Peer-reviewed article
Updates in paediatric advanced life support (PALS) 2025: Implications for clinical practice.
Saroj Kumar Tripathy, Sarthak Das, Ehtesham Ansari ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This document presents clinical guidelines for pediatric advanced life support (PALS) developed by the American Heart Association and American Academy of Pediatrics. It describes updated protocols for managing cardiac arrest in children, including new recommendations for blood pressure targets, epinephrine administration timing, and post-arrest care. The guidelines aim to improve survival and neurological outcomes in pediatric emergency care.
Key points
- Blood pressure target set above 10th centile post-cardiac arrest
- Epinephrine administration timing revised for both shockable and non-shockable rhythms
- Emphasis on high-quality CPR, targeted post-arrest care, and continuous neurological monitoring
- IV sotalol recommended as option for refractory supraventricular tachycardia
- Family presence during resuscitation integrated as vital aspect of care
Limitations
This document is a clinical guideline summary rather than an empirical study, so it cannot provide evidence of intervention effectiveness through research data. It does not evaluate whether these specific protocol changes actually improve outcomes compared to previous practices.
Abstract
The 2025 pediatric advanced life support guidelines, developed by the American Heart Association and the American Academy of Pediatrics, are a resource for healthcare professionals caring for infants and children under 18 years of age in peri-arrest and other emergency care situations. The new guidelines address evolving pediatric cardiac arrest patterns, characterized predominantly by respiratory failure or shock, with persistent disparities in out-of-hospital survival and neurological outcomes. Major revisions include setting a blood pressure target above the 10th centile post-cardiac arrest, administering epinephrine after two attempts of defibrillation in a shockable rhythm, and administering early epinephrine in non-shockable cardiac arrest, as well as preventing hyperthermia. It also emphasizes evidence-based strategies such as early high-quality cardiopulmonary resuscitation (CPR), targeted post-arrest care, continuous electroencephalogram for neurological monitoring, and IV sotalol as an option for refractory supraventricular tachycardia. Long-term survivor support and family presence during resuscitation are integrated as vital aspects of care. While core recommendations-such as CPR technique, ventilation strategies, and shock management-are reaffirmed, the update provides a robust framework for multicentric harmonization. The adoption of these updated protocols in promises enhanced resuscitation outcomes, consistent neurological recovery, and the development of context-specific best practices in pediatric emergency care.