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

초록

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 in-hospital 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 breaths per minute (<1 yr), 20–30 breaths per minute (1–8 yr), and 10–20 breaths per minute (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.

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