Resuscitation Council UK

Evidence-Based Enhancements in Resuscitation Council (UK) Guidelines (2025)

These updates emphasize minimal interruption to chest compressions, early defibrillation, and system improvements to increase overall survival rates.

Adult Basic Life Support (BLS) & Defibrillation

The focus is on maximizing the efficiency of the initial response and CPR.

Immediate Call & Assisted Recognition:

• • Change: Rescuers are now instructed to immediately call 999 (or 112) using a speakerphone if the victim is unresponsive, before checking for breathing, enabling the dispatcher to guide the entire process.

  • Rationale: This minimizes the time to emergency activation and leverages the dispatcher’s expertise to rapidly identify abnormal/agonal breathing (present in $\approx 50\%$ of cardiac arrests), thus reducing time-to-CPR.

•  CPR Quality and Interruption:

  • Change: A renewed emphasis on maintaining a compression rate between 100–120 compressions per minute and a depth of 5–6 cm.

  • Rationale: Evidence confirms that minimizing the pre-shock pause (the time between stopping compressions and delivering the shock) to less than 5 seconds is critical for improving defibrillation success and Return of Spontaneous Circulation (ROSC).

    AED Use and Pad Placement:

    • Change: For standard Adult AED pads, the lateral (apical) pad placement must be firmly applied in the mid-axillary line, just below the armpit.

    • Rationale: This ensures optimal vectoring of the electrical current across the entire heart muscle, maximizing the chance of successful defibrillation.

Paediatric Life Support (PLS)

The PLS guidelines fine-tune the techniques for infant and child resuscitation.

Infant Compression Technique:

• • Change: For single rescuers, the two-thumb encircling technique is now confirmed as the preferred method for achieving the target compression depth ($4\text{ cm}$) and pressure consistency in infants (under 1 year).

  • Rationale: Studies show the two-thumb technique generates better peak systolic and coronary perfusion pressures compared to the two-finger technique.

Paediatric Defibrillation (Dose & Pad):

• • Change: The energy dose for the first and subsequent defibrillation attempts in children is standardized to $4\text{ J}/\text{kg}$.

  • Change: For children under $\approx 8$ years or $25\text{ kg}$, the antero-posterior pad placement (one pad front, one pad back) is the clarified preferred method to ensure current passes through the small thoracic volume.