Updated pediatric cardiopulmonary resuscitation: a comprehensive review of the 2025 guidelines

Pediatric cardiac arrest differs fundamentally from adult arrest in its etiology, physiology, and clinical course. In children, most events arise from progressive respiratory failure or circulatory compromise rather than primary cardiac causes. The 2025 American Heart Association pediatric cardiopulmonary resuscitation (CPR) guidelines provide an updated, evidence-based framework that reflects these distinctions. This review summarizes key revisions across basic life support, advanced life support, and post-cardiac arrest care (PCAC), and outlines practical considerations for clinical implementation. Major updates include refined chest compression techniques for infants, earlier administration of epinephrine for non-shockable rhythms, revised management of foreign-body airway obstruction, and clearer guidance on the use and limitations of end-tidal carbon dioxide monitoring. The guidelines also emphasize targeted hemodynamic management, including maintaining diastolic pressures ≥ 25 mmHg in infants and ≥ 30 mmHg in children during CPR, and sustaining systolic and mean arterial pressures above the age-specific 10th percentile after return of spontaneous circulation. Temperature management prioritizes the strict avoidance of hyperthermia, with the optional use of structured temperature control protocols. The unified Chain of Survival-comprising (1) recognition and emergency activation, (2) high-quality CPR, (3) defibrillation, (4) advanced resuscitation, (5) PCAC, and (6) recovery and survivorship-serves as an integrated framework linking early recognition of arrest to long-term rehabilitation. Implementation of these recommendations requires coordinated teamwork, system-level preparedness, and age-appropriate clinical decision-making. Applied within this framework, the 2025 pediatric CPR guidelines have the potential to improve survival and neurological outcomes in infants and children experiencing cardiac arrest.