Nothing new today — and the biggest gap in this archive closed: the ERC 2025 resuscitation guidelines

No new guidelines from tracked societies today. And the sweeps could not have found any: as established in today’s literature brief, Europe PMC has indexed zero records for 12 September — no journal, no subject — against 1,035 for 11 September. An indexing lag, verified against a working control. The trailing-window sweep for 11–12 September returned three guideline hits, none in scope (two preprints and the 2026 Taiwan migraine guidelines), and the French-society sweep was a confirmed zero for the twelfth consecutive day.

So the day went to the landmark backlog — and checking which societies had never been swept turned up something that should have been caught weeks ago.

The omission

Resuscitation is named in this project’s primary scope. Twenty-seven daily guidelines entries have been published since 28 August. Not one has contained a document from the European Resuscitation Council or ILCOR. A grep of the whole archive for “European Resuscitation Council”, “ILCOR” or “ERC guidelines” returns nothing.

Meanwhile the ERC Guidelines 2025 were published in October 2025 — eleven months ago, across twelve sections in Resuscitation, and they are the current European standard. The daily watch looks back 7–10 days, so it was never going to see them; the landmark backlog was built around the societies already on the tracked list, and the resuscitation bodies were simply missing from it. That is a process failure, not a search failure, and it is recorded as such in the source notes.

Three sections are covered below — the executive summary, adult advanced life support, and post-resuscitation care — as the ones closest to this scope.

1. ERC Guidelines 2025 — Executive Summary

Society · Published: European Resuscitation Council. Resuscitation, October 2025 — eleven months old Greif, Lauridsen, Djärv, Ek, Monnelly, Monsieurs, Nikolaou, Olasveengen, Semeraro, Spartinou, Yeung, Baldi, Biarent, Djakow, van Gils, van Goor, Gräsner, Hogeveen, Karageorgos, Lott, Madar, Nabecker, de Raad, Raffay, Rogers, Sandroni, Schnaubelt, Smyth, Soar, Wittig, Perkins, Nolan and the ERC Guidelines 2025 writing groups

How the guidelines were built, in their own words:

The ERC Guidelines 2025 are based on evidence produced by the International Liaison Committee on Resuscitation (ILCOR) in the form of systematic reviews, scoping reviews, and evidence updates, published as the ILCOR Consensus on Science with Treatment Recommendations. The certainty of evidence of these ILCOR treatment recommendations was used to issue the ERC Guidelines 2025 Recommendations. In some cases, the ERC made good practice statements when evidence was absent for certain topics. If no ILCOR review was available, the ERC writing groups conducted their own reviews.

The twelve sections: epidemiology of cardiac arrest; the role systems play in saving lives; adult basic life support; adult advanced life support; resuscitation in special circumstances; post-resuscitation care; newborn resuscitation and support of transition at birth; paediatric basic and advanced life support; resuscitation ethics; education for resuscitation; first aid.

And the closing caveat, which is the one most often ignored:

These guidelines are a framework of recommendations… the implementation is achieved locally taking local legislation and health care regulations into consideration.

Interpretation. Worth understanding the architecture before the content, because it explains why resuscitation guidance differs between continents while the evidence does not.

ILCOR produces the evidence synthesis; ERC and AHA each write their own guidelines from it. So a divergence between ERC 2025 and an AHA recommendation is usually not a disagreement about the science — it is two committees applying different thresholds and local context to the same CoSTR. The three-tier structure here is explicit and unusually honest: ILCOR-graded recommendations where a review exists, ERC’s own reviews where ILCOR has not addressed a topic, and “good practice statements” where evidence is absent. That third category is the one to watch, because a good practice statement reads in print exactly like a recommendation and carries none of the same backing.

2. ERC Guidelines 2025 — Adult Advanced Life Support

Society · Published: European Resuscitation Council. Resuscitation, October 2025 Soar, Böttiger, Carli, Jiménez, Cimpoesu, Cole, Couper, D’Arrigo, Deakin, Ek, Holmberg, Magliocca, Nikolaou, Paal, Pocock, Sandroni, Scquizzato, Skrifvars, Verginella, Yeung, Nolan

The section abstract is framing only — it states the ILCOR basis, the scope (adults with in-hospital or out-of-hospital cardiac arrest), and the emphasis on “providing early and effective ALS interventions to improve survival.” It contains no recommendations.

3. ERC/ESICM Guidelines 2025 — Post-Resuscitation Care

Societies · Published: European Resuscitation Council with the European Society of Intensive Care Medicine — ESICM is a tracked society. Resuscitation, October 2025, with a parallel publication in Intensive Care Medicine on 22 October 2025 (DOI 10.1007/s00134-025-08117-3) Nolan, Sandroni, Cariou, Cronberg, D’Arrigo, Haywood, Hoedemaekers, Lilja, Nikolaou, Olasveengen, Robba, Skrifvars, Swindell, Soar

Topics covered, per the abstract: post-cardiac arrest syndrome; diagnosis of the cause of arrest; control of oxygenation and ventilation; coronary reperfusion; haemodynamic monitoring and management; control of seizures; temperature control; general intensive care management; prognostication; long-term outcome; rehabilitation; and organ donation. Paediatric post-resuscitation care sits in the Paediatric Life Support section instead.

Again, the abstract lists topics rather than recommendations.

What actually changed in 2025 — from a review, not from the guidelines

This is the important caveat on the whole entry. The ERC section abstracts deposited in Europe PMC describe structure and scope, not content — a pattern this archive has now seen repeatedly with long-form guidelines, and the full texts were not reachable. So the changes below come from a peer-reviewed review article, not from the guidelines themselves:

“The 2025 updated European Resuscitation Council guidelines: overview of the most important changes” — Rott, Reinsch, Böttiger. Polish Archives of Internal Medicine, 16 March 2026. DOI 10.20452/pamw.17251, PMID 41841349. Böttiger is an author on the ERC ALS section itself, which makes this a well-placed summary but not a substitute for the source document.

Per that review, the stated aim is to “sustainably improve the survival rate after cardiac arrest through structured and evidence-based care systems,” and “the importance of the first 3–5 minutes after cardiac arrest has been further strengthened.” The changes it highlights, in adult ALS, post-resuscitation care, and systems:

• Lay people should be educated in CPR by physicians
• An expanded role for the dispatch centre in helping the caller recognise cardiac arrest and ventilation failure
• Intravenous access identified as superior to other routes of drug administration
• Vector change in defibrillation highlighted as an option
• Provider experience emphasised in the context of point-of-care ultrasound use
• A role for sedation during CPR

Interpretation. Four of these are worth comment, and two are genuinely new directions.

IV superior to IO is the substantive pharmacological change, and it follows the trials — PARAMEDIC-3 and IVIO both reported better ROSC or drug-delivery outcomes with intravenous access, without a clear survival benefit. Promoting IV over intraosseous reverses a decade of drift toward “IO first because it’s faster,” and for anyone running an in-hospital arrest it means the familiar answer is also the preferred one. Note what it does not say: it does not say delay drugs to obtain IV access.

“A role for sedation during CPR” is the one that will surprise people most, and it is a real conceptual shift. It follows from CPR-induced consciousness — a phenomenon with rising reported incidence. Resuscitation published “Trends in the incidence and outcomes of cardiopulmonary resuscitation-induced consciousness in out-of-hospital cardiac arrest” on 4 September; it surfaced in this archive’s sweep that week and was not written up, so its numbers are not reported here. A patient who is conscious, in pain and resisting compressions during effective CPR is both a humane problem and a quality-of-compressions problem. A guideline acknowledging sedation during resuscitation is the field catching up with something clinicians have been improvising for years.

“Provider experience in the context of point-of-care ultrasound” is a hedge, and a justified one. Echo during arrest lengthens pauses in inexperienced hands, and the evidence that it changes outcomes is weak. Conditioning its use on operator experience is the right answer and also an unenforceable one.

Vector change in defibrillation — switching pad position after failed shocks — reflects the DOSE-VF trial, and listing it as a possibility rather than a recommendation matches the strength of that single trial.

The first 3–5 minutes, and the dispatch centre, are where the survival is. Both highlighted changes in that area are about the system rather than the clinician: teaching lay CPR, and dispatcher recognition of arrest and of agonal breathing. That is consistent with everything known about out-of-hospital arrest survival, and it is also the part a hospital anaesthetist or intensivist has least control over.

Where this connects to the rest of the archive. The post-resuscitation care section’s prognostication content is the live issue here: the WEAN SAFE failed-weaning phenotypes raised exactly the same problem in a different setting — a clinical test that informs a withdrawal decision it was never validated for. Post-arrest neuroprognostication is where that problem was first taken seriously — and Resuscitation published “Under-reporting of hypoxic-ischaemic brain injury on routine CT and MRI during neuroprognostication after out-of-hospital cardiac arrest” on 5 September, which also surfaced in that week’s sweep without being written up. Both are now on the outstanding list; together they suggest the imaging leg of neuroprognostication is shakier than assumed, but I have not read either abstract and am not characterising their findings beyond their titles.

Still needed: the recommendation tables from the ALS and post-resuscitation care sections. Both are on the outstanding list. The remaining nine ERC 2025 sections — basic life support, special circumstances, paediatric, newborn, ethics, education, first aid, epidemiology, systems — are catalogued there too, with paediatric and special circumstances next in priority.

Executive Summary · PMID 41117573 · Adult ALS · PMID 41117572 · Post-Resuscitation Care · PMID 41117575 · the changes review · PMID 41841349