Bibliographie sur l'arrêt cardiaque

Study objectives: Ventricular fibrillation (VF) is traditionally identified on ECG but echocardiography can visualize myocardial fibrillation. The prevalence and importance of occult VF defined as a nonshockable ECG rhythm but VF by echocardiography is unknown.

Methods: In this multicenter, prospective study, emergency department patients presenting following out-of-hospital cardiac arrest were eligible for inclusion if echocardiography and ECG were performed simultaneously. Recorded echocardiography and ECG were interpreted separately by physicians blinded to all patient and resuscitation information. The primary outcome was percentage of occult VF. The secondary outcomes included survival to hospital discharge, termination of defibrillated VF, and return of spontaneous circulation (ROSC). Termination of VF is described as a postdefibrillation change in ECG rhythm to a nonshockable rhythm. Multivariate modeling accounted for confounding variables.

Results: Of 811 patients enrolled, 5.3% (95% confidence interval [CI] 3.9 to 7.1) demonstrated occult VF. An additional 24.9% (95% CI 22.1 to 28.0) demonstrated ECG VF. Of the patients with occult VF, 81.4% demonstrated ECG pulseless electrical activity (PEA) and 18.6% demonstrated ECG asystole. Occult VF was less likely to be defibrillated compared with ECG VF. Defibrillation was not significantly more likely to terminate occult VF (75.0% vs 55.6%; odds ratio [OR], 2.3; 95% CI 0.42 to 15.24). ROSC was not statistically different for occult VF compared with ECG VF (39.5% vs 24.8%; OR, 2.26; 95% CI 0.87 to 5.9). Survival to hospital discharge was no different for patients with occult VF compared with ECG VF (7.0% vs 5.4%; OR, 3.6; 95% CI 0.63 to 19.2) despite fewer defibrillation attempts for patients with occult VF.

Conclusion: Occult VF was seen in 5.3% of patients following out-of-hospital cardiac arrest. Recognizing and treating occult VF who otherwise would have been treated as PEA or asystole led to survival outcomes indistinguishable to traditionally recognized VF.

Background: The use of double external defibrillation (DED) in refractory cardiac arrest has been gaining increasing interest in recent years. Unlike traditional defibrillation, DED uses two defibrillators, either simultaneously or sequentially, to deliver shocks. This approach aims to maximize the probability of restoring normal heart rhythm when conventional techniques fail. While a number of studies have examined the use of DED in the pre-hospital setting, data on its use in the hospital setting, particularly in the emergency department, is significantly lacking.

Objective: Synthesize current knowledge on the use of DED in hospital settings, focusing on reported practices and challenges arising from its implementation. Methods: A quick review of the literature was conducted, in accordance with the methodological recommendations of the Cochrane Rapid Review Working Group (Garritty et al., 2024). Databases consulted included PubMed, MEDLINE, EMBASE, CINAHL and the Cochrane Library.

Results: The initial search identified 356 articles published between 2004 and 2024. Fifteen articles were selected, detailing 18 case reports. Analysis of the cases helped to identify the potential benefits, limitations and risks associated with the use of DED in a hospital setting.

Conclusion: DED is generally used as a last resort, after traditional methods have failed. At present, the limited robustness of available studies does not allow us to establish its efficacy in comparison to simple defibrillation. Thus, randomized controlled trials are required to confirm its efficacy. For future practice, the uniqueness of clinical cases must be taken into account, and healthcare teams must consider a risk-benefit analysis for prolonged resuscitation. Standardization of procedures will also be essential to ensure optimal use of DED.

Editorial: The International Liaison Committee on Resuscitation conducts continuous reviews of new, peer-reviewed published cardiopulmonary resuscitation science and publishes more comprehensive reviews every 5 years. The Advanced Life Support Task Force chapter of the 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations addresses all resuscitation evidence reviewed by the task force in the past year, as well as brief summaries of topics reviewed since 2020, to provide a comprehensive update. Newly updated topics this year include defibrillator pad placement, mechanical cardiopulmonary resuscitation devices, mechanical circulatory support after return of spontaneous circulation, intravenous versus intraosseous access, vasopressor choice and hemodynamic targets after return of spontaneous circulation, treatment of cardiac arrest related to hyperkalemia and opioid toxicity, and neuroprotective drugs, among others. Task Force members have assessed, discussed, and debated the certainty of the evidence based on Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task force are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task force lists priority knowledge gaps for further research.

Editorial: This executive summary provides an overview of the , which is organized around the Utstein Formula for Survival and provides updated recommendations aimed at improving survival rates and neurological outcomes following cardiac arrest. This executive summary outlines key changes, emphasizing the importance of high-quality chest compressions, early defibrillation, and the integration of advanced resuscitation techniques. These Guidelines also highlight critical post-cardiac arrest care strategies, including targeted temperature management and hemodynamic stabilization. Additionally, they stress the need for population-specific resuscitation approaches, particularly for pediatric patients, pregnant individuals, and individuals with cardiac arrest due to special circumstances. A strong focus is placed on continuous training and education for both medical professionals and lay rescuers to enhance the implementation and effectiveness of these lifesaving interventions. The 2025 Guidelines also highlight the importance of an integrated system of people, protocols, policies, and resources to achieve quality improvement in cardiac arrest care. An overview of ethical considerations relevant to emergency cardiovascular care, resuscitation, and approaches to decision-making surrounding cardiac arrest is also included. By following these updated recommendations, the American Heart Association seeks to optimize resuscitation efforts and improve patient outcomes in cardiac emergencies.

Editorial: In these guidelines, the American Heart Association provides updated guidance for resuscitation of adults and children in cardiac arrest or with a life-threatening condition due to special circumstances, including anaphylaxis, asthma, cardiac arrest in the cardiac intervention suite, cardiac arrest following cardiac surgery, drowning, electrocution, gas embolism, high-consequence respiratory pathogens, hyperkalemia, hyperthermia, hypothermia, left ventricular assist device failure, pregnancy, pulmonary embolism, and poisoning due to benzodiazepines, β-blockers, calcium channel blockers, cocaine, cyanide, digoxin and related cardiac glycosides, local anesthetic systemic toxicity, methemoglobinemia, opioids, organophosphates and carbamates, sodium channel blockers, sympathomimetics, and volatile hydrocarbons. Recommendations are also provided for alternatives to cardiopulmonary resuscitation and the use of extracorporeal membrane oxygenation for poisoned patients. Adults and children with these conditions require modification of basic life support and advanced life support. These guidelines are based on systematic evidence reviews and provide separate graded recommendations for adults and children.

Editorial: Cardiac arrest is common and deadly, affecting up to 700 000 people in the United States annually. Advanced cardiac life support measures are commonly employed to improve outcomes. This 2025 guideline on adult post-cardiac arrest care from the American Heart Association summarizes the most recent published evidence for and recommendations on several important areas of post-cardiac arrest management. Based on structured evidence reviews, guidelines are provided for initial blood pressure, oxygen, ventilation, and glucose goals. Evidence evaluating the routine use of antibiotics after return of spontaneous circulation is reviewed. The update also reviews diagnostic testing modalities, temperature control goals and duration, and the use of percutaneous coronary intervention and mechanical circulatory support in the patient resuscitated from cardiac arrest. New data regarding the detection and management of seizures have been incorporated, along with updates regarding the timing and modalities used in neuroprognostication. These guidelines now differentiate prognostication for favorable versus unfavorable outcome. New sections on the utility of advanced neuromonitoring, along with definitions and treatment options for myoclonus, are included to guide the clinician. Expanded recommendations regarding how to optimize survivorship for patients, caregivers, and rescuers are reviewed. Finally, the potential role of organ donation in the patient resuscitated from cardiac arrest is reviewed.

Editorial: Developed by the American Heart Association, these Guidelines represent the first comprehensive update of education recommendations since 2020. Incorporating the results of structured evidence reviews from the International Liaison Committee on Resuscitation, these are guidelines for the design and delivery of resuscitation training for health care professionals and lay rescuers. This update emphasizes the continuous evolution of evidence evaluation and the necessity of adapting educational strategies to local needs and diverse community demographics. Existing guidelines remain relevant unless specifically updated in this publication. Key topics that are new, are substantially revised, or have significant new literature include the use of cardiopulmonary resuscitation feedback devices in training, rapid-cycle deliberate practice, teamwork and leadership training, manikin fidelity, gamified learning, virtual and augmented reality, use of cognitive aids, stepwise training, blended learning, scripted debriefing, instructor training, alternative objects for lay rescuer chest compression training, and special considerations for training in the management of opioid overdose. How certain personal considerations may influence the overall impact of education are also reviewed, including disparities accordingly related to gender, race, socioeconomic status, and language; the impact of training for school children; and factors that act as barriers or facilitators to lay rescuer willingness to perform cardiopulmonary resuscitation. We conclude with a summary of current knowledge gaps in resuscitation education science and a discussion of future directions for optimizing the impact of resuscitation training programs.

Editorial: The is based on the extensive evidence evaluation performed in conjunction with the International Liaison Committee on Resuscitation. The Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Resuscitation, Resuscitation Education Science, Special Circumstances, Post-Cardiac Arrest Care, Ethics, and Systems of Care Writing Groups drafted, reviewed, and approved recommendations, assigning to each recommendation a Class of Recommendation (ie, strength) and Level of Evidence (ie, quality). The 2025 Guidelines are organized in knowledge chunks that are grouped into discrete modules of information on specific topics or management issues. Each chapter of the 2025 Guidelines underwent blinded peer review by subject matter experts and was also reviewed and approved for publication by the American Heart Association Science Advisory and Coordinating Committee and the American Heart Association Executive Committee. Chapters with pediatric content (Neonatal Resuscitation, Pediatric Basic and Advanced Life Support) were also co-led by the American Academy of Pediatrics, and thereby the content was reviewed and approved by the American Academy of Pediatrics Board of Directors. The American Heart Association has rigorous conflict of interest policies and procedures to minimize the risk of bias or improper influence during development of the guidelines. Anyone involved in any part of the guideline development process disclosed all commercial relationships and other potential conflicts of interest.

Editorial: In this chapter, the American Heart Association provides guidance on ethical considerations relevant to cardiopulmonary resuscitation and emergency cardiovascular care. An overview is provided of ethical frameworks that provide a structure through which difficult decisions can be analyzed. These include principlism, currently the predominant medical ethical framework, which considers moral principles of beneficence, nonmaleficence, respect for autonomy, and justice. Additional consideration is given to the value of dignity, and other ethical frameworks such as narrative ethics, crisis standards of care, utilitarianism, virtue ethics, and deontology. The importance of equity and the imperative for health care professionals and their organizations to actively address structural inequities, social determinants of health and resulting disparities related to Emergency Cardiovascular Care is highlighted. Processes for decision-making are discussed, including guidance on advance directives and shared decision-making. Decisions to initiate or withhold and subsequently to continue or terminate resuscitation are reviewed at length. In addition to considering this decision in adults and geriatric patients, specific attention is given to decision-making in children, newborn infants, and pregnant patients. The impact of prognostic uncertainty on these decisions is discussed, as well as the evaluation of potentially ineffective therapies and cultural and religious considerations. Other ethical topics are addressed briefly, including processes for research and knowledge generation; the impact of resuscitation on health care professionals, survivors, laypersons, families, and caregivers; family presence during resuscitation; crisis standards of care; advanced therapies, including extracorporeal support; and organ and tissue donation.

Editorial: Improving survival and quality of life after cardiac arrest requires integrated systems of people, protocols, policies, and resources along with ongoing data acquisition and review. Such systems of care, which are highly influenced by the environment in which they operate, produce efficiency and effectiveness in responding to cardiac arrest. Part 4 of the focuses on systems of care, emphasizing elements that are relevant to a broad range of resuscitation situations. The chapter follows the Chain of Survival, beginning with prevention and preparedness to resuscitate, proceeding to early identification of cardiac arrest, and moving to effective resuscitation through to post-cardiac arrest care, survivorship, and recovery. This Part provides cardiac arrest systems of care guidelines on how to train specific personnel, protocols that have been demonstrated to be effective, as well as the incorporation of nonhuman resources to optimize cardiac arrest care with ongoing debriefing and quality improvement strategies. Specific to out-of-hospital cardiac arrest, included are recommendations about emergency medical services team composition and transport recommendations, community initiatives to promote lay rescuer response, public access defibrillation and naloxone, and an enhanced role for emergency telecommunicators. Germane to in-hospital cardiac arrest are recommendations about cardiac arrest prevention and code team composition. Specific recommendations about extracorporeal membrane oxygenation cardiopulmonary resuscitation, transport to specialized cardiac arrest centers, organ donation, survivorship systems, and performance measurement across the continuum of resuscitation situations are also included.

Editorial: The guidelines in this document from the American Heart Association and the American Academy of Pediatrics focus upon optimal care of the newborn infant, including those who are proceeding to a normal transition from the fluid-filled uterine environment to birth. Newborn infants who are proceeding to normal transition can benefit from deferred cord clamping for at least 60 seconds in most instances, skin-to-skin with their parent soon after birth, and appropriate assistance with thermoregulation. Some newborn infants require assistance during transition, with interventions ranging from warming and tactile stimulation to advanced airway management, assisted ventilation, oxygen therapy, intravascular access, epinephrine, and volume expansion. In this context, individuals, teams, and health care settings that care for newborn infants should be prepared and have access to appropriate training and resources for neonatal resuscitation. The newborn chain of care provides guidance on considerations that may lead to optimal outcomes for newborn infants starting from prenatal care to recovery and follow-up.

Editorial: Codeveloped by the American Heart Association and the American Academy of Pediatrics, this publication presents the 2025 guidelines for basic life support during cardiopulmonary resuscitation and emergency cardiovascular care of the pediatric patient, excluding the newborn infant, and represents the first comprehensive update of treatment recommendations since 2020. Incorporating the results of structured evidence reviews from the International Liaison Committee on Resuscitation, these guidelines are for lay rescuers and health care professionals with recommendations designed to improve survival from sudden cardiac arrest and acute life-threatening cardiopulmonary problems. Existing guidelines remain relevant unless specifically updated in this publication. Topics reviewed include the initiation of cardiopulmonary resuscitation; pulse check; components of high-quality cardiopulmonary resuscitation; chest compression technique; support surfaces for cardiopulmonary resuscitation; opening the airway; coordination of shock and cardiopulmonary resuscitation; types of defibrillators or automated external defibrillators; defibrillator paddle or pad size, type, position; treatment of inadequate breathing with a pulse; and foreign-body airway obstruction. Key topics that are new, are substantially revised, or have significant new literature include the elimination of 2-finger chest compressions in infants due to ineffectiveness of achieving proper depth with a recommendation of 1-hand or 2 thumb-encircling hands technique; the immediate application and use of an automated external defibrillator with a pediatric attenuator if available for cardiac arrest; and in infants with severe foreign-body airway obstruction repeated cycles of 5 back blows alternating with 5 chest thrusts (no abdominal thrusts), and in children with severe foreign-body airway obstruction repeated cycles of 5 back blows alternating with 5 abdominal thrusts.

Editorial: The American Heart Association's 2025 Adult Basic Life Support Guidelines build upon prior versions with updated recommendations for assessment and management of persons with cardiac arrest, as well as respiratory arrest and foreign-body airway obstruction. The chapter addresses the important elements of adult basic life support including initial recognition of cardiac arrest, activation of emergency response, provision of high-quality cardiopulmonary resuscitation, and use of an automated external defibrillator. In addition, there are updated recommendations on the treatment of foreign-body airway obstruction. The use of opioid antagonists (eg, naloxone) during respiratory or cardiac arrest is incorporated into the adult basic life support algorithms, with more detailed information provided in "Part 10: Adult and Pediatric Special Circumstances of Resuscitation."

Editorial: The American Heart Association and the American Academy of Pediatrics provide these pediatric advanced life support guidelines focusing on resuscitation during cardiopulmonary resuscitation and emergency cardiovascular care. These guidelines are intended to be a resource for health care professionals to identify and treat infants and children up to 18 years of age (excluding newborn infants) in the prearrest, intra-arrest, and post-cardiac arrest states as well as select other emergency care situations. These guidelines apply to infants and children in various settings, including the community, prehospital environments, and hospital environments. Topics presented include ventilation and advanced airway strategies during cardiopulmonary resuscitation; drug administration and weight-based dosing of medications during cardiopulmonary resuscitation; energy doses for defibrillation; measuring cardiopulmonary resuscitation physiology and quality; extracorporeal cardiopulmonary resuscitation; post-cardiac arrest care related to management of core temperature, blood pressure, oxygenation/ventilation, neurologic monitoring, and seizures; neurological prognostication post-cardiac arrest; post-cardiac arrest survivorship; family presence during cardiopulmonary resuscitation; evaluation of sudden unexplained cardiac arrest; management of shock types; airway/intubation management; arrhythmia management including bradycardia and tachycardia (narrow and wide complex); treatment of myocarditis/cardiomyopathies; resuscitation of patients with single ventricle congenital heart disease; management of pulmonary hypertension; and management of traumatic cardiac arrest. Lastly, important gaps in resuscitation science knowledge are identified, aiming to encourage further scientific inquiry and provide additional evidence for future pediatric advanced life support guidelines.

Editorial: In these 2025 Advanced Life Support Guidelines, the American Heart Association provides comprehensive recommendations for the resuscitation and management of adults experiencing cardiac arrest, respiratory arrest, and life-threatening cardiovascular emergencies. Based on structured evidence reviews and the latest clinical research, these guidelines offer evidence-based strategies to optimize survival and patient outcomes. The 2025 guidelines provide guidance for the treatment of cardiac arrest, including ventricular fibrillation, pulseless ventricular tachycardia, asystole, and pulseless electrical activity, as well as peri-arrest conditions such as atrial fibrillation and flutter with rapid ventricular response. Recommendations are made for defibrillation, electrical cardioversion, advanced airway management, drug therapies, and intravenous access. Additionally, guidelines are provided for the use of double sequential defibrillation, head-up cardiopulmonary resuscitation, and point-of-care ultrasound in the advanced life support setting. Termination of resuscitation rules have been refined to guide decision-making based on the emergency medical services professional's scope of practice. Finally, these guidelines also underscore the importance of identifying causative versus secondary arrhythmias to inform the appropriate timing of therapeutic strategies.

Background: Previous studies show higher mortality for female patients with out-of-hospital cardiac arrest (OHCA) compared to males. The BOX (Blood Pressure and Oxygenation Targets in Post Resuscitation Care) trial investigated the effects of different mean arterial pressure (MAP) targets, oxygenation levels, and durations of fever control, finding no significant differences between groups.

Objectives: The purpose of this study was to explore the association between sex and mortality rates by examining both the individual and possible interactive effects of the interventions in the BOX trial for both sexes.

Methods: This two-center, randomized trial included adult comatose OHCA patients (age ≥18 years) of presumed cardiac cause. Participants were assigned to a blinded MAP target of 63 or 77 mm Hg, open-label arterial oxygen levels of 9-10 or 13-14 kPa, and fever prevention for 36 or 72 hours. The primary outcome was 1-year all-cause mortality.

Results: Of 789 comatose OHCA patients, 152 (19%) were females. The median ages of females and males were similar, 64 (51-71) years and 64 (55-73) years, respectively. Comorbidities and characteristics of the cardiac arrest were comparable between sexes except for ischemic heart disease (females: 12%, males 24%). Mortality in females was 42% and 35% in males; HR: 1.27 (95% CI: 0.96-1.69). None of the targeted interventions had a statistically significant impact on mortality for either sex. No mortality difference between sexes was observed across the interventions.

Conclusions: Among comatose patients following OHCA, no differences were observed between sexes in 1-year mortality or the efficacy of the blood pressure, oxygen, or temperature intervention.

Background: Cardiac arrest is a time-critical medical emergency during which prompt and effective drug delivery plays a key role in patient outcomes. Current resuscitation guidelines recommend intravenous (IV) access as the first-line route, with intraosseous (IO) access recommended as an alternative when IV access is delayed or not feasible. Although the endotracheal (ET) route was previously included in resuscitation protocols, it is no longer recommended. This study aims to evaluate the pharmacokinetic (PK) and pharmacodynamic (PD) effects of resuscitation drugs administered through different injection sites and under varying hemodynamic conditions in in vivo animal models.

Methods: PubMed, CENTRAL and ClinicalTrials.gov were searched up to August 2025 for studies comparing different injection sites for the same drug (adrenaline/epinephrine, amiodarone, lidocaine and vasopressin) during CPR. Study selection, data extraction, and quality assessments were performed independently by two reviewers. Frequentist random-effects models were used to calculate mean differences and odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Fourteen prospective experimental studies (sample sizes ranging from 15 to 49 animals) conducted on swine were included. For epinephrine under normovolemia, humeral IO (HIO) access achieved significantly higher maximum concentrations (C; = 0.0238) and a shorter time to the maximum concentration (T; < 0.01) compared to IV, translating into faster return of spontaneous circulation (ROSC) ( = 0.0681). Under hypovolemia, IV access proved superiority over IO for epinephrine administration (MD = +382.80 ng/mL; = 0.0022). The time to ROSC was significantly shorter with sternal IO (SIO) compared to tibial IO (TIO) ( = 0.0109). For amiodarone and vasopressin, no consistent or statistically significant differences were observed between administration routes, and in several cases, the findings were based on a single study.

Conclusion: The injection site significantly influences the PK and PD of epinephrine during cardiac arrest. Proximal IO routes may offer advantages under normovolemic conditions, while IV access appears superior in cases of hypovolemic shock. Further research is needed to guide optimal drug delivery in varying hemodynamic conditions during cardiac arrest.

Background: Automated external defibrillators (AEDs) from community first responder systems (CFR-system) are important to achieve early defibrillation in out-of-hospital cardiac arrest (OHCA). It is unclear how far community first responders (CFR) can travel to fetch and connect an AED to achieve this goal. This study aims to evaluate the relation of the distance between OHCA and the dispatched CFR-system AED and speed of AED-connection.

Methods: Within the Dutch prospective ARREST registry, OHCA patients from 2016 to 2021 with a connected CFR AED were identified. The location of each connected AED was retrieved. Straight-line distances between patient and AED-location were calculated using Google Maps. Time intervals between emergency-call and AED-connection were compared according to straight-line distances and degree of urbanization.

Results: Out of 3231 OHCAs with the CFR-system activated, 2037 (63%) patients had an AED connected before emergency medical services arrival, of which 426 by a CFR. Exact AED-locations were known in 387 OHCA (study population). Overall, the AEDs connected by a CFR where located within 949 m straight-line distance of the OHCA. AEDs connected within 6, 8, or 10 min of the emergency-call, were located within 506 m, 796 m and 838 m straight-line distance, respectively. In 44% of these cases, the CFR connected an AED to which he/she was not referred to, but taken from another address, which significantly impacted the maximal distance covered: 773 m for CFR-system referred AEDs versus 1126 m for not CFR-system referred (p = 0.001).

Conclusion: To facilitate early AED-connection (≤6 min), any address should have a CFR-system AED located within approx. 500 m.

Aim: Hypoxia may induce harmful effects in critically ill patients, potentially including pulmonary vasoconstriction. We aimed to assess the impact of two different oxygen targets on pulmonary hemodynamics in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA). Furthermore, we assessed the prevalence of pulmonary hypertension in patients with OHCA and its association with outcome.

Methods: Predefined, two-centre, prospective, double-blinded sub-study of the "Blood pressure and oxygenation targets after out-of-hospital cardiac arrest (BOX)"-trial. Patients were randomized to a restrictive oxygen target of a partial pressure of arterial oxygen (PaO) of 9-10 kPa or a liberal oxygen target of a PaO of 13-14 kPa. Invasive hemodynamic assessment was recorded from pulmonary artery catheterization and serial blood-gas analyses for an initial 48 h. The primary endpoint was the difference in pulmonary vascular resistance (PVR) within 48 h between oxygen groups using linear mixed models for repeated measures.

Results: Among 789 randomized patients, 730 (93%), who had right heart catheterization, were included in this sub-study. At admission, the median PVR, mean pulmonary artery pressure (mPAP), and pulmonary artery pulsatility index (PAPi) were 2.4 wood unit (WU) (95% CI, 1.7-3.4), 25 mmHg (95% CI, 21-30) and 1.3 (95% CI, 0.8-1.8), respectively. The average PVR in the liberal oxygen group was comparable to that of the restrictive group (mean difference 0.05 WU, 95% CI, -0.09 to 0.18, p = 0.50). MPAP, PAPi, and right atrial pressure did not differ between groups (p > 0.05). The adjusted odds ratio for one-year mortality increased progressively and linearly over a wide mPAP range. Compared with mPAP < 20 mmHg, pulmonary hypertension (mPAP > 30 mmHg) was associated with an increased risk of mortality (OR = 4.2; 95% CI, 2.0-9.2, p < 0.001).

Conclusion: Pulmonary hypertension is an independent risk factor for mortality in comatose resuscitated patients after OHCA. However, a restrictive oxygen strategy aiming at a PaO of 9-10 kPa during post-resuscitation critical care was not associated with a higher PVR or deterioration of right ventricular function compared to a liberal oxygen strategy.

Editorial: The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations (CoSTR) pubished by the International Liaison Committee on Resuscitation (ILCOR). The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation, and organ donation. The post-resuscitation care of children is described in the ERC Guidelines 2025 Paediatric Life Support.

Editorial: These European Resuscitation Council (ERC) Guidelines 2025 Adult Advanced Life Support (ALS) are based on the International Liaison Committee on Resuscitation (ILCOR) Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations (CoSTR). The evidence informing the ALS Guidelines is also included. When ILCOR has not addressed a specific topic, the ERC ALS Writing Group has provided its own guidance and the evidence supporting it. This section provides recommendations for ALS for adults with in- or out-of-hospital cardiac arrest. The ERC Guidelines 2025 ALS emphasise providing early and effective ALS interventions to improve survival from cardiac arrest in adults.

Editorial: The European Resuscitation Council has produced these ERC Guidelines 2025 Basic Life Support for adults based on the ILCOR Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations published since 2021. The topics addressed include how to recognise cardiac arrest, alerting the emergency services, delivering chest compressions, performing rescue breaths, how to use an automated external defibrillator (AED) and safety considerations for rescuers. Quality of cardiopulmonary resuscitation (CPR) and the use of technology has been embedded into the relevant sections, rather than reported separately. The management of cardiac arrests in children, infants and neonates are described in the ERC guidelines 2025 Neonatal Life Support and Paediatric Life Support.

Editorial: These Resuscitation Guidelines 2025 of the European Resuscitation Council (ERC) on Education for Resuscitation are based on the 2025 Consensus of Science with Treatment Recommendations (CoSTR) of the International Liaison Committee on Resuscitation (ILCOR), reviews of peer-reviewed literature and expert consensus. These guidelines provide directions for laypeople and healthcare professionals on teaching and learning the competencies (knowledge, skills, and attitudes) for resuscitation for in-hospital and out-of-hospital cardiac arrest of all age groups. Furthermore, the guidelines focus on technology-enhanced learning, simulation-based resuscitation education, assessment, feedback and debriefing, faculty development, and educational effects on patient outcomes.

Editorial: These European Resuscitation Council Guidelines 2025 on epidemiology of resuscitation provides key information about incidence, patients' characteristics, system organisation and outcomes for both out-of-hospital and in-hospital cardiac arrest in Europe and beyond. Information regarding patients' post survival experience and causes of cardiac arrest, including genetic factors, are also reported. Recommendations are provided to support the development of cardiac arrest registries, and improve out-of-hospital cardiac arrest (OHCA) follow-up with an emphasis on quality of life, and perform autopsy including genetic analysis in young individuals.

Editorial: These Guidelines of the European Resuscitation Council (ERC) on Ethics in Resuscitation provide evidence-informed recommendations on the ethical considerations of resuscitation, focusing on advance care planning, the involvement of bystanders and first responders, family presence during resuscitation, termination of resuscitation, and ethical considerations for systems, education, research, and low-resource settings. The recommendations in this chapter are informed by the Consensus on Science and Treatment Recommendations (CoSTR) by the International Liaison Committee on Resuscitation (ILCOR), focused reviews by the ERC Ethics Writing Group of the ERC Guidelines 2025 on Ethics in Resuscitation, and expert consensus within the writing group. We have emphasised considerations for out-of-hospital cardiac arrest, in-hospital cardiac arrest, and paediatric cardiac arrest throughout the guidelines. These guidelines aim to ensure that resuscitation decisions are made in alignment with patient values and preferences, and they emphasise the importance of a patient-centred approach to care. The Guidelines also address the balance between beneficence and autonomy, stakeholder involvement, transparency and the use of artificial intelligence in resuscitation research, and the multiple aspects for education in ethics in resuscitation.

Editorial: The 2025 European Resuscitation Council (ERC) Guidelines present the most up-to-date evidence-based guidelines for the practice of resuscitation across Europe. The ERC Guidelines 2025 are based on evidence produced by the International Liaison Committee on Resuscitation (ILCOR) in the form of systematic reviews, scoping reviews, and evidence updates, published as the ILCOR Consensus on Science with Treatment Recommendations. The certainty of evidence of these ILCOR treatment recommendations was used to issue the ERC Guidelines 2025 Recommendations. In some cases, the ERC made good practice statements when evidence was absent for certain topics. If no ILCOR review was available, the ERC writing groups conducted their own reviews to provide recommendations. The ERC Guidelines 2025 cover the epidemiology of cardiac arrest, the role that systems play in saving lives, adult basic life support, adult advanced life support, resuscitation in special circumstances, post resuscitation care, newborn resuscitation and support of transition of infants at birth, paediatric basic and advanced life support, resuscitation ethics, education for resuscitation, and first aid. These guidelines are a framework of recommendations for the approach to out-of-hospital and in-hospital resuscitation; the implementation is achieved locally taking local legislation and health care regulations into consideration.

Editorial: The European Resuscitation Council has produced these First Aid Guidelines based on the 2025 International Consensus on Science with Treatment Recommendations on First Aid of the International Liaison Committee on Resuscitation (ILCOR), reviews of the expert group composed to write these recommendations, and available selected peer-reviewed literature after discussion and agreement within this experts' group. General topics include expectations of a first aid provider, first aid courses, contents of a first aid kit, how to approach a person with impaired responsiveness, recovery position, use of a pulse oximeter and administration of oxygen. Medical emergencies include anaphylaxis, choking, asthma, chest pain, hypoglycaemia, opioid overdose, recognition of stroke, and suicidal thoughts. Trauma-related emergencies include cervical spinal motion restriction, control of life-threatening bleeding, management of open chest wounds, concussion and preservation of an amputated body part. Environmental emergencies include drowning, hypothermia, hyperthermia and snake bite. First aid procedures for the prevention and management of life-threatening conditions that could progress to cardiac arrest, have been included. The management of cardiac arrest is described in the 2025 ERC Guidelines Basic Life Support.

Editorial: These European Resuscitation Council (ERC) Guidelines 2025 on Newborn Life Support are based on the International Liaison Committee on Resuscitation (ILCOR) Consensus on Science with Treatment Recommendations (CoSTRs) for Neonatal Life Support. These Guidelines present a logical approach to resuscitation and support of transition to extra-uterine life, for both preterm and term newborn infants. These Guidelines include factors before birth, training and education, thermal control, management of the umbilical cord after birth, initial assessment, airway, breathing and circulation assessment and interventions, emergency vascular access, low resource and out of hospital settings, communication with parents, and considerations on withholding and discontinuing life sustaining treatments. Life support guidelines for older infants and children are covered in the ERC Guidelines 2025 Paediatric Life Support.

Editorial: These European Resuscitation Council Guidelines 2025 Paediatric Life Support (PLS) are based on the Consensus on Science with Treatment Recommendations (CoSTR) of the International Liaison Committee on Resuscitation (ILCOR) and rapid reviews performed by the ERC Writing Group Paediatric Life Support of topics not covered by ILCOR. These Guidelines provide recommendations on the prevention of cardiac arrest, basic life support, advanced life support, resuscitation in special circumstances, post-resuscitation care, prognostication, and post-discharge care in infants, children and adolescents add brackets (aged 0-18 years), but does not cover resuscitation of the neonate at birth. The recommendations have been formulated for healthcare providers who take care of children and for the general public and includes recommendations on how to implement the Guidelines and system factors. Stakeholders from a range of health care settings were involved in the Guidelines development process and the views of the community advisors representing families of paediatric cardiac arrest survivors and non-survivors were also considered.

Editorial: These European Resuscitation Council (ERC) Guidelines 2025 on Special Circumstances in Resuscitation are based on the 2025 Consensus on Science with Treatment Recommendations (CoSTR) of the International Liaison Committee on Resuscitation (ILCOR), reviews by the expert writing group and relevant peer-reviewed literature. The guideline chapter provides guidance for laypeople and healthcare professionals on the modifications required to basic and advanced life support in adults for the prevention and treatment of cardiac arrest for in-hospital and out-of-hospital cardiac arrest. The ERC Guidelines 2025 Paediatric Life Support cover the special circumstances in children.

Editorial: The European Resuscitation Council (ERC) developed the Systems Saving Lives Guidelines, based on the 2025 ILCOR Consensus on Science with Treatment Recommendations (CoSTR). These Guidelines addresses various topics including the Chain of Survival, advocacy, CPR awareness campaigns, Kids Save Lives, resuscitation in low-resource settings, social media, first responders, EMS organisation for cardiac arrest, in-hospital cardiac arrest management, cardiac arrest centres, system performance improvement, survivors and co-survivors, and new technologies and artificial intelligence.