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2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 1. The update process and highlights.

Published by Korean Association of Cardiopulmonary Resuscitation · GRADE / GRADE-ADOLOPMENT

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Summary

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This clinical guideline describes the update process and key highlights of the 2025 Korean Guidelines for Cardiopulmonary Resuscitation (CPR). Developed using the GRADE and GRADE-ADOLOPMENT methodologies, it introduces significant updates across basic life support, advanced life support, post-cardiac arrest care, pediatric and neonatal resuscitation, education, and first aid.

Cardiopulmonary ResuscitationHeart ArrestKACREmergency MedicineguidelinesrecommendationsAEDdefibrillation

Key Takeaways

  • 1
    Rehabilitation and recovery added as a new fifth link in the integrated chain of survival.
  • 2
    Emergency dispatchers instructed to guide callers to locate and apply AEDs to improve low prehospital AED utilization rates.
  • 3
    Rescue breathing recommended as the starting intervention for drowning victims by trained rescuers.
  • 4
    Double sequential or vector-change defibrillation suggested for refractory ventricular fibrillation.
  • 5
    Post-resuscitation targeted temperature management revised to a range of 33–37.5 °C for at least 24 hours.
  • 6
    Public access defibrillation (AED use by laypersons) extended to children aged 1 year and older.
  • 7
    Feedback devices recommended in CPR training to deliver real-time guidance on depth, rate, and hand position.

What's New in This Version

Key changes from the 2020 guidelines include: 1) Addition of rehabilitation and recovery as a fifth link in the chain of survival; 2) Combination of advanced life support and post-cardiac arrest care into a single link; 3) Dispatcher guidance on AED location and placement (including underwear adjustment guidance for female patients); 4) Rescue breaths first for drowning; 5) Double sequential/vector-change defibrillation for refractory VF; 6) Revision of target temperature range from 32-36 °C to 33-37.5 °C; 7) Layperson AED use for children >= 1 year; 8) Supraglottic airway and video laryngoscopy in neonatal resuscitation; 9) Feedback devices in training and discouraging asynchronous online learning as a routine substitute for traditional training; 10) Addition of a dedicated first aid section addressing cardiac arrest-related emergencies (such as chest pain, stroke, asthma, anaphylaxis, shock).

Key Recommendations

Basic life support

  • REC-BLS-01

    Emergency dispatchers are recommended to guide callers in locating and applying an AED.

    strongDefibrillation / AED
  • REC-BLS-02

    AED pads should be applied to the bare chest, with adjustment of underwear without removing the bra in female patients.

    strongDefibrillation / AED
  • REC-BLS-03

    Trained first responders and healthcare providers are advised to initiate resuscitation with rescue breathing for drowning victims.

    weakAirway / Ventilation
  • REC-BLS-04

    During chest compressions, rescuers are advised to place their dominant hand in the lower position.

    weakChest compressions
  • REC-BLS-05

    The chest compression fraction should be maintained at least 60% and as high as possible.

    strongChest compressions
  • REC-BLS-06

    For ventilation, a simplified rate of one breath every 6 seconds (10/min) is recommended.

    strongAirway / Ventilation

Advanced life support

  • REC-ALS-01

    For adult patients with cardiac arrest and refractory shockable rhythms, trained healthcare providers are advised to consider double sequential defibrillation or vector-change defibrillation when additional pads or defibrillators are immediately available.

    weakDefibrillation
  • REC-ALS-02

    Routine use of vasopressin and corticosteroids as adjuncts to standard CPR, as well as routine administration of buffers, including sodium bicarbonate, or calcium is not recommended during resuscitation.

    strongPharmacotherapy
  • REC-ALS-03

    Prone CPR is suggested for patients who experience cardiac arrest in the prone position and have an advanced airway in place when immediate repositioning to the supine position is not feasible or poses additional risk.

    weakCardiopulmonary resuscitation

Post-cardiac arrest care

  • REC-PCAC-01

    Targeted temperature management is recommended for comatose patients after return of spontaneous circulation, with the target temperature maintained at 33 to 37.5 °C for at least 24 hours.

    strongTargeted Temperature Management

Pediatric and neonatal resuscitation

  • REC-PEDS-01

    For infants, both lay rescuers and healthcare providers are recommended to use the two-thumb chest compression technique with both hands encircling the chest, regardless of the number of rescuers, rather than the two-finger technique.

    strongChest compressions
  • REC-PEDS-02

    Layperson defibrillation is recommended for children aged 1 year and older.

    strongDefibrillation / AED

Scope & Objectives

Clinical Topic

Cardiopulmonary Resuscitation

Objectives

To improve survival and neurological outcomes after cardiac arrest by providing evidence-based CPR guidelines adapted to the Korean context.

Target Patient Population

Patients experiencing cardiac arrest or cardiac-arrest-related emergencies (including adults, children, infants, and neonates).

Target Providers

Lay bystandersFirst respondersEmergency dispatchersHealthcare providersEMS personnel

Patient Criteria & Setting

Therapeutic Area

Emergency Medicine

Guideline Scope

Basic Life SupportAdvanced Life SupportPost-Cardiac Arrest CarePediatric ResuscitationNeonatal ResuscitationFirst AidEducation

Inclusion Criteria

  • Cardiac arrest
  • Cardiac arrest-related emergencies

Care Settings

Out-of-HospitalIn-HospitalCommunityEmergency Medical Services

Special Populations

InfantsChildrenNeonatesDrowning victimsPregnant womenPatients in prone position

Evidence Grading

System: GRADE / GRADE-ADOLOPMENT

Evidence Levels

lowLow certainty of evidence. Observational studies start here and may be upgraded or downgraded.
highHigh certainty of evidence. Randomized controlled trials start here and may be downgraded based on limitations.
moderateModerate certainty of evidence.
very_lowVery low certainty of evidence.

Recommendation Strength

weakInterventions that may be applied selectively depending on clinical context, patient preferences, or societal values. Denoted by terms such as 'we suggest', 'may be considered', or 'conditionally recommend'.
strongInterventions that should be followed in most clinical situations. Denoted by terms such as 'we strongly recommend' or 'should/should not be performed'.
expert_consensusRecommendations supported by clinical experience and expert agreement when direct clinical evidence is limited, balancing benefits, harms, values, preferences, and resources.
good_practice_statementInterventions considered self-evidently beneficial for patient health and appropriate for implementation without further research.

Safety & Contraindications

Contraindications

  • Routine use of vasopressin and corticosteroids as adjuncts to standard CPR
  • Routine administration of buffers (including sodium bicarbonate) or calcium during resuscitation
  • Routine prophylactic use of anticonvulsants, antibiotics, or corticosteroids post-resuscitation
  • Routine use of self-directed, asynchronous online learning as a standard substitute for traditional training

Monitoring Guidance

Includes guidance on monitoring during CPR (e.g., breathing, pulse, physiological monitoring, feedback devices) and specific post-resuscitation monitoring targets (MAP of at least 60 to 65 mmHg, SpO2 of 94% to 98%, PaCO2 of 35 to 45 mmHg, blood glucose of 144 to 180 mg/dL, and temperature maintained at 33 to 37.5 °C).

Authors & Contributors

Sung Phil ChungDo Kyun KimTae-Youn KimYoudong SohnGyuhong ShimYoung Hwa JungYunhee OhChun Song YounMi Jin LeeJisook LeeChang Hee LeeYoungbin JangYong Soo JangGyu Chong ChoKyoung-Chul ChaJu Sun HeoSung Oh Hwang

Guideline Features

Flowcharts includedBased on systematic reviewMultidisciplinary

Learning Context

Difficulty

advanced

Learning Paths

Basic Life SupportAdvanced Life SupportPost-Cardiac Arrest CarePediatric ResuscitationNeonatal ResuscitationFirst AidResuscitation Education