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Paeds Topicsacute-care-resuscitation-and-toxicology

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.

high11 referencesUpdated 23 Oct 20269 min readSource-verified · Oct 2026

Checked against its sources on 23 Oct 2026

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Target exams

RACP General PaediatricsMRCPCHABP General PediatricsRCPSC Pediatrics

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

neonateinfanttoddlerpreschoolschool-ageadolescent

Care settings

warded-acutepicunicuretrievalrural-remote

Clinical exam formats

written-only

Board mappings

  • 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
On this page

Related topics

  • Paediatric basic and advanced life support
  • Rapid sequence intubation in children
  • Septic shock resuscitation and vasoactive support
  • Altered conscious state in children
Study tools

Your progress

Saved on this device.

Practise this topic

  • Short-answer question1
  • Viva station1
  • Clinical case1

Target exams

RACP General PaediatricsMRCPCHABP General PediatricsRCPSC Pediatrics

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

neonateinfanttoddlerpreschoolschool-ageadolescent

Care settings

warded-acutepicunicuretrievalrural-remote

Clinical exam formats

written-only

Board mappings

  • 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
In one line[1][3]

High-quality CPR is the foundation of paediatric advanced life support. Give epinephrine as soon as possible for a non-shockable rhythm, and defibrillate rapidly for a shockable one. After return of circulation, the post-cardiac arrest syndrome follows: brain injury, myocardial dysfunction, a systemic ischaemia-reperfusion response and the persisting precipitating cause.

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]

Two phases, two sets of priorities[1]

During arrest, the priorities are high-quality CPR, early epinephrine for non-shockable rhythms and rapid defibrillation for shockable ones. After return of circulation, the AHA highlights preventing hyperthermia and keeping systolic and mean arterial pressure above the 10th percentile for age and sex.

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References11ShowHide
  1. [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. [2]Djakow J, Turner NM, Skellett S, et al. European Resuscitation Council Guidelines 2025 Paediatric Life Support. Resuscitation, 2025.PMID 41117571
  3. [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. [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. [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. [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. [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. [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. [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. [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. [11]Ohshimo S, Wang CH, Couto TB, et al. Pediatric timing of epinephrine doses: A systematic review. Resuscitation, 2021.PMID 33529645

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Related topics

  • Paediatric basic and advanced life support
  • Rapid sequence intubation in children
  • Septic shock resuscitation and vasoactive support
  • Altered conscious state in children