2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 4. Adult advanced life support

¹인하대학교 의과대학 응급의학교실
²연세대학교 원주의과대학 응급의학교실
³이화여자대학교 의과대학 심장내과학교실
⁴한림대학교 의과대학 응급의학교실
⁵연세대학교 의과대학 마취통증의학과
⁶인제대학교 상계백병원 소아청소년과
⁷서울대학교 의과대학 응급의학교실
⁸서울아산병원 디자인콘텐츠팀
⁹가천대학교 의과대학 심장내과학교실
¹⁰가톨릭대학교 의과대학 응급의학교실
¹¹백석대학교 응급구조학과
¹²가톨릭대학교 성빈센트병원 응급의학과
¹³전남대학교병원 의과대학 응급의학과
¹⁴연세대학교 강남세브란스병원 응급진료센터
¹⁵아주대학교 의과대학 응급의학교실
¹⁶남서울대학교 응급구조학과
¹⁷서울대학교 의과대학 마취통증의학과
¹⁸연세대학교 의과대학 응급의학교실
¹⁹서울대학교 의과대학 소아청소년과학교실

Tae-Youn Kim¹

, Gyo Jin Ahn²

, Jin Wi⁹

, Chun Song Youn¹⁰

, Myung-Lyeol Lee¹¹

, Mi Jin Lee¹²

, Byung Kook Lee¹³

, Byung Heon Lee¹⁴

, Ji Sook Lee¹⁵

, Chang Hee Lee¹⁶

, Hannah Lee¹⁷

, Youngbin Jang¹⁸

, Young Hwa Jung¹⁹

, Sung Phil Chung¹⁸

, Ju Sun Heo¹⁹

Correspondence

Kyoung-chul Cha ,Tel: 033-741-1617, Fax: 033-742-3030, Email: chaemp@yonsei.ac.kr,

Received: February 14, 2026; Revised: April 25, 2026 Accepted: June 30, 2026. Published online: June 30, 2026.
*Tae-Youn Kim and Gyo Jin Ahn contributed equally to this work.

ABSTRACT

The 2025 Korean advanced life support guidelines were updated using a structured evidence evaluation process informed by recent randomized controlled trials and systematic reviews. The guideline development group prioritized patient-important outcomes and assessed the certainty of the evidence to formulate graded recommendations. For drug administration during adult cardiac arrest, intravenous access is the preferred initial route, with intraosseous access recommended when intravenous access cannot be rapidly established. Epinephrine remains the recommended vasopressor. Routine administration of vasopressin, either alone or in combination with corticosteroids, is not recommended for in-hospital or out-of-hospital cardiac arrest. In the absence of specific indications, the routine use of buffering agents and calcium is discouraged owing to insufficient evidence of their benefits and potential harm. Defibrillation recommendations were refined based on emerging evidence. In adults with refractory ventricular fibrillation or pulseless ventricular tachycardia after multiple unsuccessful defibrillation attempts, vector change or double sequential defibrillation may be considered in selected settings when performed by experienced teams with appropriate equipment. Airway management guidelines recommend cricothyroidotomy as a rescue technique when conventional airway management strategies fail. For patients receiving cardiopulmonary resuscitation while on mechanical ventilation, specific ventilator settings during chest compressions are recommended to optimize ventilation and minimize interference with high-quality cardiopulmonary resuscitation. The guidelines also address cardiopulmonary resuscitation-induced consciousness, allowing the cautious use of sedatives and/or analgesic agents when awareness interferes with resuscitation quality or safety. Overall, the guidelines emphasize evidence-based practice and individualized clinical decision-making.

Key words: Cardiopulmonary resuscitation; Heart arrest; Advanced life support