The 2025 International Liaison Committee on Resuscitation (ILCOR) Consensus on Science with Treatment Recommendations (CoSTR) Executive Summary presents a synthesis of evidence reviews and updated recommendations across six domains: Basic Life Support (BLS), Advanced Life Support (ALS), Pediatric Life Support (PLS), Neonatal Life Support (NLS), Education, Implementation and Teams (EIT), and First Aid. The document summarizes key advances and treatment recommendations developed between 2020 and 2025 to support evidence-informed global resuscitation guidelines. Major BLS updates include continued discouragement of head-up CPR outside research settings, support for dispatcher-assisted AED retrieval and use, recommendations to avoid locking public-access AED cabinets, and confirmation that CPR techniques need not be modified for obese patients. In ALS, temperature management after cardiac arrest now favors active normothermia (≤37.5°C), while double sequential external defibrillation or vector-change defibrillation may be considered for refractory ventricular fibrillation. Intravenous access remains preferred over intraosseous access for drug delivery during resuscitation, and insulin plus glucose is suggested for hyperkalemia-associated cardiac arrest. PLS recommendations expand guidance on neurological prognostication, support either compression-first or ventilation-first CPR initiation, and introduce diastolic blood pressure targets during pediatric CPR. NLS updates strengthen support for delayed cord clamping, selective cord milking, supraglottic airway use, and video laryngoscopy during neonatal resuscitation. EIT recommendations endorse post-event debriefing, CPR coaching, feedback devices, and in situ simulation training. First Aid guidance emphasizes escalating interventions for choking, encourages layperson-initiated CPR without fear of injury, supports uterine massage to reduce postpartum hemorrhage, and recommends appropriate preservation of amputated body parts for replantation. Collectively, these recommendations reflect ILCOR’s commitment to continuously integrating emerging evidence to improve resuscitation outcomes worldwide.
Berg, K. M., Bray, J. E., Djarv, T., Drennan, I. R., Greif, R., Liley, H. G., Scholefield, B. R., Atkins, D. L., Carlson, J. N., De Caen, A. R., Lavonas, E. J., Lockey, A. S., Montgomery, W. H., Morrison, L. J., Olasveengen, T. M., Rabi, Y., Sandroni, C., Schmolzer, G. M., Singletary, E. M., Welsford, M., Yeung, J., Billi, J. E., Bhanji, F., Nadkarni, V. M., Neumar, R. W., Perkins, G. D., Previdi, J. K., Escalante-Kanashiro, R., Chung, S. P., Scott, T., Stanton, D., Chakra Rao, S. S., Semeraro, F., Hoover, A. V., Morley, P. T., Nolan, J. P., Executive Summary: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations, <<CIRCULATION>>, 2025; 152 (16): S2-S22. [doi:10.1161/CIR.0000000000001361] [https://hdl.handle.net/10807/337620]
Executive Summary: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations
Sandroni, ClaudioWriting – Original Draft Preparation
;
2025
Abstract
The 2025 International Liaison Committee on Resuscitation (ILCOR) Consensus on Science with Treatment Recommendations (CoSTR) Executive Summary presents a synthesis of evidence reviews and updated recommendations across six domains: Basic Life Support (BLS), Advanced Life Support (ALS), Pediatric Life Support (PLS), Neonatal Life Support (NLS), Education, Implementation and Teams (EIT), and First Aid. The document summarizes key advances and treatment recommendations developed between 2020 and 2025 to support evidence-informed global resuscitation guidelines. Major BLS updates include continued discouragement of head-up CPR outside research settings, support for dispatcher-assisted AED retrieval and use, recommendations to avoid locking public-access AED cabinets, and confirmation that CPR techniques need not be modified for obese patients. In ALS, temperature management after cardiac arrest now favors active normothermia (≤37.5°C), while double sequential external defibrillation or vector-change defibrillation may be considered for refractory ventricular fibrillation. Intravenous access remains preferred over intraosseous access for drug delivery during resuscitation, and insulin plus glucose is suggested for hyperkalemia-associated cardiac arrest. PLS recommendations expand guidance on neurological prognostication, support either compression-first or ventilation-first CPR initiation, and introduce diastolic blood pressure targets during pediatric CPR. NLS updates strengthen support for delayed cord clamping, selective cord milking, supraglottic airway use, and video laryngoscopy during neonatal resuscitation. EIT recommendations endorse post-event debriefing, CPR coaching, feedback devices, and in situ simulation training. First Aid guidance emphasizes escalating interventions for choking, encourages layperson-initiated CPR without fear of injury, supports uterine massage to reduce postpartum hemorrhage, and recommends appropriate preservation of amputated body parts for replantation. Collectively, these recommendations reflect ILCOR’s commitment to continuously integrating emerging evidence to improve resuscitation outcomes worldwide.
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