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Doing CPR on a bird may seem absurd—even impossible. But animal doctors will tell you it sometimes comes with the job. “Birds are the group of animals we see the most,” says , a wildlife veterinarian with the at the Cornell University Hospital for Animals. “They encompass about 70 to 80 percent of cases every year.” Her avian patients range from Bald Eagles to hummingbirds, and about 5 percent of those she takes in need CPR.

Severe infection, poisoning, and hemorrhages can all trigger cardiac arrest in a bird. Or, it could be a simpler problem—inadvertently inhaling a seed could stop them from breathing. Many birds bearing these symptoms come through the center’s doors. “We’ll first look at the entire bird, open the mouth, clear any obstruction, try to find a pulse, then proceed,” says Abou-Madi.

Specific guidelines are still being developed for birds, so right now they are rescued in the same way a human would be—with a few adjustments. One adjustment is when to start chest compressions, since they can hurt birds, Abou-Madi says. Most birds have a massive keel bone that shields the heart, which can make stimulating the organ difficult. There’s also the risk of damaging the attached ribs if the keel is pumped too vigorously, so bird medics try to avoid pumping if possible.

If a bird isn’t breathing but still has a pulse, resuscitation alone is usually a sure fix—though this isn’t a case of mouth-to-mouth. Birds can pass diseases onto humans, so instead of breathing directly into a bird’s beak, medics use ‘intubation’. “Placing a tube inside the trachea so that we can assist and breathe for [the bird],” Abou-Madi explains. The air inflates the lungs until the animal starts inhaling again on its own.

In worst-case scenarios—when both heartbeat and breathing are absent—the situation turns into a full-on avian rescue. A bird gets laid on its back, the breathing tube is inserted, and intubation is paired with small, rapid compressions on the chest that push the keel downward towards the spine. Two people working on a bird can simultaneously do 10 breaths and 100 compressions per minute. Working alone, a medic switches between 20 compressions and two breaths.

Of course, CPR differs depending on the size of the bird. An average compression on a hummingbird would be like giving it a punch in the gut—so scale becomes important.  On an eagle, you might use four fingers, and on a hummingbird, you’d use just one. The breathing tube is similarly sized to fit. Smaller birds are intubated using only the plastic casing on a catheter, which is just a few millimeters wide.

If the measures work, the patient starts getting twitchy. “The first thing we look for is some movement of the chest. We feel for a pulse and listen to the heart,” Abou-Madi says. “If we are really successful the bird will start to regain consciousness. The eyes will start to move, and the muscles will start to tremble.” It’s miraculous, Abou-Madi says. “We have revived several birds, from eagles to finches, and seeing them being released is the best memory I have.”