TRC Guidelines.

The Tunisian Resuscitation Council (TRC) Guidelines for Resuscitation provide specific instructions for how resuscitation should be practiced, considering both ease of teaching and learning, as well as the latest scientific evidence. These guidelines have been developed by Tunisian experts and are specifically tailored to address the unique needs and practices within Tunisia.

Introduction :

The Tunisian Resuscitation Council (TRC) has begun the process of developing the Resuscitation Guidelines 2025. 

In the first phase, we will form writing groups and reach a consensus on the topics to be included in various chapters. The TRC 2025 resuscitation guidelines will be evidence-based, utilizing the evaluation process of ILCOR and/or reviews initiated by TRC Writing Groups.

The TRC Guidelines 2025 Steering Committee is also pleased to introduce a new initiative to incorporate feedback from cardiac arrest survivor organizations and patient groups into the Guidelines 2025. This initiative aims to make the guidelines more inclusive and focused on the needs of those directly impacted by cardiac arrest.

If you are connected with or know of any cardiac arrest survivor or patient organizations, you can assist us in the following ways:

  • Provide your contacts or suggest organizations by emailing the TRC at trc.tun216@gmail.com
  • Share this information within your network.

This collaboration will help create guidelines that are truly beneficial for cardiac arrest survivors and patients.

Guideline Objectives:
  • To present an evidence-based summary for the prevention and management of cardiac arrest across all age groups.
  • To highlight the significant updates in the 2025 Guidelines compared to the previous ERC guidelines.
  • To detail the process of guideline development and the management of conflicts of interest (COI).

Intended Audience:

  • Laypersons
  • Healthcare professionals
  • Stakeholders
  • Governments

Setting:

  • Out-of-hospital cardiac arrest
  • In-hospital cardiac arrest
  • Low-resource settings and remote areas

Writing Group Members:

  • Robert Greif
  • Gavin D. Perkins
  • Jan-Thorsten Gräsner
  • Federico Semeraro
  • Mike Smyth
  • Jas Soar
  • Jana Djakow
  • Marije Hogeveen
  • Carsten Lott
  • Jerry Nolan
  • Sabine Nabecker
  • Violetta Raffay
  • Therese Djärv
  • Theresa M. Olasveengen
  • Joyce Yeung
  • Natasha Spartinou
  • Kasper G. Lauridsen
  • Vix Monnelly
  • Nikolaos Nikolaou
  • Koen Monsieurs

Section Headings:

  • Key Content and Main Changes
  • Epidemiology
  • Community Response Systems and IHCA
  • Systems Saving Lives
    • Low Resource Settings
    • New Technology
    • AI
  • Basic Life Support (Adults)
    • Video-Assisted Dispatch
    • Drones
  • Advanced Life Support (Adults)
    • Anticipatory Charging
    • FONA
    • Physiology-Guided CPR
  • Pediatric Life Support (BLS & ALS)
  • Post-Resuscitation Care and Post-Discharge Care
  • Neonatal Life Support
  • Special Circumstances
    • Discontinuing/Withholding
    • Sports
    • Drowning and Water Rescue
    • ECPR
  • Post-Resuscitation Care
    • Investigating Sudden Unexplained Cardiac Arrest
    • Cardiac Arrest Centers
  • Education
    • Tailored Education for Different Providers
    • Assessment
  • Ethics
    • Ethical Challenges for Bystanders and First Responders
  • First Aid
    • Conditions Leading to Cardiac Arrest if First Aid is Not Administered

Guideline Objectives:

  • To present a summary of evidence regarding the epidemiology and outcomes of in-hospital and out-of-hospital cardiac arrest, and to examine variations in EMS organization, community response, and hospital systems across different countries.
  • To offer recommendations for the establishment of cardiac arrest registries by health systems to measure patient and system characteristics, enhance the quality of care, and improve responses to cardiac arrest.

Intended Audience:

  • Laypersons
  • Healthcare professionals
  • Stakeholders
  • Governments

Setting:

  • Out-of-hospital cardiac arrest
  • In-hospital cardiac arrest

Section Headings:

Key Content / Considerations

  • OHCA – Incidence:

    • Discuss the incidence of out-of-hospital cardiac arrest (OHCA) in Europe compared to other regions globally.

  • OHCA – Characteristics and Presenting Rhythms:

    • Evaluate the characteristics of cardiac arrests with a focus on presenting rhythms, noting differences between countries.

  • OHCA – EMS Organization:

    • Assess variations in EMS organization across countries, with particular attention to EMS response times.

  • OHCA – Community Response:

    • Analyze community response (bystanders and First Responders) in different European countries, highlighting epidemiological differences.

  • OHCA – Outcome:

    • Examine patient outcomes after OHCA in European countries and compare with other parts of the world.

  • OHCA – Pediatric Population:

    • Investigate the unique aspects of OHCA in children, focusing on incidence and outcomes.

  • IHCA – Incidence:

    • Assess the incidence of in-hospital cardiac arrest (IHCA) in European countries.

  • IHCA – Response Organization:

    • Discuss system configurations for detecting critical illness and responding to IHCA, including response times.

  • IHCA – Outcome:

    • Evaluate outcomes after IHCA, considering patient characteristics and the ILCOR Ten-Steps for IHCA.

  • Long-term Survival and Return to Society – Measurement of Outcome and Recovery:

    • Review different reporting systems for outcomes and patient recovery following cardiac arrest.

  • Long-term Survival and Return to Society – Rehabilitation and Return to Society:

    • Assess pathways for patient rehabilitation and reintegration into society post-cardiac arrest, with a focus on European countries.

  • Genetic Variants in Cardiac Arrest Patients:

    • Explore the impact of genetic and epigenetic factors on the predisposition to cardiac arrest.

  • Low Resource Settings and Remote Areas:

    • Examine the epidemiology of cardiac arrest in lower-resource settings, addressing the challenges and strategies for effective response in these areas.
 

Guideline Objective:

To provide guidance to governments, health and education system managers, healthcare professionals, teachers, students, survivor communities, and the general public on evidence-based best practices to improve survival and outcomes in cardiac arrest patients.

Intended Audience:

Individuals and groups interested or involved in resuscitation implementation.

Setting:

Communities, In-Hospital, and Out-of-Hospital.

Section Headings:

Key Content / Considerations

  • Chain of Survival & the Formula of Survival:

    • Description of the traditional chain of survival and its updated representation, highlighting essential steps and strategies to enhance cardiac arrest survival rates.

  • Measuring the Performance of Resuscitation Systems:

    • Evidence on improving survival through quality indicators and cardiac arrest management models, focusing on evaluating the effectiveness of resuscitation systems (e.g., dashboards, data registries).

  • EMS Organization in Response to Cardiac Arrest:

    • Analysis of Emergency Medical Services structures and operations during cardiac arrest, including the roles of dispatchers and the effectiveness of dispatch-assisted CPR.

  • First Responders:

    • Importance of initial responders in cardiac arrest situations, including community engagement and the use of responder apps.

  • Awareness Campaign to Promote CPR:

    • Community awareness and ERC campaign activities to increase public CPR knowledge and skills (e.g., ERHD, WRAH, UEFA, EFA).

  • Advocacy and Survivors:

    • Advocacy efforts for improved cardiac arrest management and the experiences of survivors, including laws at the EU level and survivor community awareness.

  • Kids Save Lives (KSL):

    • Training schoolchildren in CPR and first aid techniques, focusing on the KSL campaign’s impact in Europe and globally.

  • Low Resource Settings and Remote Areas:

    • Strategies to improve cardiac arrest response in resource-limited settings, including ILCOR reviews and collaborations with scientific societies.

  • Rapid Response Systems and In-Hospital Cardiac Arrest:

    • Implementation of NEWS, RRS, and MET systems to enhance survival rates, exploring hospital response systems for in-hospital cardiac arrests.

  • Cardiac Arrest Centres:

    • The role of Cardiac Arrest Centres dedicated to managing and treating cardiac arrest patients, including updates and joint statements with other scientific societies.

  • Social Media:

    • The role of social media in improving science communication and survival rates, including experiences and effective communication strategies in science and education.

  • New Technology and Artificial Intelligence:

    • The impact of emerging technologies and AI on cardiac arrest response and resuscitation efforts, including wearable devices, big data, and AI advancements.
 

Guideline Objective:

To provide evidence-based guidance to the public on the initial stages of resuscitation before advanced support is initiated.

Intended Audience:

Laypersons, first responders, healthcare professionals, Basic Life Support (BLS) and Automated External Defibrillator (AED) trainers/instructors.

Setting:

Out-of-hospital cardiac arrest.

Section Headings:

Key Content / Considerations

  • Adult BLS Sequence

    • Summary Algorithm
    • Cardiac Arrest Recognition
      • Identifying cardiac arrest; opening the airway; unconscious and abnormal breathing; agonal breathing; differentiating from epileptic seizures.

  • Alert Emergency Services

    • Summoning help; prioritizing initial tasks; using a single emergency number; utilizing a smartphone in hands-free mode.

  • Role of Dispatcher

    • Dispatcher recognition of cardiac arrest; video-assisted dispatch; dispatcher-assisted CPR; dispatching lay responders; dispatching AEDs; using AI for recognition improvement.

  • Chest Compressions

    • Delivering chest compressions (rescuer position, hand position, rate, depth, duty cycle, recoil, alternating rescuer); CPR feedback technology including smartphones and watches.

  • Rescue Breaths

    • Assessing and managing the airway; how and when to perform rescue breathing; compression-ventilation ratio.

  • AED

    • Understanding AEDs; evidence on outcomes; locating AEDs using smartphone apps; using AEDs; optimal AED placement; role of drones in AED delivery; timing of compressions before defibrillation; fully automated AEDs; AED safety; signage; in-hospital AED use; pad placement and size.

  • CPR Quality Measurement

    • Measuring rate, depth, recoil, pauses for quality care and outcomes; role of smart technology (phones/watches).

  • Safety

    • Risks to lay responders (fatigue, defibrillation, disease transmission, psychological); risks to the person receiving CPR (arrested and non-arrested); welfare of responders and bystanders; ethical challenges.

  • Foreign Body Airway Obstruction

    • Recognizing and treating airway obstructions (responsive and unresponsive); back slaps; abdominal thrusts; chest compressions; use of suction and other devices.

  • Extended Scope for Individuals with a Duty to Respond (Firefighters, Lifeguards, etc.)

    • Supraglottic airways; bag valve mask ventilation and feedback devices; mechanical CPR devices; vector change; naloxone.

  • Low Resource Settings and Remote Areas

    • Implementation, response, and practice of BLS in low-resource settings; addressing challenges and strategies for BLS in areas with limited resources or remote areas.

Guideline Objective:

These European Resuscitation Council Advanced Life Support guidelines, based on the 2025 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations, provide guidance on preventing and treating both in-hospital and out-of-hospital cardiac arrest. Adult Advanced Life Support (ALS) encompasses interventions following Basic Life Support (BLS) and Automated External Defibrillator (AED) use. BLS and AED specifics are covered in Chapter 4, with BLS continuing during and overlapping with ALS interventions. This section includes prevention and treatment of in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA), the ALS algorithm, manual defibrillation, airway management during CPR, drug delivery during CPR, and treatment of peri-arrest arrhythmias.

Intended Audience:

ALS providers.

Setting:

Any healthcare setting.

Section Headings:

Key Content / Considerations

  • Prevention of Cardiac Arrest

    • Prevention strategies for IHCA and OHCA.

  • Treatment of Cardiac Arrest

    • Management algorithms for IHCA and OHCA, including transport considerations to cardiac arrest centers.
    • ALS algorithm.
    • New in 2025: ALS for witnessed and closely monitored cardiac arrest in clinical settings.
    • New in 2025: CPR-induced consciousness.

  • Defibrillation

    • Manual vs. AED use.
    • Safe and effective defibrillation practices.
    • Energy levels and number of shocks.
    • Management of recurrent or refractory VF, including double shock.
    • Paddles vs. pads.
    • New in 2025: Anticipatory charging.
    • Waveform-guided defibrillation/monitoring during compressions.
    • Management of patients with ICDs.

  • Airway and Ventilation

    • Basic vs. advanced airway management (SGAs vs. TT, DL vs. VL).
    • Ensuring correct tube placement.
    • Optimal ventilation strategies and oxygen delivery.
    • Ventilator vs. bag ventilation.
    • New in 2025: FONA (front of neck access).

  • Drugs and Fluids

    • Administration routes (IV, IO, IM).
    • Use of vasopressor drugs (adrenaline, vasopressin, noradrenaline).
    • Antiarrhythmic drugs (amiodarone, lidocaine, beta-blockers).
    • Thrombolytic drugs.
    • Fluid options (crystalloid, colloid, blood/blood products).
    • Other drugs (steroids, calcium, magnesium, bicarbonate, atropine).

  • Monitoring and Investigations during ALS

    • Use of waveform capnography and ultrasound imaging.
    • New in 2025: Physiology-guided CPR (including continuous arterial BP).
    • New in 2025: Brain monitoring (NIRS, EEG).

  • Devices

    • Mechanical chest compression devices.
    • Impedance threshold devices (ITD).
    • New in 2025: Head-up CPR (overlapping with BLS).
    • New in 2025: Ventilators with synchronized compressions.
    • New in 2025: REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta).
    • New in 2025: Intra-arrest cooling (overlapping with post-resuscitation care).

  • ECPR

    • Alignment with ERC, Euro ELSO, ESICM guidelines.

  • Peri-arrest Arrhythmias

    • Management algorithms for tachycardia and bradycardia.

  • Organ Donation

    • Considerations for ‘uncontrolled’ organ donation after circulatory death.

  • Debriefing

    • Importance of debriefing in post-resuscitation care and system improvements.

  • Duration of ALS / Termination of Resuscitation

    • Guidelines for deciding when to terminate ALS efforts.

  • Low Resource Settings and Remote Areas

    • Recommendations for implementing ALS in resource-limited and remote settings, addressing challenges and strategies.
 

Guideline Objective:

To provide evidence-based guidelines for the management of children during cardiac arrest and critical conditions.

Intended Audience:

Bystanders, parents, other caregivers, healthcare professionals across various care levels (EMS, emergency departments, pediatric wards, pediatric ICUs, post-discharge care physicians, etc.), hospital and EMS management, and government structures.

Setting:

In-field, out-of-hospital, in-hospital, post-cardiac arrest care.

Section Headings:

Key Content / Considerations

  • Recognition and Management of Critically Ill Children

    • Assessment of seriously ill or injured children.
    • General management approaches for respiratory failure (AB).
    • Specific management protocols for status asthmaticus and anaphylaxis.
    • Management of circulatory failure (C).
    • Management of neurological and other medical emergencies (D) (E).
    • Treatment protocols for status epilepticus, hypoglycemia, hypokalemia, hyperkalemia, and hyperthermia.

  • Pediatric Basic Life Support

    • Sequence of actions in PBLS.
    • Adaptations for rescuers trained only in adult BLS.
    • Guidelines for untrained lay rescuers.
    • Use of automated external defibrillators (AEDs) in pediatric cases.
    • PBLS considerations for traumatic cardiac arrest (TCA).
    • Application of the recovery position.
    • Management of pediatric foreign body airway obstruction (FBAO).

  • Pediatric Advanced Life Support

    • Sequence of actions in PALS.
    • Defibrillation protocols during pediatric PALS.
    • Strategies for oxygenation and ventilation.
    • Key measurable factors during PALS.
    • Special circumstances and reversible causes in PALS.
    • Management of traumatic cardiac arrest (TCA) and hypothermic arrest.
    • Utilization of extracorporeal life support.

  • Post-Resuscitation Care and Post-Discharge Care for Pediatric Patients after Cardiac Arrest and Their Families

  • Low Resource Settings and Remote Areas

    • Recommendations for implementing PLS in resource-limited and remote settings.
    • Addressing challenges and strategies specific to PLS in these contexts.
 

Guideline Objective:

To provide evidence-informed guidance for the assessment and management of newborns of any gestation at birth who require resuscitation or assistance with transition.

Intended Audience:

Any health professional involved in the management of newborns at birth.

Setting:

Various settings where newborns are born, including hospitals and community settings.

Section Headings:

Key Content / Considerations

  • Introduction

  • Algorithm

Algorithmic approach to newborn resuscitation.

  • Epidemiology

Incidence of newborns needing resuscitation and appropriate interventions.

  • Education

Methods for training in newborn resuscitation.

  • Preparation, Briefing Human Factors

Differences between home deliveries and hospital settings, equipment, environment, and personnel required for successful newborn resuscitation, non-technical skills (human factors).

  • Thermal Control

Management of hypo/hyperthermia, optimal methods for temperature maintenance and measurement.

  • Cord Clamping

Benefits of delayed cord clamping, optimal timing and methods compared to milking, balancing benefits and risks.

  • Initial Actions and Assessment

Stimulation and assessment of newborns at birth, including evaluation of color, tone, breathing, and heart rate to guide resuscitation/stabilization.

  • Airway

Optimal positioning for establishing and maintaining the airway, interventions for airway obstruction, including suction and surfactant/lavage for aspiration.

  • Breathing

Indications and methods for providing respiratory support, optimal timing and sequence of interventions.

  • Airway Adjuncts, Assisted Ventilation Devices, PEEP/CPAP

Use of airway adjuncts (e.g., oropharyngeal airway, nasal airway, supraglottic devices, tracheal tube), positive pressure respiratory support methods (e.g., self-inflating bag, flow-inflating bag, T-piece), indications for PEEP/CPAP.

  • Air/Oxygen

Administration of supplemental oxygen, considerations for preterm versus term infants.

  • Monitoring

Monitoring parameters including saturation, ECG, end-tidal CO2, and flow/volume during resuscitation.

  • Cardiac Compression

Indications and methods for cardiac compressions, compression-to-ventilation ratios, continuous or synchronized compression after intubation.

  • Vascular Access

Indications and methods for securing vascular access (e.g., umbilical vein, intraosseous needle).

  • Drugs & Fluids

Indications for drugs during resuscitation (e.g., adrenaline, bicarbonate, fluids, blood, glucose).

  • Special Circumstances

Guidance for managing transition in newborns with specific conditions (e.g., surgical abnormalities, cardiac problems).

  • Discontinuing/Withholding

Ethical considerations and protocols for withholding or discontinuing resuscitation efforts.

  • Post-Resuscitation Care, Prognosis

Management of post-resuscitation care including glucose management and therapeutic hypothermia.

  • Parent Communication, Debriefing

Communication strategies with parents and family members, team debriefing following resuscitation.

  • Ethics

Ethical dimensions surrounding newborn resuscitation.

  • Low Resource Settings and Remote Areas

Recommendations for implementing newborn life support in resource-limited or remote settings, addressing challenges and strategies specific to these environments.

Guideline Objective:

To provide guidance and recent evidence on the management of patients at risk of or suffering from cardiac arrest under special circumstances. This includes deviations from standard algorithms.

Intended Audience:

Healthcare professionals and stakeholders.

Setting:

Out-of-hospital and in-hospital cardiac arrest scenarios.

Section Headings:

Key Content / Considerations

  • Trauma

Management differences in traumatic cardiac arrest (TCA), role of chest compressions, and principles of Hypotensive Resuscitation and Permissive Hypotension.

  • Anaphylaxis

Management and prevention of cardiac arrest related to anaphylactic reactions based on current guidelines.

  • Electrolytic Disorders

Updated management of cardiac arrest in electrolyte disorders, focusing on hyperkalemia and relevant electrolytic imbalances.

  • Hypothermia

Management of cardiac arrest in hypothermic patients, including scenarios like avalanche and drowning, ECMO considerations, and strategies for both low-resource/remote and urban areas.

  • Hyperthermia

Management of cardiac arrest in hyperthermic patients, encompassing syndromes such as malignant hyperthermia, neuroleptic malignant syndrome, and serotonin syndrome.

  • Asthma, COPD

Guidelines for managing and preventing cardiac arrest in patients with asthma and COPD, aligning with updated protocols.

  • Toxic Agents

Management and prevention of cardiac arrest due to toxic agents, including antidotes and methods for elimination and removal.

  • Thrombosis

Specific management of cardiac arrest caused by pulmonary embolism and coronary thrombosis.

  • Cardiac Arrest in OR

Challenges specific to cardiac arrest in operating rooms, including scenarios in general surgery (including laparoscopic/robotic procedures), prone positions, cath labs, cardiac surgery, and patients with LVAD/BIVAD and Local Anaesthetic Toxicity Syndrome.

  • Dialysis

Differences in managing cardiac arrest during dialysis, focusing on prevention and follow-up care.

  • Pregnancy

Management of cardiac arrest in pregnant patients, including considerations for amniotic fluid embolism.

  • Obesity

Special considerations and challenges in managing cardiac arrest in obese patients.

  • EMS Transport + Inflight Emergencies

Management of cardiac arrest during EMS transport and inflight emergencies.

  • Sports

Guidelines for managing cardiac arrest in sports settings, including awareness programs in sports such as football.

  • Drowning and Water Rescue

Management of cardiac arrest in drowning victims based on ILCOR statements.

  • ECPR, Mechanical Chest Compressions

Collaborative strategies between ELSO and ERC for extracorporeal CPR and the use of mechanical chest compression devices.

  • Low Resource Settings and Remote Areas

Recommendations for implementing, responding to, and practicing in lower-resource settings. Addresses unique challenges and strategies in areas with limited resources or in remote locations.

Guideline Objective:

This section of the guidelines, a collaboration between the European Resuscitation Council and the European Society of Intensive Care Medicine, provides recommendations for the treatment of patients after achieving return of spontaneous circulation following cardiac arrest. The focus is primarily on in-hospital management, encompassing investigations to diagnose the cause of cardiac arrest and comprehensive intensive care management. Topics covered include temperature control, blood pressure management, oxygenation and ventilation targets, and prognostication. It also addresses rehabilitation, organ donation, long-term outcomes, and the investigation of sudden cardiac death.

Intended Audience:

All clinicians involved in the care of post-cardiac arrest patients.

Setting:

Any clinical setting following return of spontaneous circulation.

Writing Group Members:

Jerry Nolan, Claudio Sandroni, Alain Cariou, Tobias Cronberg, Sonia D’Arrigo, Kirstie Haywood, Astrid Hoedemaekers, Gisela Lilja, Nikolaos Nicolaou, Theresa Olasveengen, Chiara Robba, Markus B. Skrifvars, Jas Soar

Section Headings

Key Content / Considerations

  • Post-Cardiac Arrest Syndrome Drawing on recent ILCOR brain injury reviews.

  • Diagnosis of Cause of Cardiac Arrest Includes relevant investigations, such as pan CT.

  • Airway and Breathing Guidelines for oxygenation and ventilation targets.

  • Circulation Includes considerations like PCI and blood pressure targets.

  • Disability Covers temperature control and seizure management.

  • General Intensive Care Management Aspects including nutrition and infection control.

  • Prognostication Comprehensive discussion using a multimodal approach.

  • Withdrawal of Life-Sustaining Therapy Timing and indications, linked with ethics considerations.

  • Long-Term Outcomes Exploration of societal participation and other aspects.

  • Rehabilitation Latest evidence on the impact of rehabilitation programs.

  • Organ Donation Draws on insights from the ILCOR Organ Donation paper.

  • Investigating Sudden Unexplained Cardiac Arrest Expanded recommendations from previous guidelines.

  • Cardiac Arrest Centres Brief section linking to broader system considerations.

  • Low Resource Settings and Remote Areas Advice on implementing and practicing post-resuscitation care in settings with limited resources or in remote areas. Addresses specific challenges and strategies relevant to these contexts.

Guideline Objective:

This chapter comprehensively addresses the multifaceted aspects of resuscitation education, catering to diverse target groups and providers across various settings. It emphasizes the importance of tailored educational strategies to enhance resuscitation outcomes, integrating simulation, faculty development, assessment, and feedback mechanisms. The chapter also identifies research gaps and sets a roadmap for future investigations in resuscitation education.

Intended Audience:

Instructors, educators, course centers, healthcare professionals, stakeholders involved in resuscitation training and education.

Setting:

Instruction, training, and education from basic to advanced life support, across different healthcare and educational settings.

Writing Group Members:

Sabine Nabecker, Timo de Raad (co-chair), Patricia Conaghan, Joyce Yeung, Lucas Pflanzl-Knizacek, Jan Breckwoldt, Sebastian Schnaubelt, Cristian Abelairas-Gomez, Barbara Farquharson, Kevin Mackie, Olfa Chakroun, Silvija Hunyadi-Anticevic, Carsten Lott, Andrew Lockey, Robert Greif

Section Headings

Key Content / Considerations

  • Introduction Expands on the foundation of medical education in resuscitation, incorporating new evidence since GL2021.

  • Resuscitation Education for Different Target Groups Examines nuances in resuscitation training across demographics, addressing challenges in low-income regions, educational disparities, EMS involvement, specialized training for high-risk groups, and team-based CPR training’s impact on outcomes.

  • Resuscitation Education Tailored for Different Providers Discusses customized education programs, their prevalence, mandatory requirements, and specific training for diverse sectors like water rescue, in-hospital cardiac arrest responses, and specialized training for dental professionals.

  • High-Quality Resuscitation Skill Development Focuses on comprehensive approaches to skill development, highlighting feedback devices, instructional methodologies, and blended learning techniques for skill mastery.

  • Technology-Enhanced Resuscitation Education Investigates innovative technologies such as simulations, gamification, and cognitive aids to optimize learning outcomes and readiness among providers.

  • Simulation-Based Resuscitation Training Details the application of high-fidelity simulations in training, emphasizing their role in replicating real scenarios and enhancing procedural proficiency.

  • Faculty Development for Resuscitation Education Addresses instructor development, stress management, and team competency building to enhance training quality.

  • Impact of Resuscitation Education on Clinical Outcomes Reviews evidence linking education to improved patient outcomes, including family presence during resuscitation, cardiac arrest center effectiveness, and public CPR willingness.

  • Debriefing and Feedback in Resuscitation Education Discusses structured debriefing and feedback mechanisms to reinforce learning and improve performance.

  • Assessment Strategies for Resuscitation Competencies Summarizes effective assessment methods within training programs and explores future directions in evaluation practices.

  • Research in Education and Future Directions Highlights ongoing research initiatives and identifies gaps in educational research, aligning with upcoming ILCOR statements on educational outcomes.

  • Low Resource Settings and Remote Areas Offers advice on implementing resuscitation education in settings with limited resources or in remote areas, addressing specific challenges and strategies.

Guideline Objective:

This guideline aims to provide evidence-based guidance for both members of the public and healthcare professionals on the ethical aspects of resuscitation and end-of-life decisions in adults and children.

Intended Audience:

Laypersons, healthcare professionals, and other stakeholders involved in decision-making around resuscitation and end-of-life care.

Setting:

Applicable to all healthcare settings, including hospitals, community settings, and emergency situations.

Writing Group Members:

Violetta Raffay, Johannes Wittig (co-chair), Spyros D. Mentzelopoulos, Jana Djakow, Patrick Van de Voorde, Ileana Lulic, Angel Estella Garcia, Leo Bossaert, Therese Djärv, Kasper Glerup Lauridsen, Koen Monsieurs

Section Headings

Key Content / Considerations

  1. Advance Directives and Advance Care Planning – DNACPR/DNR

    • Discusses the implementation and ethical considerations of Do-Not-Attempt-Cardiopulmonary-Resuscitation (DNACPR/DNR) orders.
    • Covers considerations across different cardiac arrest scenarios: out-of-hospital (OHCA), in-hospital (IHCA), and in pediatric cases.

  2. When to Stop/When to Transport

    • Provides guidance on decision-making processes regarding continuation of resuscitation efforts versus transport to healthcare facilities.
    • Addresses specific considerations for OHCA, IHCA, and pediatric cases.

  3. When and How to Involve Family/Relatives/Others in Decision Making

    • Explores the ethical dimensions of involving family members and others in decision-making processes related to resuscitation.
    • Considers legal, religious, organizational, socio-economic diversity across Europe and its impact on decision-making.

  4. Patient and Family Representatives

    • Discusses the role and involvement of official representatives of organizations, societies, clubs, etc., in decision-making processes.

  5. Ethical Challenges of Bystanders and First Responders Involvement

    • Addresses ethical considerations for bystanders under Good Samaritan laws and potential psychological consequences.
    • Explores ethical challenges for first responders involved in resuscitation efforts.

  6. Research

    • Covers ethical considerations in interventional and non-interventional research related to resuscitation across various settings.

  7. Education/Systems

    • Provides updated guidance based on narrative reviews concerning patient outcomes, educational strategies, and organizational aspects of resuscitation.

  8. Low Resource Settings and Remote Areas

    • Offers advice, possibly in the form of good practice statements, on implementing ethical principles in resuscitation in settings with limited resources or in remote areas.
    • Addresses specific challenges and strategies related to ethics in resuscitation in these settings.

This guideline aims to ensure that ethical considerations are integral to decision-making processes in resuscitation, fostering informed, compassionate, and culturally sensitive care practices across diverse healthcare contexts.

 
 
3.5

Guideline Objective:

This guideline aims to provide practical, science-based advice on life-threatening conditions that could lead to cardiac arrest without timely first aid, and on time-critical conditions where immediate first aid can mitigate severe morbidity.

Intended Audience:

  1. Trained first aiders (e.g., lifeguards, ski patrol) who are responsible for managing emergencies without formal medical education.
  2. First aiders on duty (e.g., teachers, security staff) who are expected to respond to emergencies as part of their role, though it is not their primary task.
  3. First aiders at the scene of emergencies, including bystanders and volunteers.

Setting:

Out-of-hospital settings in Europe.

Writing Group Members:

Therese Djärv, Jessica Rogers (co-chair), David Zideman, Pascal Cassan, Diana Cimpoesu, Barry Klassen, Daniel Meyran, Eunice Singletary, Adam Mellett-Smith, Jorien Laermans, Sander van Goor, Kaushila Thilakasiri, Federico Semeraro

Section Headings

Key Content / Considerations

  1. Definition of First Aid

    • Clarifies the roles and responsibilities of different types of first aiders: trained first aiders, first aiders on duty, and lay first aiders.

  2. Being a First Aider

    • Discusses legal aspects and common emotional responses when providing first aid, including managing situations where a person appears deceased and interacting with their relatives.

  3. Mental Health Crisis

    • Guidance on providing first aid when someone is experiencing suicidal thoughts or in the aftermath of a suspected suicide attempt.

  4. Drowning

    • Initial actions for water and land scenarios, including rescue breaths and CPR techniques.

  5. Prevention

    • Techniques for managing pre-syncope, counter-pressure maneuvers, stroke recognition, recovery positions, shock management, hypothermia prevention, and concussion recognition.

  6. Medical Emergencies

    • Procedures for managing airway foreign bodies, anaphylaxis recognition and treatment with adrenaline (epinephrine), oxygen use in dyspnea, stroke management, bronchodilator administration for asthma, chest pain and arrhythmia symptoms, hypoglycemia management, naloxone administration for intoxication, heat stroke management, and European snake bites requiring antidotes.

  7. Trauma Emergencies

    • Techniques for controlling life-threatening bleeding with pressure bandages, haemostatic agents, and tourniquets; basic airway maneuvers like the jaw thrust; cervical spine motion restriction (for trained first aiders); management of open chest wounds; cooling thermal burns; managing eye injuries from chemical exposure; and preserving amputated body parts.

  8. Low Resource Settings and Remote Areas

    • Provides practical advice or good practice statements on implementing, responding to, and practicing first aid in settings with limited resources or in remote areas.
    • Addresses challenges specific to these environments and strategies to overcome them.

This guideline ensures that first aiders across different capacities are equipped with the necessary skills and knowledge to effectively manage critical emergencies, thereby improving outcomes in out-of-hospital settings in Europe.

ERC Scope Document :

ERC Guidelines 2025