Wolf Creek XVIII Part 2: optimizing time intervals in cardiac arrest care

Optimizing time intervals in cardiac arrest care was a featured topic at the 50th Anniversary Wolf Creek Conference (Wolf Creek XVIII) hosted by the Max Harry Weil Institute for Critical Care Research and Innovation in Ann Arbor, Michigan, USA on June 19-21, 2025. This narrative review summarizes the presentations and discussion of the topic by invited panelist and conference participants made up of international academic and industry scientists as well as thought leaders in the field of cardiac arrest resuscitation. The proceedings highlighted the limitations of binary proportion-based resuscitation metrics (e.g. "bystander CPR-yes/no") in driving improvements in cardiac arrest outcomes and called for a paradigm shift-placing time intervals to key cardiac arrest interventions and responses to therapy at the center of benchmarking quality improvement and research. In addition to an overview of the current state and vision for the future state, we detail knowledge gaps and barriers to translation, and propose research priorities that include standardizing interval measurement, harmonizing reporting, and validating interval metrics for system performance and proximal outcomes. Making treatment and response intervals core metrics for systems-of-care, registries, and clinical trials could shift the field's focus toward the goal of faster restoration of perfusion resulting in improved survival and better neurologic recovery.