Paeds · acute-care-resuscitation-and-toxicology
Cardiorespiratory arrest and post-arrest care
Also known as Paediatric cardiac arrest · Cardiopulmonary arrest · Return of spontaneous circulation · Post-arrest syndrome · Post-cardiac arrest syndrome · Targeted temperature management in children
Fellowship guide to paediatric cardiac arrest and post-arrest care from the 2025 AHA/AAP and ERC guidelines: high-quality CPR, epinephrine timing, defibrillation energy, ECPR, temperature, blood pressure and oxygen targets after ROSC, EEG and neuroprognostication, and survivorship.
Checked against its sources on 23 Oct 2026
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Red flags
- A heart rate below 60 beats/min with cardiopulmonary compromise despite effective ventilation with oxygen needs CPR
- For a non-shockable rhythm, give epinephrine as early as possible
- For a shockable rhythm, rapid defibrillation is the priority
- Avoid central temperatures above 37.5 °C in a child who remains comatose after cardiac arrest
- Keep post-arrest systolic and mean arterial pressure above the 10th percentile for age and sex
Life stages
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- Acute and critical care
- Recognition and management of the acutely unwell child
- Paediatric emergencies including cardiac arrest
- Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Acute and critical care
- Resuscitation and post-arrest care
- Physiology of shock and perfusion
- Clinical Applications
- Acute paediatrics and resuscitation
- Management of the arrested and post-arrest child
- Short Cases
- Critical care and resuscitation scenarios
- Communication with families after cardiac arrest
- 6. Acute and emergency care
- Level 2: Manages cardiorespiratory arrest and post-arrest care
- Patient management in critical illness
- Applied Knowledge in Practice (AKP)
- Resuscitation science; paediatric life support
- Post-cardiac arrest syndrome and targeted temperature management
- Clinical
- History and management planning
- Simulation of cardiac arrest and post-arrest care
- General Pediatrics Content Outline — Domain 2: Emergency Medicine
- General Pediatrics Content Outline — Domain 16: Critical Care
- General Pediatrics EPA: Lead a paediatric resuscitation
- Patient Care 5: Emergency and acute care
- Patient Care 4: Clinical Reasoning
- Systems-Based Practice: critical-care teamwork and escalation
- Medical Knowledge 1: Clinical Knowledge — resuscitation
- Medical Expert
- Collaborator
- Pediatrics: Core EPA — Lead a paediatric resuscitation and manage post-arrest care
Overview & Definition
The 2025 AHA/AAP guideline covers infants and children up to 18 years, excluding newborns. It reaffirms the components of high-quality CPR: adequate compression rate and depth, minimal interruptions, full chest recoil and sufficient ventilation while avoiding excessive ventilation. [1]
Successful resuscitation results in a post-cardiac arrest syndrome, which can evolve over days to weeks after return of sustained circulation. Its components are brain injury, myocardial dysfunction, a systemic ischaemia-reperfusion response and persistent precipitating pathophysiology. [3]
References11ShowHide
- [1]Lasa JJ, Dhillon GS, Duff JP, et al. Part 8: Pediatric Advanced Life Support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 2025.PMID 41122885
- [2]Djakow J, Turner NM, Skellett S, et al. European Resuscitation Council Guidelines 2025 Paediatric Life Support. Resuscitation, 2025.PMID 41117571
- [3]Topjian AA, de Caen A, Wainwright MS, et al. Pediatric Post-Cardiac Arrest Care: A Scientific Statement From the American Heart Association. Circulation, 2019.PMID 31242751
- [4]Moler FW, Silverstein FS, Holubkov R, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. The New England journal of medicine, 2015.PMID 25913022
- [5]Moler FW, Silverstein FS, Holubkov R, et al. Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children. The New England journal of medicine, 2017.PMID 28118559
- [6]Ichord R, Silverstein FS, Slomine BS, et al. Neurologic outcomes in pediatric cardiac arrest survivors enrolled in the THAPCA trials. Neurology, 2018.PMID 29884735
- [7]ICU-RESUS and Eunice Kennedy Shriver National Institute of Child Health, Human Development Collaborative Pediatric Critical Care Research Network Investigator Groups, Sutton RM, et al. Effect of Physiologic Point-of-Care Cardiopulmonary Resuscitation Training on Survival With Favorable Neurologic Outcome in Cardiac Arrest in Pediatric ICUs: A Randomized Clinical Trial. JAMA, 2022.PMID 35258533
- [8]Gardner MM, Hehir DA, Reeder RW, et al. Identification of post-cardiac arrest blood pressure thresholds associated with outcomes in children: an ICU-Resuscitation study. Critical care (London, England), 2023.PMID 37805481
- [9]Barreto JA, Weiss NS, Nielsen KR, et al. Hyperoxia after pediatric cardiac arrest: Association with survival and neurological outcomes. Resuscitation, 2022.PMID 34906621
- [10]Hoyme DB, Zhou Y, Girotra S, et al. Improved survival to hospital discharge in pediatric in-hospital cardiac arrest using 2 Joules/kilogram as first defibrillation dose for initial pulseless ventricular arrhythmia. Resuscitation, 2020.PMID 32522702
- [11]Ohshimo S, Wang CH, Couto TB, et al. Pediatric timing of epinephrine doses: A systematic review. Resuscitation, 2021.PMID 33529645