Updates in paediatric advanced life support (PALS) 2025: Implications for clinical practice

Area of Science:

• Pediatric Emergency Medicine
• Cardiology
• Critical Care

Background:

• Pediatric cardiac arrest patterns are evolving, often stemming from respiratory failure or shock.
• Disparities persist in out-of-hospital survival and neurological outcomes for pediatric patients.
• Existing guidelines require updates to address current evidence and improve resuscitation success rates.

Purpose of the Study:

• To present the revised 2025 Pediatric Advanced Life Support (PALS) guidelines.
• To provide healthcare professionals with updated evidence-based strategies for emergency care of infants and children.
• To address specific challenges in pediatric resuscitation, including cardiac arrest patterns and outcome disparities.

Main Methods:

• Systematic review and evidence synthesis by the American Heart Association and American Academy of Pediatrics.
• Analysis of pediatric cardiac arrest data, focusing on respiratory failure and shock.
• Incorporation of new evidence on post-cardiac arrest care, medication administration, and monitoring.

Main Results:

• Revised guidelines recommend a post-cardiac arrest blood pressure target above the 10th centile.
• Epinephrine administration timing is updated: after two defibrillation attempts for shockable rhythms and early for non-shockable rhythms.
• Emphasis on preventing hyperthermia, high-quality cardiopulmonary resuscitation (CPR), targeted post-arrest care, and continuous electroencephalogram monitoring.

Conclusions:

• The updated PALS guidelines offer a robust framework for harmonizing pediatric emergency care.
• Adoption of these protocols is expected to enhance resuscitation outcomes and neurological recovery.
• Integration of long-term survivor support and family presence during resuscitation are key components for comprehensive care.