Post-Resuscitation Care: European Resuscitation Council and ESICM Guidelines
- In ICU
- Tue, 28 Oct 2025
The 2025 European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) post-resuscitation care guidelines mark their third joint publication, updating the 2021 edition. Building on their first collaboration in 2015, the new guidelines incorporate recent scientific advances and address key aspects of post-cardiac arrest care, including post-cardiac arrest syndrome, oxygenation and ventilation management, haemodynamic goals, coronary reperfusion, temperature control, seizure management, prognostication, and long-term outcomes and rehabilitation.
The International Liaison Committee on Resuscitation (ILCOR) unites global resuscitation councils, including the AHA, ERC, HSFC, ANZCOR, RCSA, IAHF, RCA, and IRCF. Between 2000 and 2015, ILCOR reviewed resuscitation science in five-year cycles, but since 2015 it has adopted a continuous evidence evaluation process with annual Consensus on Science with Treatment Recommendations (CoSTR) updates. For the 2025 CoSTR, six ILCOR task forces conducted systematic reviews, scoping reviews, and evidence updates, with only systematic reviews, using the GRADE methodology supporting new or revised recommendations.
The 2025 adult post-resuscitation care guidelines, largely based on the advanced life support section of the 2025 ILCOR CoSTR, reflect consensus between the ERC and ESICM. ILCOR treatment recommendations were adopted when available; otherwise, guidance was developed through group discussion until agreement was reached.
The 2025 ERC–ESICM post-resuscitation care guidelines introduce several updates and refinements to the 2021 version:
- Diagnosis of cause: Coronary angiography remains first-line if ST-elevation is present; otherwise, a dual-phase whole-body CT scan (head to pelvis, including pulmonary angiography) is now prioritized.
- Airway/oxygenation: Retains 100% oxygen initially, titrating to 94–98% SpO₂, but now cautions about pulse oximetry inaccuracies in patients with darker skin tones.
- Ventilation: Normocapnia remains recommended, with added warning about hypocapnia risk in hypothermia.
- Coronary reperfusion: Suggests delaying catheterisation in out-of-hospital cardiac arrest (OHCA) without ST-elevation unless acute coronary occlusion is strongly suspected.
- Haemodynamics: Specifies a mean arterial pressure (MAP) target of >60–65 mmHg.
- Arrhythmias: Adds a new section on recurrent and refractory arrhythmias post-ROSC.
- Seizures: Clarifies management of myoclonus with benign EEG patterns and advises wake-up trials days after arrest.
- Temperature control: Replaces "targeted temperature management" with "temperature control," focusing on active fever prevention (≤37.5 °C for ≥72 h).
- ICU management: Maintains prophylactic measures but emphasises short-acting sedatives, neurological assessment, and avoidance of routine neuromuscular blockade.
- Neurological prognostication: Extends assessment to all unconscious patients (GMS ≤ 5) and specifies indicators and timing for imaging and SSEP.
- Rehabilitation: Expands guidance to include ICU-based rehabilitation, early mobilisation, delirium prevention, ICU diaries, and engagement of co-survivors.
- Organ donation: Retains recommendation and calls for registry reporting of donation activity.
- Unexplained cardiac arrest: New guidance for comprehensive diagnostic work-up, including genetic and advanced cardiac testing, and long-term follow-up.
Source: Intensive Care Medicine
Image Credit: iStock
References:
Nolan JP, Sandroni C, Cariou A et al. (2025) European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2025: post-resuscitation care. Intensive Care Med.
