2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 8. Pediatric advanced life support

¹서울대학교 의과대학 응급의학교실
²서울대학교 의과대학 마취통증의학교실
³한양대학교 의과대학 소아과학교실
⁴서울대학교병원 진료지원팀
⁵아주대학교 의과대학 응급의학교실
⁶아주대학교 의과대학 소아청소년과
⁷서울대학교 의과대학 소아청소년과학교실
⁸연세대학교 의과대학 응급의학교실
⁹인하대학교 의과대학 응급의학교실
¹⁰한림대학교 의과대학 응급의학교실
¹¹인제대학교 상계백병원 소아청소년과
¹²서울아산병원 디자인콘텐츠팀
¹³가톨릭대학교 의과대학 응급의학교실
¹⁴가톨릭대학교 성빈센트병원 응급의학과
¹⁵남서울대학교 응급구조학과
¹⁶연세대학교 원주의과대학 응급의학교실
¹⁷2025년 한국심폐소생술 가이드라인 총괄위원회

Do Kyun Kim¹

, Jin-Tae Kim²

, Youdong Sohn¹⁰

, Gyuhong Shim¹¹

, Young Hwa Jung⁷

, Yunhee Oh¹²

, Chun Song Youn¹³

, Mi Jin Lee¹⁴

, Chang Hee Lee¹⁵

, Youngbin Jang⁸

, Yong Soo Jang¹⁰

, Gyu Chong Cho¹⁰

, Kyoung-chul Cha¹⁶

, Ju Sun Heo¹

, Sung Oh Hwang¹⁶

Correspondence

Jisook Lee ,Tel: 031-219-7750, Fax: 031-219-7760, Email: easy00@aumc.ac.kr,

Received: March 4, 2026; Revised: March 23, 2026 Accepted: March 27, 2026. Published online: June 30, 2026.

ABSTRACT

The 2025 Korean pediatric advanced life support guideline update introduces clinically important revisions emphasizing airway strategy, physiologic resuscitation targets, post-cardiac arrest hemodynamics, neuroprotection, and extracorporeal support. In out-of-hospital pediatric cardiac arrest, bag-mask ventilation is now suggested over endotracheal intubation or supraglottic airway placement. In inhospital arrest, evidence is insufficient to favor bag-mask ventilation versus advanced airways; however, endotracheal intubation or supraglottic airway insertion is reasonable when performed with minimal interruption or when bag-mask ventilation is ineffective. For patients with an advanced airway in place, age-adjusted ventilation rates are proposed to avoid hypoventilation and hyperventilation: 30/min (<1 yr), 20-30/min (1-8 yr), and 10-20/min (8-18 yr in healthcare settings). When invasive arterial monitoring is available during in-hospital cardiac arrest, target diastolic blood pressure is ≥25 mmHg in infants and ≥30 mmHg in children ≥1 year. After return of spontaneous circulation, systolic blood pressure during the first 6 hours should be maintained above the age-specific 10th percentile. Neuroprognostication should be multimodal, incorporating serial examinations, electroencephalography (up to 72 hours), early computed tomography (<24 hours), magnetic resonance imaging (72 hours to 2 weeks), lactate trends, and pupillary reflexes. Extracorporeal cardiopulmonary resuscitation (CPR) is limited to appropriately resourced hospitals and may be considered for selected in-hospital arrests (e.g., cardiac disease) unresponsive to conventional CPR; evidence remains insufficient for out-of-hospital use. These revisions shift pediatric resuscitation toward physiology-guided, resource-stratified, and neuroprotective care.

Key words: Heart arrest; Pediatrics; Resuscitation