Tae-Youn Kim, Gyo Jin Ahn, Kyoung-Chul Cha, Dong-Hyeok Kim, Youdong Sohn, Young Song, Gyuhong Shim, Do Kyun Kim, Yunhee Oh, Jin Wi, Chun Song Youn, Myung-Lyeol Lee, Mi Jin Lee, Byung Kook Lee, Byung Heon Lee, Jisook Lee, Chang Hee Lee, Hannah Lee, Youngbin Jang, Yong Soo Jang, Young Hwa Jung, Woo Jin Jung, Sung Phil Chung, Gyu Chong Cho, Ju Sun Heo, Sung Oh Hwang
Clin Exp Emerg Med 2026;13(Suppl 1):S61-S74. Published online May 31, 2026
The 2025 update of the Korean guidelines for cardiac arrest under special circumstances incorporates new evidence and expert consensus to clarify when clinicians should modify standard resuscitation algorithms. For cardiac arrest caused by acute hyperkalemia, the guidelines suggest administering intravenous insulin with glucose; however, current evidence remains insufficient to recommend for or against routine use of sodium bicarbonate or calcium. In suspected pulmonary embolism–related cardiac arrest, thrombolytic therapy may be considered. In confirmed cases, thrombolysis, surgical embolectomy, or percutaneous mechanical thrombectomy may be appropriate, despite very low certainty of evidence. For opioid-related cardiac arrest, current evidence does not support the routine administration of naloxone in addition to standard advanced life support; however, naloxone may be administered when it is unclear whether the patient is in true cardiac arrest. The guidelines also emphasize managing cardiac arrest in the prone position. If the patient is intubated and immediate repositioning is unsafe or impractical, prone cardiopulmonary resuscitation and defibrillation may be attempted using invasive arterial pressure or end-tidal carbon dioxide monitoring to guide the timing of repositioning. Immediate supination is strongly recommended for non-intubated patients. Additional updates address drowning, severe hypothermia, pregnancy, anaphylaxis, and cardiac arrest during interventional procedures, underscoring the importance of early correction of reversible causes, appropriate airway strategies, and timely consideration of extracorporeal life support in selected cases. Overall, the 2025 recommendations highlight cautious, etiology-directed interventions and explicitly grade recommendation strength and certainty to support context-sensitive clinical decision-making in high-risk and resource-variable settings.
Tae-Youn Kim, Gyo Jin Ahn, Kyoung-Chul Cha, Dong-Hyeok Kim, Youdong Sohn, Young Song, Gyuhong Shim, Do Kyun Kim, Yunhee Oh, Jin Wi, Chun Song Youn, Myung-Lyeol Lee, Mi Jin Lee, Byung Kook Lee, Byung Heon Lee, Jisook Lee, Chang Hee Lee, Hannah Lee, Youngbin Jang, Yong Soo Jang, Young Hwa Jung, Woo Jin Jung, Sung Phil Chung, Gyu Chong Cho, Ju Sun Heo, Sung Oh Hwang
Clin Exp Emerg Med 2026;13(Suppl 1):S32-S60. Published online May 31, 2026
The 2025 Korean advanced life support guidelines were updated using a structured evidence evaluation process informed by recent randomized controlled trials and systematic reviews. The guideline development group prioritized patient-important outcomes and assessed the certainty of the evidence to formulate graded recommendations. For drug administration during adult cardiac arrest, intravenous access is the preferred initial route, with intraosseous access recommended when intravenous access cannot be rapidly established. Epinephrine remains the recommended vasopressor. Routine administration of vasopressin, either alone or in combination with corticosteroids, is not recommended for in-hospital or out-of-hospital cardiac arrest. In the absence of specific indications, the routine use of buffering agents and calcium is discouraged owing to insufficient evidence of their benefits and potential harm. Defibrillation recommendations were refined based on emerging evidence. In adults with refractory ventricular fibrillation or pulseless ventricular tachycardia after multiple unsuccessful defibrillation attempts, vector change or double sequential defibrillation may be considered in selected settings when performed by experienced teams with appropriate equipment. Airway management guidelines recommend cricothyroidotomy as a rescue technique when conventional airway management strategies fail. For patients receiving cardiopulmonary resuscitation while on mechanical ventilation, specific ventilator settings during chest compressions are recommended to optimize ventilation and minimize interference with high-quality cardiopulmonary resuscitation. The guidelines also address cardiopulmonary resuscitation–induced consciousness, allowing the cautious use of sedatives and/or analgesic agents when awareness interferes with resuscitation quality or safety. Overall, the guidelines emphasize evidence-based practice and individualized clinical decision-making.
Citations
Citations to this article as recorded by
Serial Ultrasound-Guided Carotid Artery Compression During Chest Compressions for Assessing Circulatory Status: A Prospective Pilot Diagnostic Study Seung Jin Maeng, Hee Yoon, Ik Joon Jo, Sejin Heo, Hansol Chang, Gun Tak Lee, Jong Eun Park, Taerim Kim, Se Uk Lee, Sung Yeon Hwang, Jihyeon Kim, Min Ji Kim Diagnostics.2026; 16(18): 2956. CrossRef
Mi Jin Lee, Tai Ho Rho, Hyun Kim, Gu Hyun Kang, June Soo Kim, Sang Gyun Rho, Hyun Kyung Park, Dong Jin Oh, Seil Oh, Jin Wi, Sangmo Je, Sung Phil Chung, Sung Oh Hwang
Clin Exp Emerg Med 2016;3:S17-S26. Published online July 5, 2016
Gastric Inflation in Prehospital Cardiopulmonary Resuscitation: Aspiration Pneumonia and Resuscitation Outcomes Tae Youn Kim, Soyeong Kim, Sang Il Han, Sung Oh Hwang, Woo Jin Jung, Young Il Roh, Kyoung-Chul Cha Reviews in Cardiovascular Medicine.2023;[Epub] CrossRef
Effect of implementation of multi-tier response system and prolonged on-scene resuscitation for out-of-hospital cardiac arrest Eujene Jung, Young Sun Ro, Hyun Ho Ryu, So Yeon Kong, Sun Young Lee The American Journal of Emergency Medicine.2022; 51: 79. CrossRef
Impact of crowding in local ambulance demand on call-to-ambulance scene arrival in out-of-hospital cardiac arrest Dae Kon Kim, Tae Han Kim, Sang Do Shin, Young Sun Ro, Kyoung Jun Song, Ki Jeong Hong, Joo Jeong The American Journal of Emergency Medicine.2022; 52: 105. CrossRef
Right-to-Left Shunts Occur During Cardiopulmonary Resuscitation: Echocardiographic Observations Woo Jin Jung, Kyoung-Chul Cha, Young-Il Roh, Kyung Soo Bae, Tae Hyun Kwon, Jae Hun Han, Sung Oh Hwang Critical Care Medicine.2022; 50(10): 1486. CrossRef
The number and level of first-contact emergency medical services crew and clinical outcomes in out-of-hospital cardiac arrest with dual dispatch response Young Su Kim, Ki Hong Kim, Kyoung Jun Song, Sang Do Shin, Jeong Ho Park Clinical and Experimental Emergency Medicine.2022; 9(4): 314. CrossRef
Survival and Rearrest in out-of-Hospital Cardiac Arrest Patients with Prehospital Return of Spontaneous Circulation: A Prospective Multi-Regional Observational Study Jae-Hyug Woo, Jin-Seong Cho, Choung Ah Lee, Gi Woon Kim, Yu Jin Kim, Hyung Jun Moon, Yong Jin Park, Kyoung Mi Lee, Won Jung Jeong, Il Kug Choi, Han Joo Choi, Hyuk Joong Choi Prehospital Emergency Care.2021; 25(1): 59. CrossRef
Effect of Korean Advanced Life Support Education on Non-Technical and Technical Skills of Nursing Students: A Pilot Study Yon Hee Seo, Kyong Ah Cho Healthcare.2021; 9(10): 1253. CrossRef
Effect of Implementation of Cardiopulmonary Resuscitation-Targeted Multi-Tier Response System on Outcomes After Out-of-Hospital Cardiac Arrest: A Before-and-After Population-Based Study Sun Young Lee, Kyoung Jun Song, Sang Do Shin Prehospital Emergency Care.2020; 24(2): 220. CrossRef
Comparing the neurologic outcomes of patients with out-of-hospital cardiac arrest according to prehospital advanced airway management method and transport time interval Sol Kim, Dong Eun Lee, Sungbae Moon, Jae Yun Ahn, Won Kee Lee, Jong Kun Kim, Jungbae Park, Hyun Wook Ryoo Clinical and Experimental Emergency Medicine.2020; 7(1): 21. CrossRef
The Effects of Simulation-Based Advanced Life Support Education for Nursing Students Sung Hwan Kim, Barry Issenberg, Young Sook Roh CIN: Computers, Informatics, Nursing.2020; 38(5): 240. CrossRef
Effectiveness of a Real-Time Ventilation Feedback Device for Guiding Adequate Minute Ventilation: A Manikin Simulation Study Sejin Heo, Sun Young Yoon, Jongchul Kim, Hye Seung Kim, Kyunga Kim, Hee Yoon, Sung Yeon Hwang, Won Chul Cha, Taerim Kim Medicina.2020; 56(6): 278. CrossRef
Preparedness of personal protective equipment and implementation of new CPR strategies for patients with out-of-hospital cardiac arrest in the COVID-19 era Jae Wan Cho, Haewon Jung, Mi Jin Lee, Sang Hun Lee, Suk Hee Lee, You Ho Mun, Han-sol Chung, Yang Hun Kim, Gyun Moo Kim, Sin-youl Park, Jae Cheon Jeon, Changho Kim Resuscitation Plus.2020; 3: 100015. CrossRef
Intra-arrest transoesophageal echocardiographic findings and resuscitation outcomes Woo Jin Jung, Kyoung-Chul Cha, Yong Won Kim, Yoon Seop Kim, Young-Il Roh, Sun Ju Kim, Hye Sim Kim, Sung Oh Hwang Resuscitation.2020; 154: 31. CrossRef
Effects of Prehospital Factors on Survival of Out-Of-Hospital Cardiac Arrest Patients: Age-Dependent Patterns Bo Yoon Rhee, Boram Kim, Yo Han Lee International Journal of Environmental Research and Public Health.2020; 17(15): 5481. CrossRef
The gradient between arterial and end-tidal carbon dioxide predicts in-hospital mortality in post-cardiac arrest patient Yong Won Kim, Sung Oh Hwang, Hee Seung Kang, Kyoung-Chul Cha The American Journal of Emergency Medicine.2019; 37(1): 1. CrossRef
Text message alert system and resuscitation outcomes after out-of-hospital cardiac arrest: A before-and-after population-based study Sun Young Lee, Sang Do Shin, Yu Jin Lee, Kyoung Jun Song, Ki Jeong Hong, Young Sun Ro, Eui Jung Lee, So Yeon Kong Resuscitation.2019; 138: 198. CrossRef
Kinetic analysis of cardiac compressions during cardiopulmonary resuscitation Yong Won Kim, Kyoung-Chul Cha, Yun Seob Kim, Yong Sung Cha, Hyun Kim, Kang Hyun Lee, Sung Oh Hwang Journal of Critical Care.2019; 52: 48. CrossRef
Comparison of hemodynamic effects and resuscitation outcomes between automatic simultaneous sterno-thoracic cardiopulmonary resuscitation device and LUCAS in a swine model of cardiac arrest Kyoung-Chul Cha, Hyung Il Kim, Yong Won Kim, Gyo Jin Ahn, Yoon Seob Kim, Sun Ju Kim, Jun Hyuk Lee, Sung Oh Hwang, Theodoros Xanthos PLOS ONE.2019; 14(8): e0221965. CrossRef
Implementation of a bundle of Utstein cardiopulmonary resuscitation programs to improve survival outcomes after out-of-hospital cardiac arrest in a metropolis: A before and after study Jeong Ho Park, Sang Do Shin, Young Sun Ro, Kyoung Jun Song, Ki Jeong Hong, Tae Han Kim, Eui Jung Lee, So Yeon Kong Resuscitation.2018; 130: 124. CrossRef
First
Prev
