

Resuscitation may fail because of an underlying problem such as:

• Severe upper airway obstruction

• Bilateral choanal atresia

• Major congenital heart disease

• Severe cleft palate

• Lung malformation

• Hydrocephalus

• Severe skeletal deformity

• Diaphragmatic hernia

Maternal illness, twinning, dystocia, placentitis, premature placental separation, meconium aspiration, sepsis and congenital abnormalities are all recognised risk factors for perinatal hypoxia and neonatal compromise. (Merck Veterinary Manual)

The First Minute: What to Do

Step 1: Start a Timer and Call for Help

Record the time of delivery.

Have one person call the veterinarian immediately while another assesses the foal. Where several people are available, assign roles:

• One person manages the mare

• One person manages the airway and ventilation

• One person assesses the heartbeat

• One person retrieves equipment and records events

Knowing whether an intervention began 30 seconds or five minutes after delivery can be clinically important later.

Step 2: Remove the Membrane From the Nose

Immediately clear the amniotic membrane from the nostrils and mouth.

A normal foal can suffocate if the intact sac remains over its face. This should be done as soon as the nose becomes accessible. (Merck Veterinary Manual)

Step 3: Position the Airway

Place the foal in sternal recumbency, lying on its chest, if possible.

Extend the head and neck into a straight, neutral position. This helps align the nasal passages, pharynx and trachea.

Do not hang the foal upside down or suspend it by the hindlimbs. This delays ventilation, restricts movement of the diaphragm and does not effectively drain fluid from the lungs. (IVIS)

Step 4: Clear Visible Obstruction

Remove visible mucus, membrane or meconium from the nostrils.

A bulb syringe or large syringe with soft tubing may be used for brief, gentle suction when material is obstructing airflow.

Do not repeatedly or aggressively suction a clear airway. Excessive suction can trigger a vagal response, worsen bradycardia and delay ventilation. Suctioning should stop once effective breathing begins. (Merck Veterinary Manual)

Step 5: Stimulate the Foal

Rub and dry the foal firmly with clean towels, concentrating on the chest, back and neck.

This provides tactile stimulation, reduces heat loss and may trigger breathing in a mildly depressed foal.

Do not:

• Slap the foal’s face

• Strike the chest

• Shake the foal

• Pour cold water over it

• Repeatedly flex the limbs

• Suspend it upside down

If firm stimulation does not produce regular breathing within seconds, move to assisted ventilation.

Step 6: Assess the Heartbeat

Place a stethoscope over the left side of the chest, immediately behind the elbow.

A femoral pulse may also be felt high on the inside of the hindlimb, although direct auscultation of the heart is usually more reliable.

Spend no more than approximately 10 seconds deciding whether a heartbeat is present. Then act according to the heart rate and whether the foal is breathing.

Brief arrhythmias can occur during the first several minutes after birth, but persistent bradycardia, absent pulses and poor perfusion are abnormal. (Merck Veterinary Manual)

How to Provide Assisted Breathing

Positive-pressure ventilation means actively moving air into the foal’s lungs.

Simply placing oxygen tubing near the nose is not enough for a foal that is not breathing. Oxygen flow can enrich inspired air in a spontaneously breathing foal, but an apnoeic foal requires actual breaths.

Preferred Method: Endotracheal Intubation

A cuffed tube placed into the trachea provides the most reliable airway and helps prevent air entering the stomach.

Nasotracheal or orotracheal intubation should be performed by:

• A veterinarian

• Veterinary staff

• Experienced breeding-farm personnel who have received practical veterinary training

Repeated unsuccessful attempts can waste critical time, damage the airway or accidentally place the tube in the oesophagus.

If trained intubation is not immediately available, use an appropriately fitted bag and mask or emergency mouth-to-nose ventilation rather than providing no breaths.

Bag-and-Mask Ventilation

Use a resuscitation bag with a mask that seals over the foal’s muzzle.

1. Position the head and neck straight.

2. Hold the mouth closed.

3. Seal the mask over both nostrils.

4. Deliver each breath over approximately one second.

5. Watch for gentle chest expansion.

6. Allow the chest to fall fully.

7. Repeat at approximately 8 to 10 breaths per minute.

Deliver only enough volume and pressure to make the chest visibly rise.

Very rapid or forceful ventilation can:

• Injure the lungs

• Inflate the stomach

• Reduce blood return to the heart

• Make CPR less effective

If the abdomen expands but the chest does not, air may be entering the stomach. Reposition the airway, improve the mask seal and have a trained person check for airway obstruction or incorrect tube placement. (Merck Veterinary Manual)

Mouth-to-Nose Ventilation

Mouth-to-nose breathing is an appropriate emergency fallback when no resuscitation bag or trained intubator is available.

1. Straighten the foal’s head and neck.

2. Keep the mouth closed.

3. Seal your mouth around one nostril.

4. Close the opposite nostril with your hand.

5. Blow until the chest gently rises.

6. Allow full exhalation.

7. Repeat at approximately 8 to 10 breaths per minute.

Use a protective barrier where one is available.

Mouth-to-nose ventilation is less controlled than bag ventilation, but it is preferable to allowing an apnoeic foal to remain without oxygen while equipment is being located. Merck specifically recognises it as an alternative when neither an endotracheal tube nor bag-mask system is immediately available. (Merck Veterinary Manual)

Oxygen or Room Air?

Do not delay ventilation because oxygen is unavailable.

Room air can be used for initial ventilation. Oxygen can be added when equipment arrives, particularly if the foal remains hypoxic or requires continued respiratory support. (Merck Veterinary Manual)

The priority is moving air into the lungs. An unused oxygen cylinder on the other side of the barn is less valuable than effective ventilation happening now.

When Should Chest Compressions Begin?

Begin chest compressions if:

• No heartbeat is detected

• No effective pulse is present

• The heart rate is below approximately 40 beats per minute

• The heart rate remains below 60 and is not increasing after approximately 30 seconds of effective ventilation

• A heartbeat can be heard but there is no meaningful perfusion

Effective ventilation means the airway is open and each breath produces visible chest movement.

Do not start compressions automatically simply because a foal is not breathing. If the heart rate is strong and increasing, concentrate on ventilation.

If no heartbeat or effective pulse is present, do not spend 30 seconds ventilating before beginning compressions. Start full CPR immediately.

How to Perform Chest Compressions

Position the Foal

Place the foal on its right side on a firm, dry surface.

Position its topline against:

• A wall

• A firmly packed bale

• Rolled towels

• Another stable support

This prevents the foal from sliding away during compressions.

Check for Rib Fractures if Feasible

Approximately 5% of newborn foals may already have fractured ribs following delivery.

Quickly palpate the chest if this can be done without delaying essential CPR. If fractures are suspected on one side, place that side down.

Do not withhold compressions from a pulseless foal because rib injury is possible. Without circulation, the foal will not survive. (Merck Veterinary Manual)

Position Your Hands

Kneel behind the foal’s back.

Place one hand over the other:

• Directly over the heart, immediately behind the elbow, or

• At the highest and widest point of the chest

Keep your elbows straight and shoulders directly above your hands.

Compression Rate

Compress the chest at:

80 to 120 compressions per minute

A practical target is close to 100 compressions per minute.

Compression Depth

Compress approximately:

40% of the chest’s width

Allow the chest to recoil completely after every compression. Do not lean continuously on the chest between compressions because the heart needs to refill. (Merck Veterinary Manual)

One Rescuer vs a CPR Team

With Two or More Rescuers

One person performs continuous chest compressions.

A second person delivers approximately 8 to 10 breaths per minute without unnecessarily interrupting compressions.

Additional people can:

• Monitor heart rate

• Prepare equipment

• Contact the veterinarian

• Record timings

• Manage the mare

• Prepare transport

With One Rescuer

Use:

30 chest compressions followed by 2 breaths

Continue this cycle until help arrives or effective circulation returns.

Rotate the Person Performing Compressions

Chest compressions are exhausting.

Where staff are available, change the person compressing every two to three minutes. Fatigue rapidly reduces compression depth and quality. (Merck Veterinary Manual)

How Often Should You Reassess?

After the first 30 to 60 seconds of compressions, reassess briefly.

Subsequent CPR rounds should last approximately two to three minutes, followed by a pause of no more than 10 seconds to assess:

• Heartbeat

• Heart rate

• Femoral pulse

• Gum colour

• Spontaneous breathing

• Movement or response

• Whether the chest is rising during ventilation

Long pauses reduce coronary and cerebral blood flow. Prepare the team so checks are brief and CPR restarts immediately when needed. (Merck Veterinary Manual)

When Can Chest Compressions Stop?

Stop compressions when the foal has:

• A regular heartbeat above 60 beats per minute

• An effective pulse

• Improving gum colour

• Improving circulation

Continue assisted ventilation if the heartbeat has returned but breathing remains inadequate.

Gradually withdraw ventilation only when the foal is producing regular spontaneous breaths and sustaining its heart rate without assistance.

One breath, one twitch or one briefly audible heartbeat is not enough reason to stop all support.

When Should CPR Be Stopped Completely?

If high-quality ventilation and chest compressions have continued for approximately 10 to 15 minutes without:

• A detectable heartbeat

• An effective pulse

• Spontaneous breathing

• Movement

• Improvement in circulation

the likelihood of successful resuscitation becomes extremely poor.

The decision should ideally be made with the veterinarian and should consider:

• Whether CPR was started immediately

• Whether ventilation was effective

• Duration of suspected oxygen deprivation

• Presence of congenital abnormalities

• Cause of the arrest

• Whether any response has occurred

Pupil appearance alone should not be used as the sole reason to stop. The more meaningful question is whether circulation or breathing has returned despite sustained, technically effective CPR. (Merck Veterinary Manual)

Advanced Drugs Are Not the First Step

Advanced resuscitation medication may be considered when a non-perfusing rhythm persists despite effective ventilation and chest compressions.

These medications require:

• Correct indication

• Weight-based dosing

• Appropriate vascular or airway access

• Ongoing rhythm assessment

• Continued high-quality CPR

Epinephrine may be used by the veterinary team, but it does not replace compressions and ventilation.

Atropine is not routinely recommended for newborn foal bradycardia because the slow heart rate is usually caused by hypoxia. Increasing the heart rate without correcting oxygen delivery can increase myocardial oxygen demand.

Doxapram is also not recommended as a substitute for ventilation because it does not reliably reverse secondary apnoea. (Merck Veterinary Manual)

The treatment for a foal that is not breathing is to breathe for it, not to search the medicine cupboard for something that might encourage it.

What Happens After the Foal Starts Breathing?

A foal that required resuscitation still needs urgent veterinary examination.

Potential complications include:

• Neonatal encephalopathy

• Seizures

• Aspiration pneumonia

• Meconium aspiration

• Persistent pulmonary hypertension

• Rib fractures

• Hypoglycaemia

• Hypothermia

• Low blood pressure

• Cardiac arrhythmias

• Acute kidney injury

• Gastrointestinal dysfunction

• Failure of passive antibody transfer

• Sepsis

Hypoxic foals can have problems involving the brain, lungs, heart, kidneys and gastrointestinal tract. A foal that looks brighter immediately after resuscitation may deteriorate several hours later. (Merck Veterinary Manual)

Immediate Post-Resuscitation Care

Keep the Foal Warm and Dry

Dry the coat thoroughly and move the foal onto clean, dry bedding.

Hypoxic foals may struggle to generate heat normally. Safe supplemental warmth may be needed, but avoid overheating or placing unprotected heat lamps close enough to cause burns. (Merck Veterinary Manual)

Maintain Sternal Positioning

Keep the foal lying on its chest where possible.

Sternal recumbency helps improve lung expansion and oxygenation compared with prolonged flat lateral recumbency.

Continue Oxygen When Needed

A foal breathing independently may still need supplemental oxygen.

Oxygen saturation, respiratory effort and blood-gas measurements help determine whether basic nasal oxygen, high-flow support or mechanical ventilation is needed.

Monitor Glucose

Newborn foals have limited energy reserves.

A foal that cannot nurse can rapidly become hypoglycaemic, which worsens weakness, neurological dysfunction and cardiovascular instability.

Assess the Ribs and Lungs

Thoracic ultrasound may be needed to detect:

• Rib fractures

• Lung collapse

• Aspiration

• Meconium-associated disease

• Pneumonia

• Pleural abnormalities

Assess Passive Immunity

A foal that required CPR may not stand or nurse promptly enough to obtain adequate colostrum.

The veterinarian should establish a plan for:

• Safe colostrum administration

• IgG testing

• Plasma transfusion if passive transfer is inadequate

Do Not Feed Until Swallowing Is Safe

Do not immediately bottle-feed a weak or recently resuscitated foal.

The foal must demonstrate:

• A strong suckle reflex

• Coordinated swallowing

• Normal tongue movement

• Adequate awareness

• No coughing during attempted nursing

• No milk or fluid from the nostrils

A weak foal may eagerly grasp a teat or bottle while still being unable to swallow safely.

Force-feeding can push milk into the lungs and cause aspiration pneumonia. A veterinarian may need to provide milk or colostrum through a correctly placed feeding tube, or use intravenous nutrition in a severely compromised foal.

Colostrum remains urgent, but it must be delivered safely.

What Should You Do With the Umbilical Cord?

Allow the cord to separate naturally when the mare rises where possible.

Do not routinely tie, clamp or cut the cord immediately. The vessels normally retract after natural separation.

If the umbilical stump is bleeding actively, apply a clean umbilical clamp or tape while the veterinarian is contacted.

Breathing and circulation take priority. Do not lose critical time treating the umbilicus while the foal remains apnoeic.

How Worried Should You Be?

Normal Transition

The foal:

• Moves and breathes within seconds

• Develops regular breathing

• Has a heart rate above 60 and rising

• Has pink gums

• Responds to stimulation

• Develops a strong suckle reflex

What to do: allow bonding, continue monitoring and arrange the routine newborn examination.

Respiratory Emergency

The foal:

• Has a heartbeat above 60

• Is not breathing

• Is only gasping

• Does not respond to drying and rubbing

What to do: begin assisted ventilation immediately. Chest compressions are not needed while the heartbeat remains effective.

Severe Bradycardia

The foal:

• Has a heartbeat below 60

• Is not breathing normally

• Remains limp or poorly responsive

What to do: begin effective ventilation. Add compressions if the heart rate is below approximately 40 or remains below 60 despite chest-moving breaths.

Cardiopulmonary Arrest

The foal:

• Has no heartbeat

• Has no effective pulse

• Is not breathing

• Is completely unresponsive

• Has blue or grey gums

What to do: begin ventilation and chest compressions immediately.

Resuscitated but Still High Risk

The foal:

• Has started breathing but remains weak

• Cannot stand or nurse

• Has abnormal respiratory effort

• Is cold

• Appears confused

• Has an irregular heart rate

• Develops tremors or seizures

What to do: continue supportive care and arrange emergency neonatal assessment or referral.

What Else Can Cause a Foal to Appear Unresponsive?

Not every weak or non-responsive newborn has simple birth asphyxia.

Important differentials include:

• Neonatal encephalopathy

• Prematurity or dysmaturity

• Sepsis

• Hypoglycaemia

• Hypothermia

• Maternal drug depression

• Meconium aspiration

• Pneumonia

• Severe anaemia or haemorrhage

• Neonatal isoerythrolysis

• Congenital airway obstruction

• Congenital heart disease

• Rib fractures

• Pneumothorax

• Diaphragmatic hernia

• Severe electrolyte or acid-base disturbance

• Major congenital neurological disease

Several problems can exist together. A foal may experience hypoxia during dystocia, inhale meconium, fail to nurse colostrum and then develop infection.

Successful CPR restores breathing and circulation. It does not identify or correct every disease that caused the arrest.

Common Mistakes During Foal CPR

Waiting Too Long to Ventilate

Firm rubbing should produce a response within seconds.

Do not spend several minutes continuing stimulation while the foal remains apnoeic or gasping.

Starting With Chest Compressions Despite a Strong Heartbeat

If the heartbeat is strong but breathing is absent, assisted ventilation is the priority.

Assuming Gasping Is Normal Breathing

Occasional open-mouth gasps do not provide reliable ventilation.

Persistent gasping beyond approximately 30 seconds requires intervention.

Hanging the Foal Upside Down

This restricts the diaphragm, delays ventilation and does not effectively remove lung fluid.

Suctioning for Too Long

Briefly remove obstructing material. Do not repeatedly suction a clear airway while oxygen levels continue falling.

Ventilating Too Fast or Too Hard

Aim for gentle chest rise at approximately 8 to 10 breaths per minute.

More air and more speed do not mean better resuscitation.

Using Oxygen Without Ventilating

Nasal oxygen cannot replace positive-pressure breaths in a foal that is not breathing.

Force-Feeding After Resuscitation

Check the suckle and swallowing reflex before offering milk.

Stopping After One Breath

Continue monitoring until the foal sustains regular breathing and circulation independently.

Having Equipment Without Training

A resuscitation bag, oxygen cylinder and endotracheal tube are only useful when someone can assemble and use them rapidly.

The first attempt at foal intubation should not happen during a red bag delivery at two in the morning.

What Should Be in a Foaling Emergency Kit?

A practical kit should include:

• Multiple clean towels

• A working stethoscope

• A watch or timer with seconds

• A bulb syringe

• A large syringe with soft suction tubing

• Clean gloves

• A bright headlamp

• A correctly sized foal resuscitation bag and mask

• A barrier for emergency mouth-to-nose ventilation

• A thermometer

• An umbilical clamp or clean umbilical tape

• Veterinary-approved umbilical antiseptic

• A laminated CPR algorithm

• Your veterinarian’s emergency number

• Referral-hospital details

• A charged phone

• A ready trailer

Farms with trained staff may also maintain:

• Cuffed nasotracheal tubes in appropriate sizes

• Syringes for inflating tube cuffs

• Portable oxygen

• Oxygen regulator and tubing

• Monitoring equipment

• Veterinarian-supplied emergency medication

Equipment should be inspected before foaling season and before every high-risk delivery. Check batteries, oxygen supply, mask fit, tubing and expiry dates.

A box labelled “foal emergency kit” is not particularly reassuring when half the contents disappeared three breeding seasons ago.

How Can You Prepare Before the Mare Foals?

Identify High-Risk Pregnancies

Higher-risk situations include:

• Placentitis

• Premature udder development

• Vulvar discharge

• Twins

• Premature labour

• Previous dystocia

• Previous red bag delivery

• Severe maternal illness

• Suspected placental insufficiency

• Planned caesarean section

• Premature, dysmature or abnormal fetus

Some mares are safer foaling at a referral hospital where ventilation, oxygen, monitoring and neonatal intensive care are immediately available.

Attend the Foaling

Someone capable of recognising dystocia and neonatal compromise should be present or watching closely enough to intervene immediately.

Record:

• Time the water breaks

• Time the foal appears

• Time of complete delivery

• First breath

• Initial heart rate

• Time standing

• Time nursing

• Time the placenta passes

Practise the Plan

Before foaling season:

• Review the CPR algorithm

• Practise locating the foal’s heartbeat

• Practise fitting the mask

• Assemble the bag correctly

• Rehearse the compression rate

• Assign staff roles

• Confirm emergency contacts

• Confirm the trailer is accessible

• Know the route to the referral hospital

Hands-on instruction from an equine veterinarian is far more valuable than trying to remember an article while kneeling in a foaling stall.

Can Foal CPR Be Prevented?

You cannot prevent every neonatal emergency, but you can reduce avoidable delays and identify high-risk foals earlier.

Practical preparation includes:

• Good pregnancy management

• Prompt investigation of placentitis

• Appropriate vaccination and nutrition

• Monitoring mares with twins or previous reproductive problems

• Attended foaling

• Immediate recognition of dystocia

• Immediate action during red bag delivery

• A working foal resuscitation kit

• Staff training

• Rapid veterinary availability

• Referral planning for high-risk mares

• Newborn examination and IgG testing

The goal is not merely having equipment.

It is having the right people, the right equipment and the correct sequence ready before the emergency begins.

Will the Foal Survive?

Outcome depends on:

• Duration of oxygen deprivation

• Whether ventilation began before cardiac arrest

• Whether high-quality compressions were started promptly

• The cause of the arrest

• Prematurity

• Meconium aspiration

• Congenital disease

• Presence of sepsis

• Extent of brain and organ injury

• Quality of post-resuscitation care

The encouraging point is that most newborn foals requiring immediate resuscitation have respiratory failure rather than established cardiac arrest, and almost 90% may respond to ventilation alone. (Merck Veterinary Manual)

Prognosis becomes more guarded when:

• No heartbeat was present at birth

• The duration of hypoxia is unknown

• Ventilation was delayed

• Compressions were required

• There is no response after 10 to 15 minutes

• Severe prematurity is present

• Congenital disease is present

• Sepsis or multiorgan dysfunction develops

• Mechanical ventilation is required

A foal that begins breathing may still recover fully, but the first successful breath is the beginning of treatment rather than the end of the emergency.

FAQs About CPR in Newborn Foals

Should I perform chest compressions if the foal is not breathing?

Not automatically. If the foal has a strong heartbeat above 60 beats per minute, provide assisted ventilation. Add compressions when no effective heartbeat is present or severe bradycardia persists despite ventilation.

How fast should I breathe for a newborn foal?

Provide approximately 8 to 10 breaths per minute. Each breath should produce gentle, visible chest expansion.

How fast should chest compressions be?

Deliver 80 to 120 compressions per minute, aiming close to 100, and allow complete chest recoil after each compression.

Can I use mouth-to-nose breathing?

Yes. It is an accepted emergency fallback when no bag-mask system or trained intubator is immediately available. Keep the mouth and opposite nostril closed and blow only until the chest rises.

How long should foal CPR continue?

If there is no heartbeat, pulse, breathing or other meaningful response after approximately 10 to 15 minutes of high-quality CPR, successful resuscitation becomes unlikely. The decision to stop should ideally involve the veterinarian.

Does a foal need a vet after successful CPR?

Yes. A resuscitated foal remains at risk of delayed brain, lung, kidney, gastrointestinal and cardiovascular complications, as well as hypoglycaemia, inadequate colostrum intake and sepsis.

Final Thoughts

Newborn foal resuscitation begins with one critical question:

Is the foal breathing, and does it have effective circulation?

If the foal has a heartbeat but is not breathing, breathe for it.

If the foal has no effective heartbeat, combine ventilation with immediate chest compressions.

The essential sequence is:

1. Remove the membrane.

2. Position and clear the airway.

3. Rub and dry the foal.

4. Assess the heartbeat quickly.

5. Begin ventilation if regular breathing does not start.

6. Add chest compressions when circulation is absent or remains dangerously slow.

7. Continue until breathing and circulation are independently sustained.

8. Arrange urgent veterinary examination after resuscitation.

Do not hang the foal upside down. Do not spend minutes suctioning. Do not force-feed a weak foal. Do not mistake gasping for effective breathing.

Most importantly, prepare before the mare foals. In an emergency measured in seconds, a rehearsed plan is worth far more than a very good article that nobody has time to finish reading.

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ASK A VET™ can help you organise a foaling emergency checklist and prepare the information your veterinarian will need, but a non-breathing newborn foal requires immediate hands-on resuscitation and emergency veterinary care.