ERC–ESICM 2025 post-resuscitation guidelines: scope, basis and what the abstract omits

The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) jointly published guidelines in 2025 on the care of adults after resuscitation from cardiac arrest, in the journal Intensive Care Medicine ^[1]. This brief covers what kind of document it is, whom it addresses, which clinical domains it covers, and the limits on what its published abstract can support ^[1].

Design and evidence base

The document is a practice guideline, meaning a set of recommendations issued by professional societies. It does not report new data from a study population, and the abstract describes no trial or cohort ^[1]. The authors state that the recommendations are based on the International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations (CoSTR), which the International Liaison Committee on Resuscitation (ILCOR) publishes ^[1]. The guideline therefore takes its evidence from that international consensus process. The strength of any single recommendation depends on the evidence evaluated there, and the abstract neither summarises nor grades that evidence ^[1].

Population

The guidelines address adults ^[1]. According to the abstract, post-resuscitation care of children is handled in a separate document, the ERC guidelines 2025 Paediatric Life Support ^[1]. The abstract does not say whether the recommendations differ by the setting of the arrest or by patient characteristics ^[1].

Clinical domains covered

The abstract names twelve topics. They are grouped here by theme for readability; the grouping is this brief's, not the authors' ^[1].

• Underlying physiology: the post-cardiac arrest syndrome, a term the abstract names but does not define ^[1].
• Cause and cardiac treatment: establishing why the arrest occurred, and restoring blood flow through the coronary arteries (coronary reperfusion) ^[1].
• Organ support in intensive care: management of oxygenation and ventilation, haemodynamic monitoring and management, temperature control, and general intensive care ^[1].
• Neurological care: management of seizures and prognostication, the estimation of likely outcome ^[1].
• Beyond the acute admission: long-term outcome and rehabilitation ^[1].
• Organ donation ^[1].

Because long-term outcome and rehabilitation are on the list, the guideline treats post-resuscitation care as extending past the intensive care period ^[1].

Some anatomical background clarifies two of these topics. The coronary arteries supply the heart muscle itself, and a heart attack (myocardial infarction) is a sudden blockage of a coronary artery that cuts off oxygen to part of that muscle ^[5]. The heart also maintains blood pressure, which is the physiological context for haemodynamic monitoring and management ^[5].

What the abstract does not report

The abstract states no specific recommendation ^[1]. It gives no numerical targets for oxygenation, ventilation, temperature or blood pressure, no certainty-of-evidence ratings and no patient outcome data ^[1]. Readers seeking the guideline's actual positions on any listed topic, such as temperature control or the timing of prognostication, need the full text ^[1].

Context: rehabilitation evidence in adjacent cardiac populations

The guideline names rehabilitation as a domain ^[1]. Two recent studies illustrate the rehabilitation evidence available in other cardiac populations; neither enrolled cardiac arrest survivors, so neither tests the guideline's recommendations ^[1][2][3].

The first is REHAB-HF, a multicentre randomized controlled trial in older adults with acute decompensated heart failure (ADHF) that compared a multidomain physical rehabilitation intervention with attention control ^[2]. A prespecified secondary analysis of its 349 participants (183 female, 166 male) examined sex differences in 3-month outcomes, with the Short Physical Performance Battery (SPPB), a measure of physical function, as the primary outcome ^[2].

• Female participants started with lower SPPB scores and 6-minute walk distances and a higher frailty burden ^[2].
• The SPPB effect size was 1.9 (95% CI 1.1 to 2.7) in women and 1.0 (95% CI 0.1 to 1.8) in men, with P for interaction = 0.1, against a prespecified interaction threshold of 0.1 ^[2].
• Frailty burden by Fried phenotype criteria improved in women (effect size -0.5, 95% CI -0.9 to -0.2) but not in men (0.00, 95% CI -0.4 to 0.4), with P for interaction = 0.04 ^[2].
• Adverse clinical outcomes and adherence did not differ by sex ^[2].

The second is a systematic review of early mobilization, defined as starting within 48 h of cardiac surgery ^[3]. It included 20 studies with 11,631 participants: 12 randomized controlled trials, four observational cohort studies and four other study types ^[3]. Early mobilization appeared safe and was associated with better walking capacity and functional independence, while results on hospital length of stay were inconsistent, with approximately half of the studies reporting significant reductions ^[3].

Limitations

• This brief rests on the published abstract, which lists topics but no recommendations, grades or data ^[1].
• As a practice guideline, the document is only as strong as the CoSTR evidence it draws on, which the abstract does not characterise ^[1].
• The guideline comes from European societies, and the abstract does not address its application to health systems elsewhere ^[1].
• The scope is adults only; paediatric care is covered in a separate ERC document ^[1].
• The context studies involve heart failure and cardiac surgery populations, not cardiac arrest survivors, and cannot be extrapolated to them ^[2][3].
• The REHAB-HF finding comes from a secondary analysis that used a 0.1 interaction threshold ^[2].
• The early mobilization review combined mixed study designs, and the magnitude of benefit varied across studies ^[3].