Rethinking cardiac arrest: new paradigms in the 2025 ERC guidelines

The 2025 European Resuscitation Council (ERC) cardiac arrest guidelines mark a substantial evolution in modern resuscitation practice. Grounded in the most recent evidence reviews from the International Liaison Committee on Resuscitation (ILCOR), the guidelines move beyond isolated technical updates and adopt a broader, system-oriented perspective on cardiac arrest care. This approach integrates prevention strategies, early identification, high-quality resuscitation, structured post-resuscitation management, and long-term recovery within an updated concept of the chain of survival. In Basic Life Support, the algorithms have been streamlined to improve accessibility and increase bystander participation, with early cardiopulmonary resuscitation (CPR) and defibrillation now presented as a combined, immediate response. Within Advanced Life Support, the guidelines prioritize maintaining uninterrupted chest compressions, accelerating rhythm analysis and defibrillation, and considering defibrillation pad repositioning in cases of refractory ventricular fibrillation. Greater emphasis is also placed on physiology-guided CPR, whereas novel concepts, such as CPR-induced consciousness, are introduced. Post-resuscitation care is further strengthened, with recommendations supporting timely coronary angiography when appropriate, thorough investigation of the underlying cause of arrest, active temperature management with rigorous prevention of fever, and the use of multimodal approaches for neurologic prognostication. Overall, the 2025 ERC guidelines underscore that successful resuscitation depends on coordinated systems, timely action, and continuous training, aiming to improve survival and long-term outcomes after cardiac arrest.