A survey of Advanced Life Support practices in countries implementing the European Resuscitation Council guidelines

The 2025 European Resuscitation Council (ERC) Advanced Life Support (ALS) Guidelines writing group aims to produce inclusive guidelines enabling implementation by National Resuscitation Councils (NRC) based on local resources and practices. We aimed to describe ALS practices across NRCs to further inform the 2025 ERC ALS Guidelines.

A cross-sectional survey was conducted to assess clinical practices for defibrillation, drugs and airway management during ALS in out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) amongst countries represented by an NRC. NRCs were invited to suggest practices for consideration in the 2025 ERC ALS Guidelines.

Among 31 NRCs, 30 (96.8 %) provided data. Defibrillation pads were used for OHCA in 21 (70 %) and for IHCA in 15 (50 %) of countries, while paddles were reported by 3 (10 %) and 6 (20 %) for OHCA and IHCA, respectively. Most NRCs reported not using a pre-charging strategy (23 [76.7 %] OHCA; 26 [86.7 %] IHCA). Amiodarone was the primary antiarrhythmic (26 [89.7 %], OHCA; 28 [93.3 %], IHCA), and adrenaline was the primary vasopressor (27 [90 %], OHCA; 29 [96.7 %], IHCA). Airway management practices varied, 12 (41.4 %) reported supraglottic airway devices as the primary choice for OHCA and 1 (3.3 %) for IHCA, while 22 (73.3 %) reported tracheal tubes for IHCA and only 9 (31 %) for OHCA. Open-ended responses emphasised the importance of guidance in low-resource settings.

Current ALS practices vary across countries, and between OHCA and IHCA settings with a need to consider low-resource settings. Understanding these practices has implications for guideline development and research planning.