The new 2025 Korean Guidelines for Cardiopulmonary Resuscitation (CPR) were published in the 2026 supplement issue of Clinical and Experimental Emergency Medicine. This guideline is the fourth revision since 2006 and comprises 11 papers in total.
The focus of the 2025 Korean CPR guidelines is to promote the use of automated external defibrillators (AEDs) by laypersons. Defibrillation is an essential element of the chain of survival; however, less than 3% of cardiac arrests are treated with AEDs in Korea [
1]. Notably, the deployment of AEDs is increasing because of legal requirements in many public places. In one study, only 0.7% of patients with witnessed cardiac arrest were treated with AEDs along with bystander CPR [
2]. These guidelines recommend that 119 (Korean emergency medical services) dispatchers instruct laypersons to get and apply AEDs along with chest compressions to increase AED utilization. Additionally, a recommendation was made to extend AED use. Previously, AED use was only recommended for adults; however, now its use is being extended to children aged above 1 year. To address the fact that female patients with cardiac arrest are less likely to receive AEDs than male patients, a recommendation was made to allow the application of AEDs by simply adjusting the position of the patient's underwear without removing it.
The 2025 Korean guidelines added the concepts of “rehabilitation and recovery” to the chain of survival. As post–cardiac arrest care continues after the return of spontaneous circulation, rehabilitation to enhance the quality of life and recovery of social reintegration of survivors should follow after hospital discharge. The American Heart Association (AHA) added a recovery link to the chain of survival in its 2020 guidelines [
3]. In Korea, relatively little research has been conducted on the rehabilitation and social reintegration of cardiac arrest survivors. Of the 33,034 out-of-hospital patients with cardiac arrest transported to the hospital in 2024, 3,038 (9.2%) survived and 2,085 (6.3%) achieved good neurological recovery (Cerebral Performance Category score of 1 or 2) [
4]. A systematic, multidisciplinary rehabilitation program should be developed along with a cross-sectional study of these survivors, and integrated rehabilitation treatment, including neurocognitive therapy and psychosocial support, should be provided to improve their quality of life and facilitate social reintegration [
5].
The 2025 Korean guidelines include a new section regarding first aid. As the CPR guidelines focus on the treatment of cardiac arrest, first aid was not previously covered in the Korean guidelines. The CPR guidelines of AHA and the European Resuscitation Council (ERC) already include first aid guidelines for circumstances that can lead to cardiac arrest, with the goal of preventing cardiac arrest [
6,
7]. Although the scope of first aid is broad, from minor to life-threatening situations, these guidelines focus on care that can be provided by laypersons for several circumstances related to cardiac arrest, such as chest pain, stroke, and seizures.
These guidelines have been adapted to fit the sociocultural and medicolegal context of Korea by reviewing the evidence summary published by the International Liaison Committee on Resuscitation [
8]. Therefore, some of the contents in the updated Korean guidelines may differ from those recommended by the AHA and ERC guidelines. For example, in the United States, where the rate of cardiac arrest due to opioid overdose is relatively high, public access naloxone is recommended for use by the general public [
9]. However, in Korea, cardiac arrest due to opioid overdose is uncommon, and the use of naloxone by emergency medical technicians (EMTs) is not legally permitted. Additionally, because EMTs are not legally permitted to declare death at the cardiac arrest scene in Korea, the termination of resuscitation rule was not included in the guidelines [
10].
These guidelines were developed through consensus among experts from 17 professional organizations, including the Korea Disease Control and Prevention Agency and the Korean Association of Cardiopulmonary Resuscitation. The class of recommendations and certainty of evidence were provided based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology; for topics with insufficient evidence, we attempted to provide as much guidance as possible by utilizing expert consensus and good practice statements [
11]. The authors hope that this update of Korean CPR guidelines will lead to changes in the sociomedical environment for treating cardiac arrest, thereby improving the survival rate and the quality of life of patients with cardiac arrest in Korea.
NOTES
-
Conflicts of interest
Sung Phil Chung and Sung Oh Hwang are editorial board members of this journal, but were not involved in the peer reviewer selection, evaluation, or decision process of this article. The authors have no other conflicts of interest to declare.
-
Funding
The authors received no financial support for this study.
-
Data availability
Data sharing is not applicable as no new data were created or analyzed in this study.
REFERENCES
- 1. Oh YT, Ahn C. Characteristics and treatment outcomes of out-of-hospital cardiac arrests occurring in public places: a national population-based observational study. J Pers Med 2023;13:1191.
- 2. Heo JY, Oh YT, Kim JH, et al. Association between bystander automated external defibrillator use and survival in witnessed out-of-hospital cardiac arrest: a nationwide observational study in South Korea. Resuscitation 2024;203:110388.
- 3. Berg KM, Cheng A, Panchal AR, et al. Part 7: systems of care: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2020;142(16_suppl_2):S580-604.
- 4. Kim J. Trends of survival and neurological recovery in out-of-hospital cardiac arrest patients, 2014-2024. Jugan Geongang Gwa Jilbyeong 2025;18:2096-7.
- 5. Salwa K, Kaziród-Wolski K, Rębak D, Sielski J. Current perspectives on rehabilitation following return of spontaneous circulation after sudden cardiac arrest: a narrative review. Healthcare (Basel) 2025;13:1865.
- 6. Hewett Brumberg EK, Douma MJ, Alibertis K, et al. 2024 American Heart Association and American Red Cross guidelines for first aid. Circulation 2024;150:e519-79.
- 7. Djärv T, Rogers J, Semeraro F, et al. European Resuscitation Council guidelines 2025 first aid. Resuscitation 2025;215 Suppl 1:110752.
- 8. Berg KM, Bray JE, Djärv T, et al. Executive summary: 2025 International Liaison Committee on Resuscitation consensus on science with treatment recommendations. Circulation 2025;152(16_suppl_1):S2-22.
- 9. Dezfulian C, Cabañas JG, Buckley JR, et al. Part 4: Systems of care: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2025;152(16_suppl_2):S353-84.
- 10. Smyth MA, Gunson I, Coppola A, et al. Termination of resuscitation rules and survival among patients with out-of-hospital cardiac arrest: a systematic review and meta-analysis. JAMA Netw Open 2024;7:e2420040.
- 11. Dewidar O, Lotfi T, Langendam MW, et al. Good or best practice statements: proposal for the operationalisation and implementation of GRADE guidance. BMJ Evid Based Med 2023;28:189-96.
Citations
Citations to this article as recorded by
