Top Things to Know: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations

1. Sudden cardiac arrest, occurring in the out-of-hospital or in-hospital setting, remains a leading cause of death worldwide. While outcomes have gradually improved over the past 25 years, mortality and morbidity remain high. In the United States and Europe in recent years, for example, survival after EMS-treated adult out-of-hospital cardiac arrest averaged 10.2%. In 2023 the US Get-With-The-Guidelines Resuscitation registry documented a survival rate to hospital discharge of 23.6% after in-hospital cardiac arrest.¹
2. The International Liaison Committee on Resuscitation (ILCOR) mission is to promote, disseminate and advocate for international implementation of evidence-informed resuscitation and first aid, using transparent evaluation and consensus summary of scientific data. The goal of this 2025 CoSTR Summary is to provide a summary of the most recent analyses of published resuscitation evidence, as well as the resulting ILCOR Task Force treatment recommendations, to aid ILCOR member councils in the development of evidence-based resuscitation and first aid guidelines and training materials.
3. For this 2025 CoSTR, in which all topics reviewed by ILCOR since the 2020 publication are presented, three types of evidence evaluations are included:
   • Systematic reviews: structured evidence searches with rigorous analysis of evidence using the Grading of Recommendations, Assessment, Development a1nd Evaluations (GRADE) approach. Based on ILCOR consensus, only these reviews can lead to new or modified treatment recommendations.
   • Scoping reviews: structured evidence searches resulting in a summary of available evidence, with no bias assessment or GRADE analysis. These searches result in recommendation for or against proceeding to a systematic review, based on the quantity and types of evidence identified. In some cases task forces also have created good practice statements if they believed a guiding statement was important, even without a systematic review.
   • Evidence updates: These reviews update previous searches, often in a single database, to screen for new evidence. Evidence updates are utilized to identify when there is sufficient new evidence to warrant a more detailed review.
4. Topics specifically highlighted by individual task forces in their 2025 CoSTR summaries include:
   • BLS Task Force: Head-Up CPR, Optimization of dispatcher-assisted recognition of cardiac arrest, CPR, dispatcher-assisted automated external defibrillator retrieval and use, drone AED delivery, AED accessibility (i.e.,use of locked cabinets), removal of bra before defibrillation of females in cardiac arrest, effectiveness of ultraportable/pocket AEDs, and CPR in obese people.
   • ALS Task Force: Temperature control after cardiac arrest, mechanical CPR, double sequential external defibrillation, intravenous versus intraosseous route for initial access attempt, treatment of hyperkalemia, and mechanical circulatory support after ROSC.
   • PLS Task Force: Prediction of survival with poor neurological outcome after return of circulation following pediatric cardiac arrest, airway, breathing, compressions versus compressions, airway, breathing (i.e., order of ventilation and compression), blood pressure monitoring and targets during pediatric in-hospital cardiac arrest, and pulse check accuracy in children during resuscitation.
   • NLS Task Force: Umbilical cord management, supraglottic airway devices during neonatal resuscitation, oxygen concentration for commencing resuscitation, and video laryngoscopes.
   • EIT Task Force: Debriefing of clinical resuscitation performance, prehospital critical care for OHCA, CPR coaching during adult and pediatric cardiac arrest, CPR feedback device use in resuscitation training, and in situ (at the workplace) simulation-based CPR training.
   • FA Task Force: Foreign-body airway obstruction, unintentional injury from laypersons providing chest compressions to patients who are not in cardiac arrest, external uterine massage for prevention of postpartum hemorrhage, and preservation of amputated body parts.
5. The ILCOR task forces will continue to prioritize questions and topics and analyze published studies to develop future evidence-based treatment recommendations.

References
¹ Martin SS, Aday AW, Allen NB, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Bansal N, Beaton AZ, Commodore-Mensah Y, Currie ME, Elkind MSV, Fan W, Generoso G, Gibbs BB, Heard DG, Hiremath S, Johansen MC, Kazi DS, Ko D, Leppert MH, Magnani JW, Michos ED, Mussolino ME, Parikh NI, Perman SM, Rezk-Hanna M, Roth GA, Shah NS, Springer MV, St-Onge MP, Thacker EL, Urbut SM, Van Spall HGC, Voeks JH, Whelton SP, Wong ND, Wong SS, Yaffe K, Palaniappan LP; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Committee. 2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation. 2025 Feb 25;151(8):e41-e660. doi: 10.1161/CIR.0000000000001303. Epub 2025 Jan 27. Erratum in: Circulation. 2025 Jun 24;151(25):e1096. doi: 10.1161/CIR.0000000000001345. PMID: 39866113; PMCID: PMC12256702