More rescue breaths for children and other takeaways from new resuscitation guidelines

Every nine minutes, someone in Canada suffers a cardiac arrest. In more than nine out of 10 cases, they will not survive. The new 2025 guidelines on cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC), published by the Heart & Stroke Foundation based on recommendations from the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR), aim to strengthen every link in this chain.The 2025 update is not limited to technical adjustments. It is based on two major, closely linked orientations: recognizing the specific needs of children and rehabilitating artificial respiration when appropriate; and integrating resuscitation into an ethical, equitable and structured approach, from the site of cardiac arrest to long-term recovery.From prevention to rehabilitationThe 2025 guidelines merge previous approaches into a single chain of survival applicable to adults, children and both in-hospital and out-of-hospital cardiac arrests. This comprehensive approach integrates prevention, early recognition, high-quality CPR, rapid defibrillation, specialized care and post-cardiac arrest followup. This systemic vision is based on Utstein’s formula for survival, which links the quality of evidence, the quality of training and the quality of local implementation.Specifically, the authors emphasize:preventing cardiac arrests in hospitals through early warning systems, rapid response teams and safety briefingsstructuring resuscitation teams with clearly defined roles and documented expertise in advanced caresystematically integrating immediate and delayed debriefings to support teams and improve practicesimplementing organized rehabilitation pathways, including cognitive, functional, and psychosocial assessments of survivorsRestoring rescue breathsThe central message of the Canadian update, consistent with the AHA, is that CPR with rescue breaths must once again become the standard of care for trained responders, including lay first aiders guided by 911 operators, in infants and children. Pediatric cardiac arrests frequently result from respiratory failure; therefore, effective oxygenation is a key determinant of prognosis.The guidelines specifically recommend:explicit instruction in chest compressions combined with rescue breaths for infants and childrenCPR training before the age of 12 to build future confidence and commitmentthe use of playful teaching methods to promote engagement and retentionIn adults, CPR by compressions alone remains appropriate for untrained or reluctant bystanders, provided that the call to 911 or the use of an automated external defibrillator is never delayed.Neonatal resuscitation and ECMO-CPR In neonatal resuscitation, algorithms are being updated to better integrate delayed cord clamping (at least 60 seconds when the situation allows), cautious oxygenation, and early cardiac monitoring. This approach is part of a "newborn care pathway" that encompasses the prenatal period, birth, and postnatal followup, with an emphasis on standardizing practices in maternity wards and tertiary care centres.The guidelines also specify the framework for the use of extracorporeal membrane oxygenation (ECMO-CPR): patient selection criteria, required expertise in cannulation, regionalization of centres, and explicit consideration of the potentially futile nature of certain interventions. The goal is to offer this option to a limited number of patients for whom a real benefit is plausible, while preserving equitable access and the efficient use of resources.Opioids, naloxone, and airway obstructionThe integration of opioid-related emergencies into the chain of survival is strengthened. The recommendations support:expanding community access to naloxone;protecting lay first responders who administer it in good faith;training in the recognition of opioid-related respiratory arrest or distress, with rapid administration of naloxone, CPR, and referral to prehospital services.In parallel, the management of airway obstruction in adults is clarified, with an emphasis on the appropriate use of back blows, anticipating the risk of cardiac arrest, and calling emergency services early.Ethics of resuscitation A specific chapter is now devoted to the ethical dimensions of resuscitation. It offers a structured framework to guide decisions in situations where there is no single "right" answer. The authors highlight:the importance of accessible and respected advance medical directivesshared decision-making when multiple options are medically justifiablethe framework for decisions not to initiate or to discontinue CPR, ideally with the support of ethics committees and clear institutional policiesthe responsibility of professionals and organizations to address the structural inequalities that affect access to CPR, defibrillation, naloxone, and post-cardiac arrest careA structuring frameworkThe guidelines also acknowledge the frequent emotional distress experienced by survivors, their loved ones, and the professionals involved, and recommend formalized support mechanisms integrated into healthcare systems.The 2025 version is based on 760 recommendations. Only a small proportion rely on A-level evidence, illustrating the methodological constraints inherent in resuscitation, but also the extent of the need for clinical and organizational research. This relative lack of very high-level data does not, however, call into question the robustness of the proposed architecture: a focus on the quality of compressions, early defibrillation, pediatric adaptation, system structuring, and consideration of ethical issues and the social determinants of health.This article has been translated from its original French and first appeared on our sister site Profession Santé.

More rescue breaths for children and other takeaways from new resuscitation guidelines

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