CONFIDENTIAL

1 2025 ILCOR Statement

2 2025 International Consensus on Cardiopulmonary Resuscitation and Emergency

3 Cardiovascular Care Science With Treatment Recommendations

4 Education, Implementation, and Teams

6 Authors: Robert Greif (chair EIT), Adam Cheng (vice-chair EIT), Cristian Abelairas-

7 Gomez, Katherine Allan, Jan Breckwoldt, Andrea Cortegiani, Aaron Donoghue, Kathryn

8 Eastwood, Barbara Farquharson, Ming-Ju Hsieh, Tracy Kidd, Ying-Chih Ko, Kasper G

9 Lauridsen, Yiqun Lin, Andrew Lockey, Tasuku Matsuyama, Sabine Nabecker, Kevin Nation,

10 Alexander Olaussen, Sebastian Schnaubelt, Taylor Sawyer, Chih-Wei Yang, Joyce Yeung

11 Collaborators: Alanoud Alghaith, Theresa Aves, Adam Boulton, Natalie Anderson, Emma

12 Buergstein, Aida Carballo-Fazanes, Jon Duff, Bianca Flaim, Heike Geduld, Mariachiara Ippolito,

13 Teruko Kishibe, Tse-Ying Lee, Julian Lennertz, Brenna Leslie, Kai-Wei Lin, Henry Cheng-Heng

14 Liu, Matthew Olejarz, Timo de Raad, Andrea Scapigliati, Federico Semeraro, Charly Southern,

15 Devita Stallings, Lorrel Toft, Sandra Viggers

16

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1 ABSTRACT

2 The International Liaison Committee on Resuscitation conducts continuous reviews of

3 new, peer-reviewed, published cardiopulmonary resuscitation science and publishes more

4 comprehensive reviews every 5 years. The Education, Implementation, and Teams chapter of the

5 2025 International Consensus on Cardiopulmonary Resuscitation and Emergency

6 Cardiovascular Care Science With Treatment Recommendations describes all published

7 resuscitation evidence reviewed by the International Liaison Committee on Resuscitation’s

8 Education, Implementation, and Teams Task Force science experts since 2020. This summary

9 addresses the evidence in 4 subchapters: (1) training populations, (2) faculty development, (3)

10 knowledge translation and implementation, and (4) instructional design. Members from the

11 Education, Implementation, and Teams Task Force have assessed, discussed, and debated the

12 quality of the evidence, based on Grading of Recommendations, Assessment, Development, and

13 Evaluation criteria, and their statements include consensus treatment recommendations. Insights

14 into the deliberations of the task force are provided in the Justification and Evidence-to-Decision

15 Framework Highlights sections. Priority knowledge gaps for further research are listed.

16 Key words: Education, implementation, team, resuscitation, CPR, teaching, training,

17 simulation, laypersons, health care professional, facilitator, instructor, faculty development

18

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1 INTRODUCTION

2 This International Liaison Committee on Resuscitation (ILCOR) Education, Implementation,

3 and Teams (EIT) Task Force 2025 International Consensus on Cardiopulmonary Resuscitation

4 and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR)

5 publication includes all the reviews conducted by the EIT Task Force in the previous year.

6 Reviews conducted and published since the 2020 publication are also summarized to provide a

7 single, more comprehensive reference document for readers. New work from the past year

8 encompasses 12 PICOST (population, intervention, comparator, outcome, study design, and time

9 frame) studies reviewed in some capacity, including 10 systematic reviews (SysRevs). Draft

10 CoSTRs for all 2025 topics evaluated with SysRevs were posted between December 1, 2024, and

11 January 15, 2025, on the ILCOR website.1 Each draft CoSTR includes the data reviewed and

12 draft treatment recommendations, with public comments accepted for 2 weeks after posting. EIT

13 Task Force members considered public feedback and provided responses. All CoSTRs are now

14 available online, adding to the existing CoSTR statements.

15 Although only SysRevs can generate a full CoSTR and new treatment recommendations,

16 many other topics were evaluated with more streamlined processes, including scoping reviews

17 (ScopRevs) and evidence updates (EvUps). Good practice statements, which represent the

18 opinion of task force experts in light of very limited or no direct evidence, can be generated after

19 ScopRevs and occasionally after EvUps in cases where the task force thinks providing guidance

20 is especially important. A separate publication in this issue includes the full details of the

21 evidence evaluation process.2

22 This summary statement contains the final wording of the treatment recommendations and

23 good practice statements as approved by the ILCOR EIT Task Force, as well as summaries of the

24 evidence identified. SysRevs include evidence-to-decision highlights and knowledge gaps, and

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1 ScopRevs summarize task force insights on specific topics. Links to the published reviews and

2 full online CoSTRs are provided in the corresponding sections. Evidence-to-decision tables for

3 SysRevs are provided in Appendix A, and the complete EvUp worksheets are provided in

4 Appendix B.

5 Topics are presented using the Grading of Recommendations, Assessment, Development,

6 and Evaluation (GRADE) approach3 in the PICOST format. To minimize redundancy, the study

7 designs have been removed from the text except in cases where the designs differed from the EIT

8 standard criteria. Standard study designs included are randomized controlled trials (RCTs) and

9 nonrandomized studies (nonrandomized controlled trials, interrupted time series, controlled

10 before-and-after studies, cohort studies), and all languages were included provided there was an

11 English abstract. Unpublished studies (eg, conference abstracts, trial protocols), letters,

12 editorials, comments, and case reports were excluded.

13 From 2020 onward, the EIT Task Force grouped its PICOST questions in 4 categories and

14 identified some topics to exclude because the content was either outdated or irrelevant due to

15 more modern teaching or methods of implementation. The 4 categories and the topics addressed

16 in this EIT Task Force CoSTR summary are delineated in Table 1. All EIT PICOST questions

17 reviewed since 2020 have been reviewed in some form for 2025. The type of review done this

18 year and the most recent preceding review are summarized in Table 1. A supplementary Table

19 S1 lists previous and updated treatment recommendations from 2021 to 2025 and includes the

20 corresponding knowledge gaps.

21 Readers are encouraged to monitor the ILCOR website1 to provide feedback on planned

22 systematic reviews and to provide comments when additional draft reviews are posted.

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1 Table 1. Overview of PICOSTs Addressed From 2021-2025

Year of Type of
Type of review for
PICOST number previous previous
2025
review review
Training populations
Disparities in education EIT 6102 EvUp 2023 ScopRev
EMS experience and exposure EIT 6104 EvUp 2020 SysRev
BLS training for likely rescuers of high-risk populations EIT 6105 EvUp 2022 SysRev
Patient outcomes when team member attended CPR course EIT 6106 EvUp 2022 SysRev
CPR education tailored for specific populations EIT 6108 EvUp 2024 ScopRev
Faculty development
Faculty development approaches for CPR instructors EIT 6200 EvUp 2022 ScopRev
Knowledge translation and implementation
Debriefing of resuscitation performance EIT 6307 SysRev 2020 SysRev
Medical emergency systems for adults EIT 6309 SysRev 2020 SysRev
Systems performance improvements EIT 6310 SysRev 2020 SysRev
Prehospital critical care for OHCA patients EIT 6313 SysRev new in 2025
CPR coaching during adult and pediatric cardiac arrest EIT 6314 SysRev new in 2025
OHCA Termination of Resuscitation rules EIT 6303 Adolopment 2020 SysRev
Community initiatives to promote BLS implementation EIT 6306 ScopRev 2020 ScopRev
Family presence in adult resuscitation EIT 6300 EvUp 2023 SysRev
Cardiac arrest centers EIT 6301 EvUp 2024 SysRev
Technology to summon providers EIT 6302 EvUp 2020 SysRev
Willingness to provide CPR EIT 6304 EvUp 2020 ScopRev
Clinical decision rules to facilitate in-hospital DNACPR EIT 6305 EvUp 2022 SysRev
Termination of resuscitation for IHCA EIT 6308 EvUp 2020 SysRev
Chain of survival EIT 6311 EvUp 2024 ScopRev
Impact of support on mental health in co-survivors of CA patients EIT 6315 EvUp new in 2025
Instructional design
CPR feedback devices during training EIT 6404 SysRev 2020 SysRev
CPR self-instruction versus instructor-guided EIT 6406 SysRev 2021 SysRev
In situ training EIT 6407 SysRev 2020 EvUp
Manikin fidelity in resuscitation education EIT 6410 SysRev 2020 EvUp
Cognitive aids during resuscitation EIT 6400 EvUp 2024 SysRev

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Year of Type of
Type of review for
PICOST number previous previous
2025
review review
Provider workload and stress during resuscitation EIT 6401 EvUp 2024 ScopRev
Stepwise approach to skills training in resuscitation EIT 6402 EvUp 2023 SysRev
Immersive technologies–virtual and augmented reality EIT 6405 EvUp 2024 SysRev
Blended learning approach for life-support education EIT 6409 EvUp 2022 SysRev
Gamified learning versus nongamified learning EIT 6412 EvUp 2024 SysRev
Scripted debriefing versus nonscripted debriefing EIT 6413 EvUp 2024 ScopRev
Rapid-cycle deliberate practice in resuscitation training EIT 6414 EvUp 2024 SysRev
Team competencies in resuscitation training EIT 6415 EvUp 2024 SysRev
1 BLS indicates basic life support; CPR, cardiopulmonary resuscitation; DNACPR, do not attempt cardiopulmonary resuscitation; EMS, emergency medical services;
2 IHCA, in-hospital cardiac arrest; OHCA, out-of-hospital cardiac arrest; and PICOST, population, intervention, comparator, outcome, study design, and time frame.

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1 CONTENTS

2 • Training Populations

3 – Disparities in Education (EIT 6102, ScopRev 2023, EvUp 2025)

4 – Emergency Medical Services (EMS) Experience and Exposure (EIT 6104, EvUp

5 2025)

6 – Basic Life Support (BLS) Training for Likely Rescuers of High-Risk Populations

7 (EIT 6105, SysRev 2022, EvUp 2025)

8 – Patient Outcome of Team Member Attending Cardiopulmonary Resuscitation (CPR)

9 Course (EIT 6106, SysRev 2022, EvUp 2025)

10 – CPR Education Tailored for Specific Populations (EIT 6108, ScopRev 2024, EvUp

11 2025)

12 • Faculty Development

13 – Approaches for CPR Instructors (EIT 6200, ScopRev 2022, EvUp 2025)

14 • Knowledge Translation and Implementation

15 – Debriefing of Resuscitation Performance (EIT 6307, SysRev 2025)

16 – Medical Emergency Systems for Adults (EIT 6309, SysRev 2025)

17 – Systems Performance Improvements (EIT 6310, SysRev 2025)

18 – Prehospital Critical Care for Out-of-Hospital CA Patients (EIT 6313, SysRev 2025)

19 – CPR Coaching During Adult and Pediatric Cardiac Arrest (EIT 6314, SysRev 2025)

20 – Out-of-Hospital Cardiac Arrest Termination of Resuscitation (TOR) Rules (EIT 6303,

21 SysRev ADOLOPMENT 2025)

22 – Community Initiatives to Promote BLS Implementation (EIT 6306, ScopRev 2025)

23 – Family Presence in Adult Resuscitation (EIT 6300, SysRev 2024, EvUp 2025)

24 – Cardiac Arrest Centers (EIT 6301, SysRev 2024, EvUp 2025)

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1 – Technology to Summon Providers (EIT 6302, EvUp 2025)

2 – Willingness to Provide CPR (EIT 6304, EvUp 2025)

3 – Clinical Decision Rules to Facilitate In-Hospital Do-Not-Attempt CPR (EIT 6305,

4 SysRev 2022, EvUp 2025)

5 – Termination of Resuscitation for In-hospital Cardiac Arrest (EIT 6308, EvUp 2025)

6 – Chain of Survival (EIT 6311, ScopRev 2024, EvUp 2025)

7 – Impact of Support on Mental Health in Cosurvivors of Cardiac Arrest Patients (EIT

8 6315, EvUp 2025)

9 • Instructional Design

10 – CPR Feedback Devices During Training (EIT 6404, SysRev 2025)

11 – CPR Self-Instruction versus Instructor Guided (EIT 6406, SysRev 2025)

12 – In Situ Training (EIT 6407, SysRev 2025)

13 – Manikin Fidelity in Resuscitation Education (EIT 6410, SysRev 2025)

14 – Cognitive Aids During Resuscitation (EIT 6400, SysRev 2024, EvUp 2025)

15 – Provider Workload and Stress During Resuscitation (EIT 6401, ScopRev 2024, EvUp

16 2025)

17 – Stepwise Approach to Skills Training in Resuscitation (EIT 6402, SysRev 2023,

18 EvUp 2025)

19 – Immersive Technologies–Virtual and Augmented Reality (EIT 6405, SysRev 2024,

20 EvUp 2025)

21 – Blended Learning Approach for Life-Support Education (EIT 6409, SysRev 2022,

22 EvUp 2025)

23 – Gamified Learning versus Nongamified Learning (EIT 6412, SysRev 2024, EvUp

24 2025)

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1 – Scripted Debriefing versus Non-scripted Debriefing (EIT 6413, ScopRev 2024, EvUp

2 2025)

3 – Rapid Cycle Deliberate Practice in Resuscitation Training (EIT 6414, SysRev 2024,

4 EvUp 2025)

5 – Team Competencies in Resuscitation Training (EIT 6415, SysRev 2024, EvUp 2025)

6 • Topics Not Included in the 2025 Review

7 – Resuscitation Training in Low-Income Countries (EIT 6100, ScopRev In 2020, task

8 force statement 2023)

9 – Spaced Learning (EIT 6408, SyR 2020, EvUp 2022)

10 TRAINING POPULATIONS

11 Disparity in Layperson Resuscitation Education (EIT 6102, ScopRev 2023, EvUp 2025)

12 A ScopRev was performed for 2023, and details can be found in the 2023 CoSTR

13 summary.4-6 The complete EvUp is provided in Appendix B.

14 Population, Intervention, Comparator, Outcome, and Time Frame

15 • Population: Laypersons (defined as non–healthcare professional)

16 • Intervention (Exposure): Presence of any specific factor

17 • Comparator: Absence of the specific factor

18 • Outcome: Likelihood of undertaking resuscitation education, including adult/pediatric

19 BLS, and neonatal resuscitation program

20 • Time frame: January 1, 2023, to October 31, 2024

21 Summary of Evidence

22 Two new observational studies were found investigating disparities in layperson

23 resuscitation training.7,8 The factors identified in the 2 studies align with the categories outlined

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1 in the previous scoping review, specifically personal factors, socioeconomic status and

2 education, and geographic factors. An updated SysRev was not thought to be warranted, but

3 there is a need for further research to explore overlooked aspects that may be associated with

4 these disparities.

5 EMS Experience and Exposure (EIT 6104, EvUp)

6 Population, Intervention, Comparator, Outcome, and Time Frame

7 • Population: Adults and children with out-of-hospital cardiac arrest (OHCA)

8 • Intervention: Resuscitation by experienced emergency medical service practitioners or

9 practitioners with higher exposure to resuscitation

10 • Comparator: Resuscitation by less-experienced or lower-exposed practitioners

11 • Outcomes: Improved OHCA patient outcome (good neurological outcome at

12 discharge/30 days; survival to hospital discharge/30 days; survival to hospital [event

13 survival]; return of spontaneous circulation [ROSC]); EMS personnel

14 confidence/satisfaction with OHCA procedures/training

15 • Time frame: April 10, 2020, to May 6, 2024

16 Summary of Evidence

17 A SysRev was performed for 2020 and details can be found in the 2020 CoSTR.9-11 The

18 complete EvUp is provided in Appendix B. No further relevant papers were identified; therefore,

19 a SysRev is not required.

20 Treatment Recommendations (2020)

21 We suggest that EMS systems (1) monitor their clinical personnel’s exposure to

22 resuscitation and (2) implement strategies, where possible, to address low exposure or ensure

23 that treating teams have members with recent exposure (weak recommendation, very low–

24 certainty evidence).
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1 BLS Training for Likely Rescuers of High-Risk Populations (EIT 6105, SysRev 2022, EvUp

2 2025)

3 A SysRev was performed for 2022, and details can be found in the 2022 CoSTR

4 summary.12,13 The complete EvUp is provided in Appendix B.

5 Population, Intervention, Comparator, Outcome, and Time Frame

6 • Population: Adults and children at high risk of OHCA

7 • Intervention: Targeted BLS training of likely rescuers (eg, family members or caregivers)

8 • Comparator: No such targeting

9 • Outcomes

10 – Patient: Favorable neurological outcome at hospital discharge or to 30 days, survival

11 at hospital discharge or to 30 days, ROSC, rates of bystander CPR (subsequent use of

12 skills), bystander CPR quality during an OHCA (any available CPR metrics), and

13 rates of automated external defibrillator (AED) use (subsequent use of skills)

14 – Educational: CPR quality and correct AED use at end of training and within 12

15 months of training, CPR and AED knowledge at end of training and within 12 months

16 after training, confidence and willingness to perform CPR at end of training and

17 within 12 months after training, and CPR training of others

18 • Time frame: January 1, 2014, to July 31, 2024

19 Summary of Evidence

20 The 5 new observational studies identified are consistent in supporting previous findings

21 and do not substantially change the weight of evidence.14-18 A SysRev for studies before 2010

22 will be considered.

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1 Treatment Recommendations (2022)

2 We recommend BLS training for likely rescuers of populations at high-risk of out-of-

3 hospital cardiac arrest (strong recommendation, low- to moderate-certainty evidence).

4 We recommend healthcare professionals encourage and direct likely rescuers of

5 populations at high risk of cardiac arrest to attend BLS training (good practice statement).

6 Patient Outcomes When CPR Team Member Attended a CPR Course (EIT 6106, SysRev

7 2022, EvUp 2025)

8 A SysRev was performed in 2022 and details can be found in the 2022 CoSTR

9 summary.12,13,19 The complete EvUp is provided in Appendix B.

10 Population, Intervention, Comparator, Outcome, Study Design, and Time Frame

11 • Population: Patients of any age requiring in-hospital cardiac arrest (IHCA) resuscitation

12 • Intervention: Prior participation of ≥1 members of the resuscitation team in an accredited

13 advanced life support (ALS) course

14 • Comparator: No such participation

15 • Outcomes: ROSC, survival to hospital discharge or to 30 days, survival to 1 year, and

16 survival with favorable neurological outcome

17 – Additional outcomes for Neonatal Resuscitation Training: stillbirth rate, neonatal and

18 perinatal mortality

19 • Study designs: In this review we excluded studies of the impact of individual components

20 of courses (eg, airway, drug therapy, defibrillation), studies relating to BLS and first aid

21 courses, studies on dedicated trauma courses (eg, Advanced Trauma Life Support ,

22 European Trauma Course), and studies relating to OHCA.

23 • Time frame: June 1, 2022, to July 31, 2024

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1 Summary of Evidence

2 No relevant studies were identified, and no new SysRev is indicated.

3 Treatment Recommendations (2022)

4 We recommend the provision of accredited ALS training (advanced cardiovascular life

5 support, ALS) for health care providers who provide ALS care for adults (strong

6 recommendation, very low–certainty evidence).

7 We recommend the provision of accredited courses in neonatal resuscitation training

8 (neonatal resuscitation training, neonatal resuscitation programs) and Helping Babies Breath for

9 health care providers who provide ALS care for newborns and babies (strong recommendation,

10 very low–certainty evidence).

11 We have made a discordant recommendation (strong recommendation despite very low–

12 certainty evidence) because we have placed a very high value on an uncertain but potentially

13 life-preserving benefit, and the intervention is not associated with prohibitive adverse effects.

14 CPR Education Tailored for Specific Populations (EIT 6108, ScopRev 2023, EvUp 2025)

15 The complete EvUp is provided in Appendix B. A ScopRev was performed in 2023, and

16 details can be found in the 2023 CoSTR summary.4,5,20

17 Population, Intervention, Comparator, Outcome, Study Design, and Time Frame

18 • Population: Specific adult layperson populations and/or groups (defined below)

19 participating in BLS training

20 • Intervention: Tailored BLS training

21 • Comparator: Generic BLS training

22 • Outcomes:

23 – Patient: ROSC, survival to hospital discharge, 30 days, and 12 months; neurological

24 outcome

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1 – Clinical: Starting CPR in case of real cardiac arrest, performance during real CPR

2 – Educational: knowledge and skills acquisition, willingness to perform CPR, barriers

3 to performing CPR, participant satisfaction and/or knowledge and skills retention at

4 end of the respective course and later (eg, 3 months, 1 year), implementation success,

5 resource implications, and cost-effectiveness

6 • Study designs: Research aimed at teaching BLS to children, research on CPR training for

7 various healthcare professionals (both sufficiently covered elsewhere) were excluded.

8 • Time frame: January 1, 2023, to October 22, 2024

9 Summary of Evidence

10 Insights from the 2023 review included that tailored BLS education for specific

11 populations is probably feasible and that groups that may otherwise have been left out (eg,

12 individuals with disabilities) can be added into the pool of potential bystander CPR providers.

13 Specific tailored courses for first responders with and without a duty to respond need to be

14 explored. In this EvUp search, no relevant studies were found. There is too little evidence on the

15 topic of tailored BLS training for specific population groups to perform a SysRev, but the task

16 force thought a good practice statement was important to encourage progress in this area.

17 Treatment Recommendations (2025)

18 The task force encourages resuscitation councils to develop, offer, and implement

19 tailored BLS courses for specific populations based on their needs and specific educational

20 approach (good practice statement).

21 FACULTY DEVELOPMENT

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1 Faculty Development Approaches for Resuscitation Instructors (EIT 6200, ScopRev 2022,

2 EvUp 2025)

3 A ScopRev was conducted for 2022,21 and details of that review can be found in the 2022

4 CoSTR summary.12,13 The complete EvUp is provided in Appendix B.

5 Population, Intervention, Comparator, Outcome, Study Designs and Time Frame

6 • Population: Instructors of accredited life-support courses, including basic life support

7 (BLS), pediatric basic life support, ALS, pediatric advanced life support, and neonatal

8 resuscitation programs

9 • Intervention: Any faculty development approach to improve instructional competence in

10 accredited life-support courses

11 • Comparator: No such approach or any other faculty development approach

12 • Outcomes:

13 – Patient outcomes:

14 ▪ Critical: outcome of patients resuscitated by students of the instructors, including

15 favorable neurological outcome, survival to discharge, short-term survival,

16 ROSC, sustained ROSC, and survival to admission

17 – Educational outcomes:

18 ▪ Critical: Skill performance of students of the instructors in actual resuscitation

19 ▪ Important: Knowledge, skill performance, attitudes, willingness to perform

20 resuscitation, and confidence of students of the instructors immediately after the

21 provider course or at defined periods of time after course completion

22 – Instructors outcome:

23 ▪ Important: Knowledge, instructional skills, and attitudes of instructors at end of

24 instructor training course; knowledge, instructional skills, and attitudes of

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1 instructors at defined periods of time after end of instructor training course;

2 confidence of instructors to teach students at end of instructor training course at

3 defined periods of time after course completion; instructor acceptance of a faculty

4 development approach; cost of faculty development

5 • Study designs: In addition to standard criteria, grey literature, non–peer-reviewed studies,

6 unpublished studies, conference abstracts, and trial protocols were eligible for inclusion.

7 • Time frame: January 1, 2022 (after last research), to June 30, 2024

8 Summary of Evidence

9 Two studies identified in this evidence update found that instructor courses with reduced

10 face-to-face time were not inferior to traditional instructor courses.22,23 Two other studies

11 incorporating techniques for identifying and correcting common student errors improved student

12 BLS performance.24,25 This suggests that integrating techniques for recognizing common student

13 mistakes in instructor courses may enhance the effectiveness of teaching. This ScopRev has not

14 identified sufficient evidence to support a SysRev.

15 Treatment Recommendations (2025)

16 The task force encourages resuscitation councils to implement faculty development

17 programs for the teaching staff of their accredited resuscitation courses (good practice

18 statement).

19 KNOWLEDGE TRANSLATION AND IMPLEMENTATION

20 Debriefing of Clinical Resuscitation Performance (EIT 6307, SysRev 2025)

21 Rationale for Review

22 Strategies to provide debriefing to improve CPR team performance and optimize delivery

23 of care are available and often common practice. However, there are few data showing either

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1 improved patient outcome or negative side effects (eg, cost, emotional impact on professionals).

2 The last review of this topic was in 2020, and awareness of new data prompted this SysRev,

3 which was registered in Prospective Register of Systematic Reviews (PROSPERO)

4 (CRD42024595033). The full CoSTR is available on the ILCOR website.26

5 Population, Intervention, Comparator, Outcome, and Time Frame

6 • Population: Healthcare providers performing resuscitation in any clinical setting

7 • Intervention: Postevent clinical debriefing

8 • Comparator: No debriefing

9 • Outcomes:

10 – Clinical: Resuscitation skills performance (in clinical contexts, eg, CPR quality, time

11 to medication administration, initiation of CPR, time to defibrillation, chest

12 compression fraction, etc.), and resuscitation knowledge

13 – Patient: Favorable neurological outcome at hospital discharge/30 days, survival at

14 hospital discharge/30 days, survival to hospital admission, event survival

15 • Time frame: January 1, 2014, to September 26, 2024

16 Consensus on Science

17 Six studies in adults,27-32 1 in children,33 and 3 in neonatal cardiac arrests34-36 were

18 identified. All were nonrandomized studies providing very low certainty of evidence.

19 Interventions included post-resuscitation debriefings;27 audiovisual feedback plus weekly post-

20 event debriefings;28 short, individual oral debriefings;29 hot or cold debriefings;30 weekly

21 debriefing sessions with audiovisual feedback during cardiac arrest31 after-training workshops

22 with debriefing;34 video-assisted, performance-focused debriefings;36 positive-pressure

23 ventilation refresher and performance debriefings;35 and post-resuscitation interdisciplinary team

24 debriefings.33 One study stratified hospitals by debriefing frequency.32 Because of this

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1 heterogeneity, no meta-analyses could be performed. Key study findings are presented in Table

2 2.

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1 Table 2. Key Findings of Included Studies on Post-event Debriefing

Favorable Survival to Chest Chest Chest Adherence to
Outcome of
neurological hospital ROSC compression compression compression resuscitation
interest
outcome discharge depth rate fraction guidelines
Number of 5 nonrandomized 6 nonrandomized 7 nonrandomized 3 nonrandomized 4 4 nonrandomized 2 studies35,36
studies studies28-30,32,33 studies27-29,32,33 studies28-31,33,34 studies28,29,31 nonrandomized studies27-29,31
studies27-29,31
Number of 46 145 46 269 46 459 1773 1897 1897 381
patients
Evidence 1 study favored hot 1 study favored 1 study30 found 1 study31 found 1 study27 found 1 study27 found 1 study36 found
debriefings30—using hot debriefings,30 48% probability that CC depth was that CC rate was that CCF was 79% a median total
a Bayesian finding 67% that hot 50 mm (10) with 93/min with (70%–85%) with NRPE score of
hierarchical logistic probability of debriefings debriefing and 44 debriefing (9) debriefing and 89% (86, 93)
regression model— increased odds of increase the odds mm (10) without and 81/min (13) 86% (82%–89%) with debriefing
77% probability of survival with hot of ROSC (OR, debriefing without without. No effect and 77% (75,
increased odds of debriefings (OR, 0.99; 95% CI, (P<0.001). No (P=0.03). No size or P value 81) without
favorable 1.06; 95% CI, 0.80–1.21) and effect size effect size reported. (P<0.001).
neurological 0.81–1.37). 89% probability reported. reported.
outcome with hot However, 11% that cold
debriefings (OR probability of debriefings
1.11; 95% CI, 0.83– increased odds of increase the odds
1.44). survival with of ROSC (OR,
However, 1% cold debriefings 1.15; 95% CI,
probability of (OR, 0.83; 95% 0.90–1.43).
increased odds of CI, 0.62–1.11)
favorable
neurological
outcome with cold
debriefings (OR
0.69; 95% CI, 0.49–
0.93).
1 study33 found 1 study33 found 1 study31–reported 1 study31 found a 1 study31 found a 1 study35 found
debriefing was no association a ROSC rate of CC rate of no-flow fraction of a median NRPE
associated with between 59% with 105/min (10) 0.13 (0.10) with score of 89%
improved favorable debriefing and debriefing, and with debriefing debriefing and 0.20 (86%–92%)
neurologic outcome. improved 45% without and 100/min (0.13) without with debriefing
Univariate: (50% survival in (P=0.03). No (13) without (P<0.001). No and 77% (75%–
versus 29%; univariate effect size (P=0.003). No effect size 81%) without
P=0.036); analysis (52% reported. effect size reported. (P<0.001.)
multivariate: (aOR, versus 33%; reported.

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Favorable Survival to Chest Chest Chest Adherence to

Outcome of
neurological hospital ROSC compression compression compression resuscitation
interest
outcome discharge depth rate fraction guidelines
2.75; 95% CI, 1.01– P=0.054); after
7.5; P=0.047). controlling for
potential
confounders
(aOR, 2.5; 95%
CI, 0.91–6.8;
P=0.075).
1 study34 showed
no significant
differences
between groups
for time of
neonate's color to
return to normal,
and Apgar scores
at 1, 5, and 10 min
were higher in the
debriefing group
compared with
those reported for
other groups. No
effect sizes
reported.
3 studies showed no 4 studies showed 4 studies showed 2 studies showed 2 studies showed 2 studies showed
effect.28,29,32 no effect.27-29,32 no effect.28,29,32,33 no effect.28,29 no effect.28,29 no effect.29,30
1 aOR indicates adjusted odds ratio; CC, chest compressions; CCF, chest compression fraction; NRPE, Neonatal Resuscitation Performance Evaluation; OR, odds ratio;
2 and ROSC, return of spontaneous circulation.

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1 Prior Treatment Recommendations (2020)

2 We suggest data-driven, performance-focused debriefing of rescuers after IHCA for both

3 adults and children (weak recommendation, very low–certainty evidence).

4 We suggest data-driven, performance-focused debriefing of rescuers after OHCA in both

5 adults and children (weak recommendation, very low–certainty evidence).

6 Treatment Recommendations (2025)

7 We suggest performing post-event debriefing after adult, pediatric, and neonatal cardiac

8 arrest in all settings (weak recommendation, very low–certainty evidence).

9 Justification and Evidence-to-Decision Framework Highlights

10 The complete evidence-to-decision table is provided in Appendix A.

11 Performance of post-event debriefing was either associated with no effect or with

12 improved outcome (favorable neurological outcome, survival to discharge, ROSC, chest

13 compression depth, chest compression rate, chest compression fraction, adherence to guidelines).

14 Because of the high heterogeneity across studies (variation in debriefing design, patient

15 population [adults, children, neonates], outcome measures) no statement can be made about the

16 most effective type of debriefing. No undesirable effects (eg, emotional trauma to the debriefed

17 team, needed resources– including costs) have been identified, but neutral to positive effects on

18 resuscitation outcomes were reported. Hence, we consider that the reported positive effects

19 outweigh any possible undesirable effects. This treatment recommendation is based on

20 nonrandomized studies. No study compared debriefing with no debriefing after CPR in a

21 randomized controlled trial, resulting in serious risk of bias.

22 Knowledge Gaps

23 • RCTs on debriefing after CPR are needed.

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1 • The effect of debriefing by subgroups such as adult versus pediatric cardiac arrest, in-

2 hospital versus out-of-hospital setting, or hot versus cold debriefing

3 • Cost-effectiveness of debriefing or effect of post-event debriefings in low-resource

4 settings are warranted.

5 • Whether there are any negative effects of debriefing on the resuscitation team

6 Medical Emergency Systems for Adult In-Hospital Patients (EIT 6309, SysRev 2025)

7 Rationale for Review

8 Patients admitted to hospital might be at risk of deterioration, which can lead to cardiac

9 arrest. These patients often have symptoms and signs of deterioration hours before cardiac

10 arrest.37 A rapid response system includes an afferent component to identify such deterioration

11 early to prevent serious adverse events and an efferent component, which is a rapid response

12 team or a medical emergency team.38,39 Because there is uncertainty if rapid response or medical

13 emergency teams improve patient outcomes after cardiac arrest, this SysRev was initiated by the

14 EIT Task Force. It was registered at PROSPERO (CRD42024615077), and the CoSTR is

15 available on the ILCOR website.40

16 Population, Intervention, Comparator, Outcome, and Time Frame

17 • Population: Adults at risk of cardiac or respiratory arrest in hospital

18 • Intervention: Rapid response system (includes rapid response team or medical emergency

19 team)

20 • Comparator: No rapid response system

21 • Outcomes: Survival to hospital discharge with good neurological outcome; survival to

22 hospital discharge; in-hospital incidence of cardiac/respiratory arrest

23 • Time frame: All years to September 9, 2024

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1 Consensus on Science

2 Because of extensive heterogeneity between the studies, no meta-analyses were

3 performed. However, the summary of available evidence indicates reduced incidence of cardiac

4 arrest in those hospitals that implemented a rapid response system, and a dose-response effect.

5 Table 3 presents data on the incidence of cardiac arrest, and survival to discharge or 30 days. We

6 did not find any study reporting data for survival with favorable neurological outcome. Of the 56

7 nonrandomized studies reporting the incidence of cardiac arrest after implementation of a rapid

8 response system,41-96 39 showed improvement,41-43,45,49,51-57,59,61-65,67,68,71,73-77,81-90,94,95 and 17

9 showed no improvement.44,46-48,50,58,66,69,70,72,78,80,91-93,96

10 Table 3. Summary of Findings of Studies on Effect of Rapid Response Systems on

11 Incidence and Outcome of In-hospital Cardiac Arrest
Study design Total number of studies Evidence
RCTs 3 RCTs97-99 on incidence of 1 study reported cardiac arrest rates of 1.3 versus 1.0/1000
cardiac arrest admissions (OR, 0.71; 95% CI, 0.33–0.52) with or without
RRS.97
After implementation of RRS, the proportion of patients
admitted to the ward who received CPR decreased from
4.86% to 3.61% (unadjusted OR, 0.73; 95% CI, 0.64–
0.85). There was no difference after adjustment (aOR,
1.00; 95% CI, 0.69–1.48).98
Cardiac arrest incidence 1.64/1000 in patients without
RRS versus 1.31/1000 with RRS (P=0.306; 95% CI,
−0.264
(−2.449 to 1.921).99

Non-RCTs 11 nonrandomized studies on 8 studies41-44,46-48,100 reported no improvement in survival

survival41-49,100,101 to discharge after cardiac arrest.
1 pre/post RRS implementation study found no difference
in survival 30 days after cardiac arrest.45
1 pre/post study showed increased long-term survival post-
surgery in hip fracture patients: 71.8 months pre-RRS
versus 75.0 months post-RRS (P=0.008).101
1 study found RRS did not impact overall survival to
discharge for female patients. However, an increase was
reported for females aged 18-34 years.49
12 CPR indicates cardiopulmonary resuscitation; RCT, randomized controlled trial; and RRS, rapid response system.

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1 Treatment Recommendations (2025)

2 We suggest that hospitals consider the introduction of a rapid response system to reduce

3 the incidence of in-hospital cardiac arrest (weak recommendation, low-quality evidence).

4 Justification and Evidence-to-Decision Framework Highlights

5 The complete evidence-to-decision table is provided in Appendix A.

6 In making these recommendations, the task force emphasizes the importance of outcomes

7 such as preventing in-hospital cardiac arrests and increasing survival to hospital discharge,

8 despite the considerable costs associated with these systems. Numerous healthcare institutions

9 globally have effectively adopted rapid response systems,102 and it is recommended by the

10 Institute for Healthcare Improvement.103

11 Implementing an effective rapid response system requires strong afferent (detection and

12 activation) and efferent (response by the rapid response team/medical emergency team team)

13 limbs. These are supported by administrative and quality improvement measures,104 which

14 include comprehensive staff training on consistent and appropriate monitoring of vital signs,

15 clear protocols on early warning scores to facilitate early detection, and a tiered clinical response

16 structure.

17 Knowledge Gaps

18 • Effect of rapid response systems on long-term survival with positive neurological

19 outcome

20 • Role of technology in enhancing rapid response systems

21 • Essential components of the afferent limb in rapid response systems (eg, which vital

22 signs, clinical observations, and laboratory parameters should be monitored, as well as

23 the optimal frequency for these assessments)

24 • Optimal design of education programs to improve the recognition of patient deterioration

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1 • Ideal composition of the efferent limb, or the response team

2 • Most effective mechanism for escalating assistance

3 • Cost-effectiveness of rapid response systems in practice

4 System Performance Improvement (EIT 6310, SysRev 2025)

5 Rationale for Review

6 The clinical outcomes of patients with cardiac arrest differ around the world. There is a

7 need for a systematic review of system-wide interventions to better understand their impact.

8 System performance improvement is defined as hospital-level, community-level, or country-

9 level advancements related to structure, care pathways, processes, and quality of care. This can

10 include single interventions or multidisciplinary approaches deployed to improve outcomes of

11 cardiac arrest patients. As the last systematic review on this topic was in 2020 the EIT Task

12 Force initiated a new review, which was registered in PROSPERO under the number

13 CRD42020161882. The full CoSTR is available on the ILCOR website.105

14 Population, Intervention, Comparator, Outcome, and Time Frame

15 • Population: Resuscitation systems caring for patients in cardiac arrest in any setting

16 • Intervention: System performance improvement initiative(s)

17 • Comparator: No system performance improvement initiative(s)

18 • Outcomes: Survival with favorable neurologic outcome at discharge, survival to hospital

19 discharge, skill performance in actual resuscitations, survival to admission, system-level

20 variables

21 • Time frame: July 1, 2020, to June 30, 2024

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1 Consensus on Science

2 This systematic review found 15 new studies,106-120 which added to the 27

3 publications31,33,121-145 from the previous CoSTR in 2020.9

4 The interventions investigated in the 15 new studies are summarized in Table 4. Those 27

5 described previously were included in the earlier publication.146 Key results from these studies

6 are summarized in Table 5.

7 Table 4. Interventions in Included Studies

Study (author,
Interventions
year, setting)
Blewer 2020 National bystander-focused public health interventions including DA-CPR, CPR training
(OHCA)107 programs, and the CC application
Lee 2020 Citywide interventions including (1) mandatory CPR and AED training, DA-CPR, and the
(OHCA)113 establishment and actions of the Daegu cc and (2) public-access defibrillation program; team CPR
program; dual-patch system; standardized post-CA treatment; education program for medical
staff; regional OHCA registry; and public reporting and feedback to provinces, hospitals, and
EMTs
Kim 2020 Implementing the PDSA model for quality improvement: (1) bystander CPR education and
(OHCA)111,112 dispatcher training, (2) regular skills training sessions for EMTs, (3) detailed data collection
instrument, (4) medical director assignment
Kim 2020 A multidisciplinary approach including (1) re-education of BLS, (2) simulation training for real-
(OHCA)110 time medical direction via video call, (3) 2-tier dispatch
Auricchio 2020 Statewide initiatives including recording of OHCAs; initiatives on AED density, bystander and
(OHCA)106 layperson recruitment; first responder network
Nehme 2021 High-performance CPR focusing on team dynamics and communication, with emphasis on
(OHCA)118 optimizing resuscitation flow and minimizing delays
Dong 2022 Citywide quality improvement program consisting of (1) standardized ambulance treatment
(OHCA)108 protocol adopted, (2) ambulance crew targeted training, (3) quality monitoring, feedback, and
post-event debriefing
Kim 2022 SALS protocol incorporating changes in CPR assistance and coaching by physicians via real-time
(OHCA)111 video calls
Lin 2022 Citywide bundle initiative including (1) commencement of medical direction and public-access
(OHCA)115,117 defibrillation project, (2) digitized Utstein-based registry, (3) public involvement and continuous
QA process, (4) proactive CPR promotion and PAD, (5) built and implemented culture of
excellence and smart technology
McCoy 2023 Bundled intervention on IHCA survival in patients on centralized telemetry: (1) telemetry hotline
(IHCA)117 for telemetry technicians t
o reach nursing staff, (2) empowerment of telemetry technicians to directly activate the IHCA
response team, and (3) standardized escalation system for automated critical alerts within the
nursing mobile phone system
Freedman 2023 Bundled intervention on IHCA including EMC restructuring, CPR coach, replacing defibrillators,
(IHCA)109 defibrillator data review, training program, metronomes, code documentation, debriefing, and
event reviews
Li 2023 RQI HeartCode Complete program, designed to enhance CPR training by using real-time
(OHCA)114 feedback manikins
Lyngby 2023 Real-time feedback displayed on the defibrillator screen, presenting compression depth,
(OHCA)116 compression rate, and audible rate guidance

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Study (author,
Interventions
year, setting)
Riyapan 2024 CQI low-dose, high-frequency training interventions included advanced airway management,
(OHCA)119 high-performance CPR, and postevent debriefing with video recording
Vaillancourt 2024 Implementation of medical directive allowing nurses to use defibrillators in AED mode for IHCA
(IHCA)120
1 AED indicates automated external defibrillator; BLS, basic life support; CPR, cardiopulmonary resuscitation; CQI,
2 Continuous Quality Improvement; DA-CPR, dispatcher-assisted cardiopulmonary resuscitation; EMC, Emergency
3 Management Committee; EMT, emergency medical technician; IHCA, in-hospital cardiac arrest; OHCA, out-of-
4 hospital cardiac arrest; PAD, public access defibrillation; PDSA, Plan-Do-Study-Act; RQI, Resuscitation Quality
5 Improvement; and SALS, Smart Advanced Life Support.

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1 Table 5. Summary of Outcomes Reported in Studies About System Interventions

Survival with favorable neurologic Survival to hospital Skill performance in
Survival to admission System-level variables
outcome at discharge discharge actual resuscitations
1 cluster-randomized trial showed 1 cluster-randomized trial 1 cluster-randomized 1 cluster-randomized trial
survival with favorable neurologic showed survival to hospital trial showed that showed survival to
outcome at discharge was not higher discharge was not higher rescuer skill admission was not higher
after interventions130 after interventions130 performance improved after interventions130
after interventions130
17 non-RCTs showed significantly 20 non-RCTs showed 16 non-RCTs reported 3 non-RCTs showed 18 non-RCTs achieved all or
higher survival with favorable significantly higher that improved rescuer significantly higher partial goals from individual
neurologic outcome at discharge after survival to hospital skill performance after survival to admission interventions or improved specific
interventions33,110,111,113,115,122,125- discharge after interventions.31,33,110,114 after system-level variables (including
128,131,133,134,139,140,142,143 interventions.33,106,107,111,113, ,116,118,120,123,128,131-
interventions.126,137,140 rate of bystander CPR or AED,
115,118,122,125-128,131,133- 133,135,136,141,145 rate of prehospital or in-hospital
135,137,139,140,143 hypothermic temperature control,
7 non-RCT showed no significant 14 non-RCTs showed no 2 non-RCTs showed 6 non-RCTs showed no use of automatic CPR devices,
improvement after significant improvement no significant significant improvement CPR feedback devices, or
interventions.106,112,123,124,129,135,144 after improvement after after percutaneous coronary
interventions.31,109,110,112,116, interventions124,138 interventions.110,115,116,119,1 intervention106,107,110,112,113,115,116,121
117,119,120,123,124,129,141,142,144 29,142 ,125,126,128,129,133,134,137,139,142,144

2 AED indicates automated external defibrillation; CPR, cardiopulmonary resuscitation; and RCT, randomized controlled trial.

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1 Prior Treatment Recommendations (2020)

2 We recommend that organizations or communities that treat cardiac arrest evaluate their

3 performance and target key areas with the goal to improve performance (strong recommendation,

4 very low–certainty evidence).

5 Treatment Recommendations (2025)

6 We recommend that organizations or communities that treat cardiac arrest use system-

7 improvement strategies to improve patient outcome (strong recommendation, very low–certainty

8 evidence).

9 Justification and Evidence-to-Decision Framework Highlights

10 The complete evidence-to-decision table is provided in Appendix A.

11 The EIT Task Force decided to exclude studies investigating extracorporeal CPR, which

12 were included previously, because the prevalence of extracorporeal CPR is increasing, and

13 several RCTs were reviewed in another PICOST. In making this recommendation, the task force

14 prioritized the benefits of system performance improvements, recognizing that they present no

15 known risks and hold substantial potential for positive impact. The task force recognized that the

16 evidence supporting this recommendation is derived from studies with very low certainty across

17 all evaluated outcomes, primarily due to risks of bias and inconsistencies. However, most studies

18 found that interventions to improve system performance not only improve system-level variables

19 and skill performance in actual resuscitations among rescuers, but also clinical outcomes of

20 patients with out-of-hospital or in-hospital cardiac arrest. We acknowledge that these

21 interventions demand funding, personnel, and stakeholder support to improve system

22 performance. Varying levels of resources across settings may influence the effectiveness of

23 implementing these performance improvements.

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1 Knowledge Gaps

2 • Cost-effectiveness of individual interventions aimed at improving systems

3 • Feasibility of implementing community interventions across diverse resource settings

4 • Effects of individual and bundled interventions across diverse resource settings

5 Prehospital Critical Care for Out-of-Hospital Cardiac Arrest (EIT 6313, SysRev 2025)

6 Rationale for Review

7 The emergency medical service (EMS) system response is a critical element in the

8 pathway of care for OHCA patients.147,148 Prehospital critical care teams as part of a tiered EMS

9 response are emerging.149-151 These are specialists in the care of critically ill patients requiring

10 resuscitation,152 and they have competencies in advanced life support beyond that of standard

11 EMS teams.153 Understanding the clinical efficacy of prehospital critical care teams may inform

12 the decision to implement this into practice. This SysRev on pre-hospital critical care teams for

13 nontraumatic OHCA154 was registered in PROSPERO under the number CRD42023478216. The

14 full CoSTR is available on the ILCOR website.155

15 Population, Intervention, Comparator, Outcome, and Time Frame

16 • Population: Adults and children with OHCA and attempted resuscitation. Traumatic

17 cardiac arrest was excluded.

18 • Intervention: Attendance of a prehospital critical care team. Prehospital critical care was

19 defined as any provider with clinical competencies beyond that of standard paramedics

20 using ALS algorithms and dedicated dispatch to critically ill patients.

21 • Comparator: Advanced life support by any other prehospital healthcare provider

22 • Outcomes: Clinical outcomes of survival, favorable neurological outcome, and ROSC;

23 resource and cost implications

24 • Time frame: All years to April 20, 2024

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1 Consensus on Science

2 Out of 15 articles included,147-153,156-163 no randomized studies were identified. A total of

3 1 188 287 patients were included in the non-RCTs, and 1 included children only.157 Seven studies

4 came from Japan, 3 from the UK, and 1 each from Australia, Iceland, Norway, Poland, and the

5 USA. In 14 studies prehospital critical care teams included physicians,147-153,156-158,160-163

6 including specialists in emergency medicine,148-150,156,157,160,162 anesthesia,156,158,162 or

7 critical/intensive care medicine.148,150,156,160,162 Four studies included specially trained critical

8 care paramedics,147,159,161,162 3 from the United Kingdom,147,161,162 and 1 from Australia that

9 included solely critical-care paramedics.159 For the combined outcome of ROSC and survival to

10 hospital admission, pooled results from 6 adult non-RCTs found a benefit from prehospital

11 critical care teams.147,148,150,156,160,162 A single non-RCT in pediatric OHCA enrolled 1187 patients

12 and also found an association of prehospital critical-care teams with better outcome157 (Figure

13 1).

14 Figure 1. Survival to hospital admission/return of spontaneous circulation with prehospital

15 critical-care teams compared with standard advanced life support.

16
17 ALS indicates advanced life support; and CCT, critical-care team.
18 Adapted from Boulton et al.153 This is an Open Access article under the CC BY 4.0 license.

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1 For survival to hospital discharge, pooled results from 5 adult non-RCTs found a benefit

2 from prehospital critical care teams.147,148,156,161,162 No study on children included this outcome

3 (Figure 2).

4 Figure 2. Survival to hospital discharge with prehospital critical-care teams compared with
5 standard advanced life support.

6
7 ALS indicates advanced life support; and CCT, critical care team.
8 Adapted from Boulton et al.153 This is an Open Access article under the CC BY 4.0 license.

9 For survival at 30 days, pooled results from 6 adult non-RCTs found a benefit from

10 prehospital critical care teams.150-153,160,163 A single non-RCT in pediatric OHCA did not find a

11 benefit from prehospital critical care teams157 (Figure 3).

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1 Figure 3. Survival at 30 days with prehospital critical-care teams compared with standard
2 advanced life support.

3
4 ALS indicates advanced life support; and CCT, critical care team.
5 Adapted from Boulton et al.153 This is an Open Access article under the CC BY 4.0 license.

6 Favorable neurological outcome at hospital discharge was addressed in 1 nontraumatic

7 OHCA study enrolling 973 patients, showing no significant difference (OR 1.35, 95% CI 0.71-

8 2.60).158 No pediatric study addressed this outcome.

9 Favorable neurological outcome at 30 days was addressed in 6 nontraumatic OHCA

10 studies, which found a benefit from prehospital critical-care teams.150-153,160,163 A single non-RCT

11 in pediatric OHCA found an association of prehospital critical-care teams with better outcome157

12 (Figure 4).

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1 Figure 4. Favorable neurological outcome at 30 days with prehospital critical-care teams

2 compared with standard advanced life support.

3
4 ALS indicates advanced life support, and CCT, critical-care team.
5 Adapted from Boulton et al.153 This is an Open Access article under the CC BY 4.0 license.

6 Treatment Recommendations (2025)

7 We recommend that prehospital critical-care teams attend adults with nontraumatic, out-

8 of-hospital cardiac arrest within EMS systems with sufficient resource infrastructure (weak

9 recommendation, low certainty of evidence).

10 We suggest that prehospital critical-care teams attend children with out-of-hospital

11 cardiac arrest within EMS systems with sufficient resource infrastructure (weak

12 recommendation, very low certainty of evidence).

13 Justification and Evidence-to-Decision Framework Highlights

14 The complete evidence-to-decision table is provided in Appendix A.

15 The EIT Task Force has made a recommendation alongside low-certainty evidence for

16 adults in light of consistent benefits across clinical outcome from a variety of different healthcare

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1 systems. One study including 1187 children also found benefit; hence the EIT Task Force also

2 made a treatment recommendation favoring prehospital critical-care teams for children.

3 This SysRev demonstrated that many settings have already implemented prehospital

4 critical-care teams. Expanding prehospital critical-care services and implementing these services

5 in other healthcare systems is likely to incur additional resources, training, and EMS

6 infrastructure costs, and hence may not be universally available.

7 Knowledge Gaps

8 • RCTs investigating prehospital critical-care teams for OHCA are needed.

9 • Evidence about children with out-of-hospital cardiac arrest is based on only 1 study.

10 • Which patient groups would benefit most from prehospital critical-care teams

11 • Optimal composition of prehospital critical-care teams, their professional background,

12 and training requirements

13 • Associated resource costs, cost-effectiveness, impact on health equity, and feasibility of

14 implementation of prehospital critical-care teams

15 CPR Coaching During Adult and Pediatric Cardiac Arrest (EIT 6314, SysRev 2025)

16 Rationale for Review

17 Despite CPR training, adherence to guidelines is poor during cardiac arrest. Visual

18 feedback devices during CPR can improve chest compression (CC) quality, but compliance for

19 CC depth is still <40%.164 To implement well-known evidence into clinical practice, the

20 integration of a CPR coach within the resuscitation team has been proposed.165,166 A CPR coach

21 is a resuscitation team member whose primary responsibility is to provide real-time coaching on

22 resuscitation quality. The EIT Task Force initiated this SysRev focusing on coaching where the

23 coach is an active resuscitation team member. The SysRev was registered on PROSPERO

24 (CRD42017080475), and the full CoSTR is available on the ILCOR website.167

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1 Population, Intervention, Comparator, Outcome, and Time Frame

2 • Population: Healthcare teams managing adult or pediatric cardiac arrest

3 • Intervention: CPR coach as a resuscitation team member

4 • Comparator: No CPR coach on the resuscitation team

5 • Outcomes: Simulation-based clinical skills: CPR skill performance, adherence to

6 guidelines, teamwork, provider workload

7 – Real-life clinical performance: CPR skill performance, adherence to guidelines

8 – Patient survival: ROSC, survival to hospital discharge or 30 days, survival with

9 favorable neurological outcome, survival beyond discharge or 30 days

10 • Time frame: All years to October 11, 2024

11 Consensus on Science

12 We identified 7 studies investigating the use of a CPR coach versus no use of a CPR

13 coach as a resuscitation team member.165,168-173 One study investigated use of CPR coaches in a

14 clinical setting,170 and 6 were simulation studies.165,168,169,171-173 Five of the simulation studies

15 were based on the same randomized controlled trial.165,169,171-173 The outcomes of the included

16 studies are presented in Table 6. The outcomes of adherence to guidelines in a clinical setting

17 and patient survival were not reported in any studies.

18

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1 Table 6. Study Outcomes and Certainty of Evidence for Use by CPR Coaches During Resuscitation
Outcome Evidence with CPR coach implementation Certainty of evidence
Clinical CPR CCF at adequate depth improved from 69.8%-80.4%. very low (downgraded for risk of bias,
performance Compression depth increased from 43.6mm to 47.2mm. indirectness, imprecision)
Time to defibrillation decreased from 13.2sec-7.2sec.170
CPR Higher fraction of excellent chest compressions (63% versus 31%; Diff, 31.8 [17.7, very low (downgraded for risk of bias,
performance 45.9]), higher fraction of compressions within guideline recommendations (38.0% imprecision) no significantly higher
in a simulated versus 69.5%; Diff, 31.5 [15.7, 47.4]), higher guideline compliance rate (88% versus
setting 80%; P=0.07), higher CCF (82% versus 77%; P=0.04) for coached versus noncoached
teams.165
Shorter total mean pause duration (98.6sec versus 120.85sec; 95% CI of mean diff 0.6
sec-43.9 sec, P=0.04).172
Shorter time to backboard placement (22 sec versus 55 sec; P=0.02). No difference in:
compression rate, no-flow time, time to first epinephrine, time to first shock, peri-
shock pause duration.168
Adherence to Clinical performance tool scores were higher (73.4 versus 68.3; Diff, 5.2 points; 95% low (downgraded for risk of bias, indirectness,
guidelines in a CI, 1.0-9.3; P=0.016).169 imprecision)
simulated
setting
Teamwork in Coached teams used more words/min (160 versus 134; P<0.05) driven by more very low (downgraded for risk of bias,
a simulated directives on chest compression rate and depth, and positive verbal cues from the CPR indirectness, imprecision)
setting coach to the team; team leaders and others said fewer words/min (70 versus 88 and 30
versus 46; P<0.05).171
Workload in a One study found no significant difference for overall workload for team leaders; chest very low (downgraded for risk of bias,
simulated compressors had lower mental demand but higher physical demand in coached inconsistency, and indirectness)
setting teams.173
Another study showed no differences on any NASA Task Load index subscales for
team leader.168
2 CCF indicates chest compression fraction; Diff, difference; NASA, National Aeronautics and Space Administration.

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1 Treatment Recommendations (2025)

2 We recommend considering the inclusion of a CPR Coach as a member of the

3 resuscitation team during cardiac arrest resuscitation in settings with adequate staffing (weak

4 recommendation, very low–certainty evidence).

5 Justification and Evidence-to-Decision Framework Highlights

6 The complete evidence-to-decision table is provided in Appendix A.

7 CPR Coaches were generally associated with improved outcomes, and no harmful effects

8 were observed. Use of a CPR Coach may be considered a specific way of using shared

9 leadership in resuscitation teams. Shared leadership has been suggested to be useful in several

10 studies on IHCA.174-176 CPR Coaches are already implemented as part of the resuscitation teams

11 in many hospitals,177 suggesting that staff members are often available to fill this role.174 This

12 may differ in low-resource settings and out-of-hospital settings.

13 Most of the evidence was based on 1 randomized simulation-based trial.173

14 Knowledge Gaps

15 • Identified evidence was limited (from 1 RCT simulation,165 1 clinical observational

16 study,170 1 pilot RCT simulation168). Further evidence on CPR Coaching from RCTs is

17 needed.

18 • Effect of CPR coaches on real cardiac arrest and patient survival outcome

19 • Effect of CPR coaches on prespecified subgroups (eg adult versus pediatric patients,

20 trained versus untrained CPR Coaches, use of CPR feedback devices versus no CPR

21 feedback devices)

22 • Optimal role and effectiveness of a CPR Coach in out-of-hospital settings and in-hospital

23 settings

24 • Cost-effectiveness or utilization of CPR Coaches in limited resource settings

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1 Out-of-Hospital Cardiac Arrest Termination of Resuscitation Rules (EIT 6303, SysRev

2 ADOLOPMENT 2025)

3 Rationale for Review

4 A systematic review on prehospital TOR rules was first published as part of the 2020

5 ILCOR CoSTR.178 Subsequently, a systematic review including these findings was published,

6 including a literature update in January 2024 that reviewed additional literature on cost-

7 effectiveness.179 The EIT Task Force conducted an adolopment of the recently published review,

8 searched recent literature from January 2023 to October 2024, and conducted data extraction and

9 risk of bias assessment for any paper published after the initial review. We considered papers on

10 prehospital TOR rules used in the prehospital setting. Studies addressing TOR for patients

11 arriving at the emergency department by ambulance in-hospital TOR were excluded. The

12 adoloped review was registered in PROSPERO (CRD42019131010), and the full online CoSTR

13 is available on the ILCOR website.180

14 Population, Intervention, Comparator, Outcome, and Time Frame

15 • Population: Adults and children in cardiac arrest who do not achieve ROSC in the out-of-

16 hospital environment.

17 • Intervention: (Index test) TOR rules.

18 • Comparator: (Reference standard) In-hospital outcome: survival, favorable or

19 unfavorable neurologic outcome

20 • Outcomes: Ability of TOR to predict death in hospital or unfavorable neurologic

21 outcome. Cost-effectiveness

22 • Time frame: January 1, 2023, to October 19, 2024

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1 Consensus on Science

2 The 2020 ILCOR CoSTR identified several studies addressing the use of TOR rules, but

3 a meta-analysis was not possible because of high risk of bias and heterogeneity.178

4 The updated review published in 2024 identified 10 new observational studies on the

5 validation of different TOR rules from historical cohorts.181-190 These studies, grouped by

6 outcome reported, are summarized in Tables 7 through 9. Several studies validated more than 1

7 score or applied the same score in different cohorts.

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1 Table 7. Prediction of No Return of Spontaneous Circulation

Study TOR Rule Population TP FP FN TN Sensitivity Specificity
Harris 2021182 MIEMS Child (trauma, 27 4 71 36 0.28 [0.19- 0.90 [0.76-
age 0-17) 0.37] 0.97]
Harris 2021182 MIEMS Child (trauma, 39 4 107 50 0.27 [0.20- 0.93 [0.82-
age 0-14) 0.35] 0.98]
Harris 2021182 MIEMS Child 44 1 1028 322 0.04 [0.03- 1.00 [0.98-
(medical, age 0.05] 1.00]
0-17)
2 FP indicates false positive; FN, false negative; MIEMS, Maryland Institute for Emergency Medical Services Systems; TN, true negative; and TP, true positive.

3 Table 8. Prediction of Death in Hospital

Study TOR Rule Population TP FP FN TN Sensitivity Specificity
Park 2023189 KoCARC 1 Adult 668 7 1039 113 0.39 [0.37- 0.94 [0.88-
(medical) 0.41] 0.98]
Park 2023189 KoCARC 2 Adult 687 11 1020 109 0.40 [0.38- 0.91 [0.84-
(medical) 0.43] 0.95]
Park 2023189 KoCARC 3 Adult 524 6 1183 114 0.31 [0.29- 0.95 [0.89-
(medical) 0.33] 0.98]
Hreinsson uTOR Adult (cardiac) 202 0 252 113 0.44 [0.40- 1.00 [0.97-
2020184 0.49] 1.00]
Hsu 2022185 uTOR Adult 40904 657 10873 2630 0.79 [0.79- 0.80 [0.79-
(medical) 0.79] 0.81
Hreinsson ALS Adult (cardiac) 35 0 414 113 0.08 [0.05- 1.00 [0.97-
2020184 0.11] 1.00]
Hsu 2022185 ALS Adult 25164 385 26613 2902 0.49 [0.48- 0.88 [0.87-
(medical) 0.49] 0.89]
Smits 2023190 ALS Adult (cardiac, 3834 6 15240 2728 0.20 [0.20- 1.00 [1.00-
male) 0.21] 1.00]
Smits 2023190 ALS Adult (cardiac, 2301 3 7704 764 0.23 [0.22- 1.00 [0.99-
female) 0.24] 1.00]
Matsui 2023188 ALS Child (medical 299 21 1319 190 0.18 [0.17- 0.90 [0.85-
& trauma) 0.20] 0.94]
Matsui 2023188 BLS Child (medical 5474 440 869 657 0.86 [0.85- 0.60 [0.57-
& trauma) 0.87] 0.63]
Hsu 2022185 GOTO 1 Adult 27856 283 23921 3004 0.54 [0.53- 0.91 [0.90-
(medical) 0.54] 0.92]

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Study TOR Rule Population TP FP FN TN Sensitivity Specificity

Jabre 2016186 JABRE Adult (cardiac) 2799 1 3435 728 0.45 [0.44- 1.00 [0.99-
0.46] 1.00]
Hreinsson JABRE Adult (cardiac) 215 0 240 113 0.47 [0.43- 1.00 [0.97-
2020184 0.52] 1.00]
Glober 2020181 Glober 1 Adult (medical 290 0 3407 344 0.08 [0.07- 1.00 [0.99-
& trauma) 0.09] 1.00]
House 2018183 PEA Adult (cardiac, 829 3 955 328 0.46 [0.44- 0.99 [0.97-
transported) 0.49] 1.00]
1 ALS indicates Advanced Life Support; BLS, Basic Life Support; FN, false negative, FP, false positive; KoCARC, Korean Cardiac Arrest Research Consortium;
2 PEA, Pulseless Electrical Activity; TN, true negative; TP, true positive; and uTOR, Universal Termination of Resuscitation.

3 Table 9. Death or Survival With Unfavorable Neurological Outcome

Study TOR Rule Population TP FP FN TN Sensitivity Specificity
Lin 2022187 uTOR Adult (2015 738 19 113 13 0.87 [0.84- 0.41 [0.24-
cohort) 0.89] 0.59]
Lin 2022187 uTOR Adult (2020 430 8 116 18 0.79 [0.75- 0.69 [0.48-
cohort) 0.82] 0.86]
Lin 2022 187 ALS Adult (2015 122 2 231 22 0.35 [0.30- 0.92 [0.73-
cohort) 0.40] 0.99]
Lin 2022 187 ALS Adult (2020 104 0 279 24 0.27 [0.23- 1.00 [0.85-
cohort) 0.32] 1.00]
Park 2023189 KoCARC 1 Adult (medical) 672 3 1074 78 0.39 [0.36- 0.96 [0.90-
0.41] 0.99]
Park 2023189 KoCARC 2 Adult (medical) 695 3 1051 78 0.40 [0.38- 0.96 [0.90-
0.42] 0.99]
Park 2023189 KoCARC 3 Adult (medical) 527 3 1183 78 0.31 [0.29- 0.96 [0.90-
0.33] 0.99]
4 ALS indicates Advanced Life Support; FN, false negative, FP, false positive; KoCARC, Korean Cardiac Arrest Research Consortium; TN, true negative; TP, true
5 positive; and uTOR, Universal Termination of Resuscitation.

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1 Following the 2024 publication, we identified 3 additional studies, 2 investigating cost-

2 effectiveness of different TOR rules191,192 and 1 on the derivation of a new TOR rule for pediatric

3 OHCA.193

4 One study estimated quality-adjusted life years for survivors following OHCA in the

5 United Kingdom.191 The most cost-effective strategies were the European Resuscitation Council

6 TOR rule (incremental cost-effectiveness ratio (ICER) of £8,111), the Korean Cardiac Arrest

7 Research Consortium 2 (KOC 2) TOR rule (ICER of £17,548), and the universal Basic Life

8 Support (BLS) TOR rule (ICER of £19,498,216).191 The KOC 2 TOR rule was cost-effective at

9 the established cost-effectiveness threshold of £20,000–£30,000 per quality-adjusted life year

10 (providing the most quality-adjusted life years being below the established ICER threshold).

11 Another study investigated the cost-effectiveness of implementation of TOR rules in

12 Singapore based on cases terminated in the field and all cases eligible for TOR but transported to

13 hospital.192 They found that terminating CPR on all patients eligible for the TOR rule would

14 result in 31 additional deaths per 10,000 patients compared with no TOR. If TOR is exercised for

15 every eligible case, it could save approximately $400,440 per quality-adjusted life year loss

16 compared with no TOR, and $821,151 per quality-adjusted life year loss compared with the

17 actual observed rate of TOR in the field.

18 TOR Rules for Pediatric Out-of-Hospital Cardiac Arrest

19 We identified 3 studies assessing TOR rules for the prediction of death in

20 children.182,188,193 One study applied adult TOR rules in children,188 another, a derivation of the

21 Maryland Institute for Emergency Medical Services Systems (MIEMSS) score,182 and the third, a

22 derivation of the pediatric TOR score.193 All studies were downgraded for risk of bias,

23 imprecision, and indirectness, and the evidence was rated as very low certainty.

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1 A new pediatric TOR rule to predict no survival or unfavorable neurological outcome

2 was included,193 which was derived from a dataset spanning 2013-2019 and validated during

3 2020-2022 (including the period of COVID-19). The specificity was 99.1% (sensitivity 29.6%)

4 in the derivation cohort and 99.7% in the validation cohort (sensitivity 30.4%).

5 Prior Treatment Recommendations (2020)

6 We conditionally recommend the use of TOR rules to assist clinicians in deciding

7 whether to discontinue resuscitation efforts out of hospital or to transport to hospital with

8 ongoing CPR (conditional recommendation/very low–certainty evidence).

9 Treatment Recommendations (2025)

10 For adult out-of-hospital cardiac arrest, we conditionally recommend that emergency

11 medical service systems may implement termination of resuscitation (TOR) rules to assist

12 clinicians in deciding whether to discontinue resuscitation efforts at the scene or to transport to

13 hospital with ongoing CPR. We suggest that TOR rules may only be implemented following

14 local validation of the TOR rule with acceptable specificity considering local culture, values, and

15 setting (conditional recommendation, very low–certainty evidence).

16 For pediatric out-of-hospital cardiac arrest because of insufficient evidence, we suggest

17 against the use of TOR rules to decide whether to terminate resuscitation efforts (conditional

18 recommendation, very low–certainty evidence).

19 Justification and Evidence-to-Decision Framework Highlights

20 The complete evidence-to-decision table is provided in Appendix A.

21 The task force made a conditional recommendation for the use of TOR rules for adult

22 OHCA in line with the last CoSTR on TOR. The values in making this recommendation remain

23 largely unchanged. The certainty of evidence is limited by a lack of clinical validation studies.

24 The task force recognizes that application of TOR rules may result in missed survivors but has

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1 the potential to reduce variation in practice associated with clinician judgment and prevent

2 premature terminations by clinicians.

3 In making this recommendation, the EIT Task Force recognizes variation in patient

4 values, resources available, and performance of TOR rules in different settings, and that the

5 performance of TOR rules varies depending on the EMS system, the setting, and the survival rate

6 in the population. Therefore, TOR rules should not be implemented without assessing the local

7 validity of a TOR rule, and the validity should be reassessed as survival outcome changes over

8 time.

9 The task force recognizes that TOR rules are already implemented in some EMS systems.

10 In settings where EMS personnel will transport all patients to the hospital, the use of TOR rules

11 may reduce costs. In contrast, the potential economic benefit in EMS systems with physician-

12 staffed ambulances already making decisions about terminating CPR may be absent.

13 The task force considered pediatric OHCA separately and acknowledged that missed

14 survivors in this population may be valued differently from the adult population. Several missed

15 survivors were seen when applying adult TOR rules to children, and the 2 TOR rules derived

16 specifically for children have yet to be externally validated.

17 Knowledge Gaps

18 • Accuracy of TOR rules in clinical practice

19 • Compliance with out-of-hospital TOR rules currently in use

20 • Evidence-based implementation strategies for TOR rules for EMS

21 • Societal perceptions and acceptability of TOR rules

22 • Validation of TOR rules in children

23 • Impact of TOR rules on non–heart-beating organ donation

24 • Risk associated with emergent transport of futile cases with ongoing resuscitation

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1 Community Initiatives to Promote BLS Implementation (EIT 6306, ScopRev 2025)

2 Rationale for Review

3 Rapid BLS interventions significantly increase survival rates and improve neurological

4 outcome for OHCA patients. Various community-based initiatives have emerged, ranging from

5 dispatcher-assisted CPR to public access defibrillation programs, AED distribution,

6 simplification of CPR techniques, and applications locating first responders and AEDs. 194-197 The

7 impact of such initiatives on BLS implementation is less clear, especially regarding public

8 education and training. Given these uncertainties, the EIT Task Force undertook a ScopRev of

9 this topic. The full report of this ScopRev is available on the ILCOR website.198

10 Population, Intervention, Comparator, Outcome, and Time Frame

11 • Population: People who have an out-of-hospital cardiac arrest

12 • Intervention (exposure): Community initiatives to promote BLS implementation

13 • Comparator: Current practice

14 • Outcomes: Survival to hospital discharge with good neurological outcome, survival to

15 hospital discharge, ROSC, time to first compressions, bystander CPR rate, and proportion

16 of population trained.

17 • Time frame: January 1, 2019, to July 31, 2024

18 Summary of Evidence

19 The scoping review included 21 studies,133,199-218 conducted in the United States

20 (47.6%),199-205,210,217 Denmark (23.8%),206,211,212,218 Korea (19.0%),133,214,215 Japan (4.8%),213

21 Singapore (4.8%),216 UK (4.8%),209 and China (4.8%).208 Design included cohort studies

22 (42.9%),200,202,205,206,209-213 before-and-after studies (28.6%),133,200,207,208,216,217 cross-sectional

23 studies (23.8%),203,214,215,218 RCT (4.8%),204 and 1 non-randomized controlled trial (4.8%).199

24 More than half were prospective (57.1%),133,199,203,204,206,208,211-214,216,218 and the others were

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1 retrospective (42.9%).200-202,207,209,210,215,217 All studies involved adult OHCA, with interventions

2 implemented in workplaces, schools, government offices, public events, and shared community

3 spaces.

4 The community initiatives, summarized in Table 10, were grouped into 3 categories:

5 1. Community CPR training programs ([n=11):200,201,203-206,210-212,216,217 (52.3% of studies)]

6 2. Mass-media campaigns [(n=1):199 (4.8%)] on public awareness through media outlets

7 3. Bundle interventions [(n=9):133,202,207-209,213-215,218 (42.9% of studies)], defined as %

8 efforts combining CPR training with other community-based strategies (eg, public

9 awareness campaigns, guideline implementation, legislative changes, and mandatory

10 training for driver’s license applicants).

11 Time to first compressions was not reported as an outcome in any of these studies.

12 The full study characteristics and detailed results are provided in supplement Table S2.

13 Table 10. Community Initiatives to Promote BLS Implementation

Community CPR training Mass-media Bundle interventions
Outcome
programs (n=11)200,201,203-206,210- campaigns
type 212,216,217 (n=9)133,202,207-209,213-215,218
(n=1)199
Bystander 7 studies reported an Reported increase Reported increase in 6
CPR rate increase200,201,203,210-212,216 following studies133,208,209,214,215,218 of
television public combinations of instructor-led
service training, guideline implementation,
announcements and public initiatives

3 studies reported no 3 studies reported no

change204,206,217 change202,207,213
Proportion 3 studies, all reporting 3 studies, all reporting
of increase200,203,206 increase133,208,213
population
trained
ROSC 2 studies,216,217 1 reported 1 study reporting increase208
increase216
Survival to 2 studies reported increase205,216 1 study reported increase208
hospital 4 studies reported no 1 study reported no increase213
discharge change201,211,212,217
after
instructor-
led training
Survival 1 study reported increase210
with good 2 studies reported no change205,212 1 study reported no change213
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Community CPR training Mass-media Bundle interventions

Outcome
programs (n=11)200,201,203-206,210- campaigns
type 212,216,217 (n=9)133,202,207-209,213-215,218
(n=1)199
neurological
outcome
after
instructor-
led training

1 Task Force Insights

2 Initially, the EIT Task Force refined the inclusion and exclusion criteria to avoid overlap

3 with other more specific PICOSTs. Therefore, we excluded studies on public access

4 defibrillation programs, dispatched or telephone CPR and apps, the impact of social or economic

5 factors on bystander engagement, and the effect of different CPR techniques or protocols

6 including guideline changes.

7 Findings strongly suggest that community initiatives are effective and able to improve

8 response to OHCA. However, for patient outcomes such as survival and neurological outcome,

9 the results did not clearly favor the intervention.

10 In 2020 the focus of this PICOST was changed to investigate system interventions in

11 general, which resulted in a scoping review,219 subsequently updated for this CoSTR. However,

12 the EIT Task Force values community initiatives to promote BLS implementation as highly

13 important because the identified studies reported positive signals without any negative or

14 detrimental effects. Thus, in addition to maintaining the existing treatment recommendation from

15 2015, the EIT Task Force generated a good practice statement in 2025 for this PICOST.

16 Treatment Recommendations (2015 and 2025)

17 We recommend implementation of resuscitation guidelines within organizations that

18 provide care for patients in cardiac arrest in any setting (strong recommendation, very low–

19 certainty evidence).

20 We propose that community initiatives to promote BLS implementation should be

21 endorsed and supported (good practice statement).

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1 Knowledge Gaps

2 • Effect of community initiatives to promote BLS implementation in more diverse

3 geographic areas, including low resource settings

4 • Effect of community initiatives to promote BLS implementation on neonatal and

5 pediatric resuscitations

6 • More well-designed RCTs are needed to report key patient outcome and enable a

7 systematic review

8 • Effect of public campaigns such as World Restart A Heart in regions beyond the United

9 Kingdom

10 • Influence of specific legal regulations on CPR uptake in countries other than China

11 • How specific laws and regulations affect community response to cardiac arrest

12 • Cost-effectiveness of each intervention for BLS implementation, and its specific impact

13 on clinical outcomes

14 Family Presence in Adult Resuscitation (EIT 6300, SysRev 2022, EvUp 2025)

15 A SysRev was conducted for 2022,220 and details of that review can be found in the 2022

16 CoSTR summary.12,13 The complete EvUp is provided in Appendix B.

17 Population, Intervention, Comparator, Outcome, and Time Frame

18 • Population: Adults requiring resuscitation in any setting

19 • Intervention: Family presence during resuscitation

20 • Comparator: No family presence during resuscitation

21 • Outcomes: patient outcomes (short- and long-term), family-centered outcomes (short-

22 and long-term psychological stress, perception of the resuscitation), and health care

23 provider-centered outcomes (psychological stress, perception of the resuscitation).

24 • Time frame: May 10, 2022, to April 28, 2024

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1 Summary of Evidence

2 The evidence update identified 7 new primary studies221-227 and 2 systematic

3 reviews.228,229 Patient outcomes were lacking. A dedicated family support role led to a more

4 positive view of family presence. Family member outcomes demonstrated mixed positive and

5 negative responses. Given the number of new studies, an escalation to a new SysRev might be

6 considered.

7 Treatment Recommendations (2022)

8 We suggest that family members be provided with the option to be present during in-

9 hospital adult resuscitation from cardiac arrest (weak recommendation; very low–certainty

10 evidence).

11 We suggest that family members be provided with the option to be present during out-of-

12 hospital adult resuscitation from cardiac arrest acknowledging that providers are often not able to

13 control this (weak recommendation; very low–certainty evidence).

14 Policies or protocols about family presence during resuscitation should be developed to

15 guide and support health care professional decision-making (good practice statement).

16 When implementing family presence procedures, healthcare providers should receive

17 education about family presence during adult cardiac arrest resuscitation, including how to

18 manage these stressful situations, family distress and their own responses to these situations

19 (good practice statement).

20 Cardiac Arrest Centers (EIT 6301, SysRev 2024, EvUp 2025)

21 A SysRev was conducted in 2024,230 and details of that review can be found in the 2024

22 CoSTR summary.231,232 The complete EvUp is provided in Appendix B.

23 Population, Intervention, Comparator, Outcome, and Time Frame

24 • Population: Adults with attempted resuscitation after nontraumatic IHCA or OHCA

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1 • Intervention: Care at a specialized cardiac arrest center

2 • Comparator: Care in an institute not designated as a specialized cardiac arrest center

3 • Outcomes: Survival with favorable neurological outcome at 30 days and at hospital

4 discharge; survival at 30 days and at hospital discharge; ROSC post-hospital admission

5 for patients with ongoing CPR.

6 • Time frame: December 31, 2023, to November 18, 2024

7 Summary of Evidence

8 Three new observational studies were found in this EvUp.233-235 The new data does not

9 warrant a new SysRev.

10 Treatment Recommendations (2024)

11 We suggest adults with OHCA should be cared for in cardiac arrest centers (weak

12 recommendation, very low–certainty evidence).

13 Technology to Summon Providers (EIT 6302, EvUp)

14 Population, Intervention, Comparator, Outcome, and Time Frame

15 • Population: Adults and children with OHCA

16 • Intervention: Having a citizen CPR responder notified of the event via mobile technology

17 or social media.

18 • Comparator: No such notification

19 • Outcomes:

20 – Patient survival to hospital discharge with good neurological function, 30-day

21 survival, survival to hospital discharge, Hospital admission, ROSC

22 – Non-patient–bystander CPR rates, time to first compression, response time, activation

23 rate, system reliability, user satisfaction, cost-effectiveness

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1 • Time frame: October 21, 2021, to October 27, 2024

2 Summary of Evidence

3 A SysRev was conducted in 2020, and details of that review can be found in the 2020

4 CoSTR; an EvUp was done in 2021.9,10,236,237 The complete 2025 EvUp is provided in Appendix

5 B. Given the absence of RCTs, the 4 newly identified observational studies do not warrant a new

6 SysRev.238-241

7 Treatment Recommendations (2020)

8 We recommend that citizen/individuals who are in close proximity to a suspected out-of-

9 hospital cardiac arrest event and are willing to be engaged/notified by a smartphone app with

10 mobile positioning system or text message-alert system should be notified (strong

11 recommendation, very low–certainty evidence).

12 Willingness to Provide CPR/AED (EIT 6304, EvUp)

13 Population, Intervention, Comparator, Outcome, and Time Frame

14 • Population: Bystanders (laypersons) in actual situation of adult or pediatric patients with

15 OHCA

16 • Intervention (Exposure): Factors (barriers or facilitators) that affected the willingness of

17 bystanders to perform CPR and/or use an AED

18 • Comparator: No such factor or any other factor that affected the willingness of bystanders

19 to perform CPR and/or use an AED

20 • Outcomes: Bystander CPR rate, rate of bystander defibrillation with an AED, willingness

21 to provide CPR in actual situation, willingness to provide defibrillation with an AED in

22 actual situation

23 • Time frame: August 1, 2022, to June 28, 2024

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1 Summary of Evidence

2 A ScopRev was conducted for 2020,242 and details of that review can be found in the

3 2020 CoSTR. An EvUp was done in 2022.9,10,12,13 The complete 2025 EvUp is provided in

4 Appendix B. Three new observational studies, like several others included in earlier searches,

5 focused on disparities in receiving CPR rather than factors affecting willingness to perform it. A

6 revised PICOST should distinguish between factors related to OHCA patients receiving CPR

7 (such as community-level disparities) and factors associated with bystanders performing CPR

8 and using AEDs (such as personal-level willingness). Because the recommendation from 2020

9 was not based on a GRADE SysRev, the EIT Task Force added a new good practice statement to

10 the existing treatment recommendations.

11 Treatment Recommendations (2020, Unchanged From 2010)

12 To increase willingness to perform CPR, laypeople should receive training in CPR. This

13 training should include recognizing gasping or abnormal breathing as a sign of cardiac arrest

14 when other signs of life are absent.

15 Laypeople should be trained to start resuscitation with chest compressions in adult and

16 pediatric victims. If unwilling or unable to perform ventilation, rescuers should be instructed to

17 continue compression-only CPR.

18 EMS dispatchers should provide CPR instructions to callers who report cardiac arrest.

19 When providing CPR instructions, EMS dispatchers should include recognition of gasping and

20 abnormal breathing.

21 Treatment Recommendations (2025)

22 The task force encourages resuscitation councils, communities, and emergency medical

23 services to provide easy access to BLS courses, raise awareness about cardiac arrest and its

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1 treatment, and utilize training, public outreach, and social media to increase laypersons'

2 willingness to perform CPR (good practice statement).

3 Clinical Decision Rules to Facilitate In-hospital Do-Not-Attempt CPR (EIT 6305, SysRev

4 2022, EvUp 2025)

5 A SysRev was conducted in 2022,243 and details of that review can be found in the 2022

6 CoSTR summary.9,10,236,237 The complete EvUp is provided in Appendix B.

7 Population, Intervention, Comparator, Outcome, and Time Frame

8 • Population: Hospitalized adults and children experiencing an in-hospital cardiac arrest

9 • Intervention: Any pre-arrest clinical prediction rule

10 • Comparator: No clinical prediction rule

11 • Outcomes: Return of spontaneous circulation, survival to hospital discharge/30-days or

12 survival with favorable neurological outcome

13 • Time frame: January 1, 2021, to November 27, 2024

14 Summary of Evidence

15 Four new studies were found.244-247 Overall, there are still no studies investigating the

16 prospective implementation of prediction models for do-not-attempt cardiopulmonary

17 resuscitation orders. Therefore, a SysRev is not warranted.

18 Treatment Recommendations (2022)

19 We recommend against using any currently available pre-arrest prediction rule as a sole

20 reason to not resuscitate an adult with in-hospital cardiac arrest (strong recommendation, very

21 low–certainty evidence).

22 We are unable to recommend for or against any available pre-arrest prediction rule to

23 facilitate do-not-attempt cardiopulmonary resuscitation discussions with adult patients or their

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1 next of kin as there are no studies investigating the effect of clinical implementation of such

2 score.

3 We are unable to provide any recommendation for pediatric patients as no studies on

4 children were identified.

5 Termination of Resuscitation for In-Hospital Cardiac Arrest (EIT 6308, EvUp 2025)

6 Population, Intervention, Comparator, Outcome, and Time Frame

7 • Population: Adults and children with IHCA

8 • Intervention: Use of any clinical decision rule

9 • Comparator: No clinical decision rule

10 • Outcomes: No return of spontaneous circulation, death before hospital discharge, survival

11 with unfavorable neurological outcome, death within 30 days

12 • Time frame: January 1, 2020, to May 20, 2024

13 Summary of Evidence

14 A SysRev was previously conducted in 2020.248 An EvUp was done in 2025.9,10,236,237

15 The complete EvUp is provided in Appendix B. This Evidence Update did not identify any new

16 studies. Accordingly, a new SysRev is not warranted.

17 Treatment Recommendations (2020)

18 We did not identify any clinical decision rule that was able to reliably predict death

19 following in-hospital cardiac arrest. We recommend against use of the UN10 rule (U–

20 unwitnessed arrest; N–nonshockable rhythm; 10–ROSC not obtained within 10 minutes) as a

21 sole strategy to terminate in-hospital resuscitation (strong recommendation, very low–certainty

22 evidence).

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1 Chain of Survival (EIT 6311, SysRev 2024, EvUp 2025)

2 A SysRev was conducted in 2024,249 and details of that review can be found in the 2024

3 CoSTR summary.231,232 The complete EvUp is provided in Appendix B.

4 Population, Intervention, Comparator, Outcome, Study Designs, and Time Frame

5 • Population: Literature using the term chain of survival or similar terms (eg, survival

6 chain, chain of [other pathology])

7 • Intervention (Exposure): Adaptations of the original chain of survival250

8 • Comparator: The original chain of survival250

9 • Outcomes: Composition of the specific variations in adapted versions, attitudes, rationale,

10 and views concerning the adaptation; incentives to develop novel versions; way of

11 implementation of adapted versions; way of using adapted versions in education;

12 variations in visualization; effect of the use of the chain of survival or variants on

13 teaching, implementation, and patient outcomes

14 • Study designs: In addition to standard criteria, designs such as narrative literature, letters,

15 commentaries, and editorials were included.

16 • Time frame: January 1, 2023, to October 21, 2024

17 Summary of Evidence

18 The 7 newly found studies do not add any new information to the CoSTR from 2024.251-
257
19 No new SysRev is indicated. Task force insights were discussed in detail in the 2024 CoSTR

20 summary.231,232,258

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1 Impact of Support on Mental Health in Cosurvivors of Cardiac Arrest Patients (EIT 6315,

2 EvUp 2025)

3 Population, Intervention, Comparator, Outcome, and Time Frame

4 • Population: Co-survivors (any age) who witnessed resuscitation of cardiac arrest (any

5 age)

6 • Intervention: Co-survivors who received support for their mental health, after the event

7 • Comparator: No support or any other type of support

8 • Outcomes: Mental health (eg, anxiety, depression, post-traumatic stress disorder), quality

9 of life, socio-economic measures

10 • Time frame: From inception to October 24, 2024

11 Summary of Evidence

12 The complete EvUp is provided in Appendix B. Co-survivor is a general term for family

13 members, friends, neighbors, or anyone in a close relationship with the cardiac arrest patient. Out

14 of 652 articles identified, none were relevant to the PICOST. We encourage further research to

15 explore the effect of support for co-survivors who witnessed a cardiac arrest and the effect on

16 their mental health. As this was a new PICOST, no treatment recommendations were generated.

17 INSTRUCTIONAL DESIGN

18 CPR Feedback Device Use in Resuscitation Training (EIT 6404, SysRev 2025)

19 Rationale for Review

20 Chest compression skills are an important component of effective resuscitation during

21 cardiac arrest. CPR feedback devices provide immediate, real-time feedback on quality of chest

22 compressions. Use of CPR feedback devices during resuscitation skills training has the potential

23 to enhance CPR skill acquisition and retention.

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1 Recent scientific statements highlight a growing trend in the use of CPR feedback

2 devices during resuscitation courses. While earlier reviews showed that these devices can

3 improve short-term educational outcomes, the results have been inconsistent. This topic was last

4 reviewed in the 2020 CoSTR9,10 and an updated review was undertaken. The review was

5 registered in PROSPERO (CRD42023376751) and the full CoSTR is available on the ILCOR

6 website.259

7 Population, Intervention, Comparator, Outcome, and Time Frame

8 • Population: All laypersons and healthcare providers in any educational setting

9 • Intervention: Use of CPR feedback/guidance device during resuscitation training

10 • Comparator: No use of CPR feedback/guidance device during resuscitation training

11 • Outcomes: Patient survival, quality of performance in actual resuscitations, skill retention

12 (performance after course conclusion), skill acquisition (performance at course

13 conclusion).

14 • Time frame: January 1, 2005, to June 13, 2024

15 Consensus on Science

16 Three studies were conducted in lay providers 260-262 and 17 in healthcare providers.263-279

17 No studies were identified that examined the impact of using CPR feedback devices during

18 resuscitation training on the outcomes of patient survival or quality of performance in actual

19 resuscitation.

20 Compression Depth

21 Fifteen randomized controlled trials (RCTs) with a total of 4185 participants evaluated

22 the effect of CPR feedback devices on objectively measured mean compression depth, favoring

23 feedback devices (standardized mean difference [SMD] 0.76; 95% CI, 0.02-1.50;

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1 I2=94%).260,261,263,265-269,274,276-279 No difference was found between health care professionals and

2 lay persons P=0.10).

3 Sixteen RCTs involving 4,304 participants examined the effect of CPR feedback devices

4 during resuscitation training on compression depth compliance, quantitatively measured as the

5 percentage of compressions meeting the resuscitation guidelines during assessment, favoring

6 feedback devices (SMD 0.98; 95%CI, 0.10-1.87; I2=94%).260-262,264-268,270-274,278-280 No difference

7 was found between health care professionals and lay persons (P=0.09).

8 Compression Rate

9 Seventeen RCTs involving a total of 4,327 participants evaluated the effect of CPR

10 feedback devices on objectively measured mean compression rate.260-263,265-270,273-279 Participants

11 trained with CPR feedback devices had a significantly lower mean compression rate compared

12 with those trained without them, as participants in the nonfeedback group tended to compress too

13 quickly (>120 bpm) (SMD –0.29; 95% CI, 0.48-0.10, I2=3%). No difference was found between

14 health care professionals and laypersons (P=0.67).

15 Nine RCTs involving 905 participants examined the effect of CPR feedback devices

16 during resuscitation training on compression rate compliance measured as the percentage of

17 compressions within the guideline-recommended rate of 100–120 bpm, and results favored use

18 of feedback devices (SMD 0.44, 95%CI, 0.23-0.66; I2=61%).260,264,267,269-272,278,279 No difference

19 was found between health care professionals and lay persons (P=0.80).

20 Chest Recoil

21 Ten RCTs involving a total of 3,496 participants evaluated the effect of CPR feedback

22 devices during training on chest recoil quantitatively measured as the percentage of

23 compressions with full chest recoil, overall favoring feedback devices (SMD 0.53; 95% CI, 0.31-

24 0.75, I2=87%). 260,261,264,265,269,271,272,276,278,279 Subgroup analysis showed that the effect of the

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1 feedback device on recoil compliance was significantly improved in the healthcare providers

2 (SMD 0.67; 95% CI, 0.52-0.82; I2=0%), but not in the laypersons (SMD 0.20; 95% CI, 0.24-

3 0.64; I2=83%).

4 Overall Quality of CPR

5 Eight RCTs involving a total of 3261 participants evaluated the effect of CPR feedback

6 devices on overall CPR quality during resuscitation training assessed by computer software

7 integrating all 3 metrics of chest compression (depth, rate and recoil), with limited validity

8 evidence favoring feedback devices (SMD 0.7; 95% CI, 0.40-1.03, I2=86%).260,261,265,269-271,276,278

9 Subgroup analysis showed that the effect of the feedback device use on the overall CPR score

10 was statistically significantly higher in the healthcare professionals than in the lay persons

11 (P=0.02).

12 Three RCTs involving a total of 349 participants evaluated the effect of CPR feedback

13 devices on overall CPR quality during resuscitation training assessed dichotomously, based on

14 whether compression depth, rate, and recoil all concurrently met guideline standards, favoring

15 feedback devices (SMD 0.19; 95% CI, 0.01-0.38, I2=76%).272,274,277

16 Prior Treatment Recommendations (2020)

17 We suggest the use of feedback devices that provide directive feedback on compression

18 rate, depth, release, and hand position during CPR training (weak recommendation, low-certainty

19 evidence).

20 If feedback devices are not available, we suggest the use of tonal guidance (examples

21 include music or metronome) during training to improve compression rate only (weak

22 recommendation, low-certainty evidence).

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1 Treatment Recommendations (2025)

2 We recommend the use of CPR feedback devices during resuscitation training for

3 healthcare providers and lay providers (strong recommendation, moderate-certainty evidence).

4 Justification and Evidence-to-Decision Framework Highlights

5 The complete evidence-to-decision table is provided in Appendix A.

6 The results of the meta-analyses of RCTs found evidence favoring the use of feedback

7 devices during training across all CPR quality outcomes with moderate to strong association.

8 Subgroup analyses showed the effect of feedback devices on resuscitation training was

9 greater in healthcare providers than in the lay providers, but there was still a significant effect for

10 most CPR metrics in lay providers. No undesirable effects were detected in the review, feedback

11 devices are well accepted, and their use is feasible with relatively low or negligible costs.

12 Knowledge Gaps

13 • Relative and synergistic effect of feedback device use when combined with other

14 educational strategies and instructional design features

15 • Impact of feedback devices on skill retention beyond the end of a course

16 • Impact of improved CPR skills from training with feedback devices on patient outcome

17 • Costs associated with implementing feedback devices during resuscitation training, as

18 well as its cost-effectiveness

19 Self-Directed, Digital-Based Versus Instructor-Led Cardiopulmonary Resuscitation

20 Education and Training in Adults and Children (EIT 6406, SysRev 2025)

21 Rationale for Review

22 CPR and AED training is known to improve the willingness and confidence in someone

23 performing bystander CPR.281 Little is known about whether self-directed digital CPR training is

24 superior to instructor-led training in developing sufficient skills to provide adequate CPR. This
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1 topic was reviewed in 2021 and included RCTs and non-RCTs. Since then, several RCTs on this

2 topic were published and the EIT Task Force initiated a new systematic review that included

3 only RCTs, which was registered in PROSPERO (CRD42020199176). The full CoSTR is

4 available on the ILCOR website.282

5 We defined self-directed digital-based CPR training as any form of digital education or

6 training for CPR that can be completed without an instructor. Instructor-led training was defined

7 as education or training that occurred in the presence of a BLS instructor.

8 Population, Intervention, Comparator, Outcome, and Time Frame

9 • Population: Adults and children undertaking CPR training

10 • Intervention: Self-directed digitally based CPR training

11 • Comparator: Instructor-led CPR training

12 • Outcomes:

13 – Patient outcomes: good neurological outcome at hospital discharge or 30 days,

14 survival at hospital discharge or 30 days, ROSC, rates of bystander CPR, bystander

15 CPR quality during an OHCA (any available CPR metrics), rates of automated

16 external defibrillator (AED) use

17 – Educational outcomes at end of training and within 12 months: CPR quality (chest

18 compression depth and rate, chest compression fraction, full chest recoil, hand

19 position, ventilation rate) and AED competency; CPR and AED knowledge;

20 confidence and willingness to perform CPR

21 • Time frame: October 11, 2022, to March 28, 2024

22 Consensus on Science

23 No studies were identified for any patient outcome.

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1 For the educational outcomes, we identified 29 RCTs.283-311 Because of the high degree

2 of heterogeneity in the interventions, comparators, and measurements of outcomes, no meta-

3 analysis was performed.

4 Sample sizes ranged from 52 participants311 to 826 participants,298 and 14 of the 29

5 studies had sample sizes less than 140 participants.283-285,294-297,299-301,305,307-309,311 Populations

6 included children; high-school students;285,288,306,310,311 university students,283,299-301 including

7 specific cohorts such as medical284,304,307,308 and nursing students;291,296

8 adults,286,287,290,292,293,297,298,303,305,309 including specific cohorts such as those over 60 years,302

9 parents/caregivers of children,295 parents of children at high risk for sudden cardiopulmonary

10 arrest;289 university staff and their spouses;300 and caregivers of family members with cardiac

11 histories.294 Details of study designs are displayed in Table 11.

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Table 11. Self-Directed Digital-Based CPR Training Versus Instructor-led CPR Training Studies
Test scores Test scores between 1-
AED use Knowledge Confidence to
Educational CPR quality Willingness to immediately to 12 months of training
10 7 perform CPR
Outcome 27 283-286,288- 284,287,288,291,300,302- 289,294,299,305,306,308,
perform CPR <1 month 15
10 283,292,294-
Study n 301,303-311
304,306,307 309 296,298,300,302,304,311 6 286,296,298,300-302 25 283-286,288- 284,285,287,290,293,294,296,302,304
301,303-312 -306,308-311

No. of studies per 8 video- 16 video + 1 app-based self- 1 virtual reality 1 video + 3 computer 1 interactive computer
intervention only283- manikin practice training 303 manikin + program/online session 306
285,287,291,293,294, approach intervention 288 scenario self- tutorial + video + 1 game-in-film 311
305 286,287,289,290,293,295-
training 287 manikin 292,300,307
299,301,302,304,308-310

Details of Video-only Videos used with Not well Not well Not well Not well Not well described
interventions interventions manikin practice described described described described
ranged from ranged from 4–
1-minute 293 35 301mins293, 300
to 20-minutes to minutes
284 in length (length often not
(length often stated)
not stated)
Comparators 7 formal Course length: 9 Not well Not well Not well Not well Not well described
certified min(1) up to 5 described described described described
courses hours307
297,298,300,302,307-
309

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1 Only some studies with self-directed training interventions had sufficient numbers for

2 comparison at immediate testing (with video + manikin and video-only self-directed training). A

3 video + manikin self-directed intervention was used in 15 studies.286,289,290,293,295-299,301,302,304,308-

310
4 Most of these studies demonstrated no difference between self-directed training using a video

5 + manikin versus an instructor-led training. Only 1 study favored video + manikin self-directed

6 training for compression rate,309 proportion of compressions at the correct rate293 and hand

7 position.293,297 Instructor-led training was favored over video + manikin self-directed training for

8 chest compression depth,293 proportion of chest compressions at the correct depth,286 hand

9 position,286,290,301 knowledge,289 and confidence.304

10 Video-only self-directed training was used in 7 studies283-285,291,293,294,305 and was the

11 favored arm in 3 instances for proportion of compressions at the correct depth,291 chest recoil,
291and
12 confidence.283 Instructor-led training was favored over video-only self-directed training in

13 other studies for proportion of compressions done at the correct rate,293 compression depth,293

14 knowledge,294 and confidence.294 Across the studies compression rate, depth, fraction, chest

15 recoil, hand position, ventilation rate, AED use, and knowledge and confidence were measured a

16 further 19 times, and no difference was identified between the video-only self-directed training

17 and instructor-led groups.

18 Educational outcomes measured up to 12 months were reported in 14 studies (at 4

19 months,296 6 months,284 between 2-6 months,308and between 1-6 months after the

20 training285,287,290,293,294,302,304-306,310,311). Many of these studies reported a reduction in the quality

21 of the skills being performed (compression rate: 2 studies,293,310 compression depth: 4

22 studies,293,304,306,310 chest compression fraction: 1 study,311 chest recoil: 1 study,304 hand position:

23 4 studies,293,304,306,310 ventilation rate: 1 study,290 AED: 1 study,302 knowledge: 1 study,294

24 confidence: 1 study304). The opposite of this was seen in 1 study where both the groups were

25 more likely to pass the AED testing at 2 months than immediately after the training.287
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1 Prior Treatment Recommendations (2020)

2 We recommend instructor-led training (with manikin practice with feedback device) or

3 the use of self-directed training with video kits (instructional video and manikin practice with

4 feedback device) for the acquisition of CPR theory and skills in layperson adults and high

5 school-aged (more than 10 years old) children (strong recommendation, moderate-certainty

6 evidence).

7 We recommend instructor-led training (with AED scenario and practice) or the use of

8 self-directed video kits (instructional video with AED scenario) for the acquisition of AED

9 theory and skills in layperson adults and high school–aged (more than 10 years old) children

10 (strong recommendation, low-certainty evidence).

11 We suggest that BLS video education (without manikin practice) be used when

12 instructor-led training or self-directed training with video kits (instructional video plus manikin

13 with feedback device) are not accessible, or when quantity over quality of BLS training is needed

14 in adults and in children (weak recommendation, low-certainty evidence).

15 There was insufficient evidence to make a recommendation on gaming as a CPR or AED

16 training method.

17 There was insufficient evidence to suggest a treatment effect on bystander CPR rates or

18 patient outcomes.

19 Treatment Recommendations (2025)

20 We suggest the use of either instructor-led training or self-directed digital training for the

21 acquisition of CPR or AED skills in lay adults and high-school–aged (>10 years) children (weak

22 recommendation, very low–certainty evidence).

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1 We suggest self-directed digital training be used when instructor-led training is not

2 accessible, or when quantity over quality of CPR training is needed in adults and children (weak

3 recommendation, very low–certainty evidence).

4 There was insufficient evidence to make a recommendation on game-in-film, virtual

5 reality, computer programs, online tutorials or app-based training as a CPR or AED training

6 method.

7 Justification and Evidence-to-Decision Framework Highlights

8 The complete evidence-to-decision table is provided in Appendix A.

9 The acquisition of CPR skills may vary across different mediums and age groups.

10 However, any form of CPR/AED training is likely to improve knowledge, confidence and

11 willingness in simulated settings, but this may not translate to real-life situations. Digital and

12 instructor-led materials need updating to ensure training complies with CPR recommendations.

13 Digital training enables skills to be refreshed at any time, and at no additional cost, and provides

14 the opportunity to teach others. It also enables more people to be educated in periods of need (eg,

15 pandemics).

16 Cost-effectiveness analysis favored digital self-directed training.292,310 This reflects the

17 known barriers that exist to attending instructor-led CPR classes (eg, time, costs, and

18 accessibility) and the need to make CPR training available to everyone.

19 Knowledge Gaps

20 • Standardized outcome measures (educational and CPR performance outcomes) are

21 needed to enable pooling of data. Comparator groups should be aligned using

22 standardized, accepted instructor-led training programmes to reduce inconsistency and

23 uncertainty.

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1 • The ability of these interventions and comparators to produce findings that meet accepted

2 standards for adequate CPR that are maintained at defined time intervals

3 • Effectiveness of specific self-directed digital interventions, such as game-in-film, virtual

4 reality, computer programmes, online tutorials or app-based training

5 • The treatment effect on bystander CPR rates and patient outcomes

6 In Situ (Workplace-Based) Simulation-Based Cardiopulmonary Resuscitation Training

7 (EIT 6407, SysRev 2025)

8 Rationale for Review

9 Simulation-based training is traditionally performed in classrooms or laboratories

10 specifically equipped with manikins, monitors, and equipment needed for running cardiac arrest

11 scenarios. Providing such training within patient care areas has theoretical advantages, with

12 learning occurring in the context of the real clinical environment and organizational structures.

13 The EIT Task Force performed a SysRev, which was registered in PROSPERO

14 (CRD42024521780). The full CoSTR can be found on the ILCOR website.313

15 Population, Intervention, Comparator, Outcome, Study Design, and Time Frame

16 • Population: Healthcare providers

17 • Intervention: In situ (workplace-based) simulation-based CPR training

18 • Comparator: Traditional training

19 • Outcomes: Patient survival and outcome, CPR skill performance at course completion

20 and in actual resuscitation, CPR skill performance <1yr and ≥1yr after course

21 completion; CPR quality (at course completion, <1yr and ≥1yr after course completion).

22 Teamwork competencies (at course completion, <1yr and ≥1yr after course completion);

23 resources (time, equipment, cost), clinical performance (adherence to guidelines, time to

24 critical interventions, medication errors, etc.)

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1 • Study Designs: In addition to standard criteria, reviews and studies with self-assessment

2 as the only outcome were excluded.

3 • Time frame: From inception to March 25, 2024

4 Consensus on Science

5 We identified 4 studies in adults,314-317 3 in children,318-320 and 2 in neonates.321,322 Results

6 globally favored in situ simulation across all studies. Because of heterogeneity in the

7 interventions and outcome definitions, no meta-analysis or formal subgroup analysis according

8 to the type of training (ie, BLS, advanced cardiovascular life support, pediatric advanced life

9 support, neonatal life support) was performed.

10 Patient Survival

11 One nonrandomized prospective observational study with historical controls319 reported

12 an association between the in situ simulation period and higher odds of survival at hospital

13 discharge in children who experienced cardiac arrest [50/124 (40.3%) survival in the pre-

14 intervention period versus 28/46 (60.9%) in the post-intervention period; (OR, 2.06; 95% CI,

15 1.02-4.25)].

16 Other Patient Outcomes

17 One nonrandomized study322 reported a lower incidence of neonatal asphyxia [88

18 (0.64%) versus 133 (0.84%); P=0.045], severe asphyxia [8 (0.058%) versus 22 (0.138%);

19 P=0.029], hypoxic-ischemic encephalopathy [2 (0.01%) versus 16 (0.1%); P=0.003], and

20 meconium aspiration syndrome [12 (0.09%) versus 31 (0.19%); P=0.014] in the post

21 intervention (in situ simulation) versus pre-intervention period, but no difference in the

22 composite outcome of neonatal asphyxia or low Apgar score [111 (0.8%) versus 154 (0.97%);

23 P=0.128], or low Apgar score [23 (0.17%) versus 21 (0.13%); P=0.445].

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1 Clinical Performance in Actual Resuscitation

2 Three nonrandomized studies were identified.315,318,319 One before-and-after study319

3 reported no difference in neurologic outcome at hospital discharge, the performance of chest

4 compressions for heart rate <60/sec, or the performance of shock <3 min from recognized

5 ventricular fibrillation/pulseless ventricular tachycardia, but found improvement in chest

6 compressions between rhythm checks with in situ simulation.

7 Another before-and-after study315 reported a 12% reduction in time to call for help, a

8 52% reduction in time elapsed to initiation of chest compressions, and a 37% reduction in time to

9 initial defibrillation, all favoring in situ simulation. A third before-and-after study318 reported a

10 39% decrease in nonadherence to pediatric advanced life support guidelines for subsequent

11 epinephrine timing, favoring in situ simulation, but no significant difference in the administration

12 of epinephrine every 3-5 min.

13 Teamwork Competencies in Actual Resuscitation at Course Completion and Less Than 1 Year

14 After the Course

15 One nonrandomized study319 reported higher adherence to resuscitation standard

16 operating performance variables amongst pediatric code teams during the period of in situ

17 simulation [38/183 (20.8%) versus 23/64 (35.9); OR, 2.14; 95% CI; 1.15-3.99].

18 Clinical Performance in Simulation

19 We found 4 RCTs320,316,321,317 and 1 nonrandomized study.314 One RCT320 reported

20 improved skill performance measured by the Clinical Performance Tool [6.2 (± 4.3) versus 1.2

21 (± 2.9); P=0.004]. One RCT317 reported shorter time to call for help and initiation of chest

22 compression with in situ simulation (P<0.001). The same study found shorter time to successful

23 defibrillation (P<0.001), and improvement in the composite outcome of initiation of

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1 compressions within 20 sec of cardiac arrest, defibrillation within 180 sec of detection of a

2 shockable rhythm and use of a backboard (P<0.001).

3 One RCT321 reported improvement in technical skills and adherence to guidelines with in

4 situ simulation and a higher percentage of scenarios with efficient resuscitation at 3 minutes [14

5 (24%) versus 2 (4%); P=0.003] and 5 minutes [40 (68%) versus 25 (47%); P=0.06].

6 One RCT316 reported better medical management test scores with in situ simulation

7 (P<0.001), while another314 reported no difference between the 2 groups during mock code.

8 Teamwork Competencies in Simulation at Course Completion and Less Than 1 Year After the

9 Course

10 One RCT320 reported no difference in teamwork assessed by the Behavioral Assessment

11 Score [2.8 (± 3.6) versus 3.0 (± 4.0); P=0.69]. Other RCTs reported better team performance

12 score321 during in situ simulation [31.1 (20.8–36.8) versus 19.9 (13.3–25.0); P=<0.001], while

13 better teamwork with in situ simulation was reported in another RCT316 [10.84 (±3.26) versus

14 7.87 (±4.14), P< 0.001].

15 CPR Skill Performance in Simulation at Course Completion

16 One nonrandomized study314 evaluated CPR fraction as a measure of skill and found

17 improvement favoring in situ simulation (1.8% per time interval of training (P=0.02).

18 No studies were found analyzing resources needed for in situ simulation, or CPR skill

19 performance in actual resuscitation.

20 Treatment Recommendations (2025)

21 We recommend that in situ simulation may be considered as an option for CPR training

22 where resources are readily available (weak recommendation, very low–certainty evidence).

23 Justification and Evidence-to-Decision Framework Highlights

24 The complete evidence-to-decision table is provided in Appendix A.

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1 Evidence from RCTs and nonrandomized studies supports the effectiveness of in situ

2 simulation to teach CPR. Critical outcomes, including patient survival and clinical performance

3 and teamwork competencies in actual resuscitation, improved with in situ simulation. The

4 balance between the benefit and the resources needed may be favorable, especially when critical

5 outcomes are considered. Studies addressing patient survival and other clinical outcomes were

6 found only in the pediatric setting, which provides indirect evidence for adults.

7 Knowledge Gaps

8 • The resources required for implementation of in situ training, including direct and

9 indirect costs, workload, and equipment needed

10 • The feasibility of in situ training in low and middle-income countries.

11 Manikin Fidelity in Resuscitation Education (EIT 6410, SysRev 2025)

12 Rationale for Review

13 Higher-fidelity manikins have physical features that make them more realistic, including

14 changes in simulated physical states. Greater realism during life support training may enhance

15 learner engagement and make it easier to suspend disbelief. However, using higher-fidelity

16 manikins depends on the availability of resources to purchase, properly implement, and maintain

17 them; additionally, centers require trained personnel who can operate such manikins. The EIT

18 Task Force initiated this SysRev that was registered in PROSPERO (CRD4202453504), and the

19 full online CoSTR is available on the ILCOR website.323

20 Population, Intervention, Comparator, Outcome, and Time Frame

21 • Population: Participants undertaking basic and advanced life support training in an

22 education setting

23 • Intervention: Use of high-fidelity manikins

24 • Comparator: Use of low-fidelity manikins

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1 • Outcomes: Patient outcomes, skill performance in actual resuscitations, skill/knowledge

2 at 1 year, skill/knowledge at time between course conclusion and 1 year, skill/knowledge

3 at course conclusion, learner confidence, learner preference, cost/resource utilization

4 • Time frame: January 1, 2005, to April 30, 2024

5 Consensus on Science

6 Twenty-one studies were included.324-344 All involved healthcare professionals or trainees

7 and were performed in North America,325-333 Asia,324,336,338,340 Europe,334 and Australia.337

8 Skill at Course Conclusion

9 Data were reported in 8 RCTs with a total of 550 participants.326,327,329-331,333,336,341 RCTs

10 assessed performance in scenarios with manikins: 4 of adults,327,331,333,341 2 of children,326,329 and

11 2 of neonates.327,333 Meta-analysis results of these studies favored high-fidelity manikins (Figure

12 5).

13 Figure 5. Skill at completion of courses using high-fidelity manikins.

14
15 Two additional RCTs with 107 participants did not report sufficient measures of variance

16 for inclusion in the meta-analysis. Both found no difference in skill performance at course

17 completion.328,337

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1 Knowledge at Course Completion

2 Data were reported in 7 RCTs with 1016 participants.324,326,327,331,334,336,341 Five scenarios

3 were in adults,324,327,331,334,341 1 in children,326 and 1 in neonates.336 The meta-analysis revealed no

4 significant effect of high-fidelity manikins (Figure 6).

5 Figure 6. Knowledge at completion of courses using high-fidelity manikins.

6
7 Three additional RCTs with 184 participants and 1 observational study of 34 subjects did

8 not report sufficient measures of variance for inclusion in meta-analysis.332,337,339,342 One of these

9 found improved knowledge at course completion;337 the others found no difference.332,339,342

10 Skill: Time-to-Task Performance at Course Conclusion

11 Three RCTs with 179 participants325,342,344 were reviewed. One found faster time-to-task

12 completion (EMS activation),335 another found shorter time to intervention and assessment,342

13 and 1 other study found no difference in time to tracheal intubation during neonatal resuscitation

14 program training.325

15 Skill: Teamwork at Course Conclusion

16 Teamwork performance was reported in 3 RCTs with 193 participants.326,337,343 Two

17 found improved teamwork behaviors with higher-fidelity manikins,337,343 and 1 found no

18 difference.326

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1 Skill: CPR Parameters at Course Conclusion

2 Two RCTs with 80 intervention subjects and 80 controls were reviewed. One study found

3 greater improvement as measured at course completion by the American Heart Association CPR

4 skills checklist among subjects trained on higher-fidelity manikins.324 The second RCT found

5 better compression depth and compression fraction immediately post–training among subjects

6 trained on higher-fidelity manikins.335

7 Skill: Clinical Performance at 3 Months or Greater

8 Clinical performance was reported in 3 RCTs with 312 participants.324,333,341 One RCT in

9 nursing students found better clinical performance in a CPR scenario 3 months after training with

10 higher-fidelity manikins;324 2 studies of advanced cardiovascular life support skills found no

11 difference at 3 months or at 1 year posttraining.333,341

12 Knowledge at 3 Months or Longer

13 Knowledge retained months after training was reported in 3 RCTs with 330

14 participants.324,341,342 Two RCTs found improved knowledge following higher-fidelity manikin

15 training (3 months after BLS training,324 6 months after pediatric advanced life support

16 training,342) and 1 RCT found no difference in advanced cardiovascular life support knowledge

17 at 6 to 9 months post-training.341

18 Attitudes and Preferences

19 Learner preference and confidence following training were reported in 10 RCTs with 818

20 participants.325,327,328,330,331,334,338,340,341,344 Seven RCTs found greater effectiveness of training

21 with higher-fidelity manikins,325,327,328,334,338,340,344 and 3 RCTs found no difference.330,331,341

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1 Prior Treatment Recommendations (2015)

2 We suggest the use of high-fidelity manikins when training centers/organizations have

3 the infrastructure, trained personnel, and resources to maintain the program (weak

4 recommendations, very low–quality evidence).

5 If high-fidelity manikins are not available, we suggest that the use of low-fidelity

6 manikins is acceptable for standard ALS training in an educational setting (weak

7 recommendation, low-quality evidence).

8 Treatment Recommendations (2025)

9 We suggest the use of high-fidelity manikins when training centers or organizations have

10 the infrastructure, trained personnel, and resources to use them (weak recommendations, very

11 low–certainty evidence).

12 If high-fidelity manikins are not available, we suggest that the use of low-fidelity

13 manikins is acceptable for life-support training in an educational setting (weak recommendation,

14 low-certainty evidence).

15 Justification and Evidence-to-Decision Framework Highlights

16 The complete evidence-to-decision table is provided in Appendix A.

17 Most studies found a positive impact on skill or knowledge at conclusion of courses with

18 high-fidelity manikins, and no study demonstrated a negative effect on educational outcomes.

19 Given that resource use and cost were not directly studied, and higher-fidelity manikins are

20 likely more expensive to obtain and maintain, we limited our recommendation to centers where

21 these resources are available.

22 The recommendation for use of low-fidelity manikins when higher-fidelity manikins are

23 not available is based on studies which found improved performance in post-training versus pre-

24 training assessment in all groups irrespective of level of manikin fidelity.

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1 No studies reported on cost or resources needed to implement higher-fidelity manikins.

2 Our recommendation is predicated on the higher-fidelity manikins being used in a setting with

3 appropriate space, infrastructure, personnel, and resources to use them properly. Educational

4 settings where these resources are less available might make implementation difficult.

5 Knowledge Gaps

6 • Cost-effectiveness and implementation needs for high-fidelity manikin use in training

7 • Effect of high-fidelity manikins on longer-term educational outcomes (skill, knowledge

8 retention, decay)

9 • Specific simulation features that are most associated with improved learning

10 • Effect of high-fidelity manikin use in training on actual patient-care processes and patient

11 outcomes

12 • Benefits of high-fidelity manikin use in training in different resource settings

13 Cognitive Aids During Resuscitation (EIT 6400, SysRev 2024, EvUp 2025)

14 A SysRev was conducted for 2024345; details can be found in the 2024 CoSTR

15 summary.231,232 The complete 2025 EvUp is provided in Appendix B.

16 Population, Intervention, Comparator, Outcome, and Time Frame

17 • Population: Adults, children and neonates in any setting (in-hospital or out-of-hospital)

18 requiring resuscitation provided by lay providers or health care professionals

19 • Intervention: Use of cognitive aids during resuscitation

20 • Comparator: No use of cognitive aids

21 • Outcomes: Survival to hospital discharge with good neurological outcome and survival to

22 hospital discharge were ranked as critical outcomes. Quality of performance in actual

23 resuscitations, skill performance 1 year after course conclusion, skill performance

24 between course conclusion and 1 year, skill performance at course conclusion, and
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1 knowledge at course conclusion were included as important outcomes. Measures of effect

2 outcomes included adherence to resuscitation guidelines, CPR quality, and test scores.

3 • Time frame: June 1, 2023, to 23 April 2024

4 Summary of Evidence

5 The 3 new studies identified are consistent in supporting previous findings and do not

6 substantially change the weight of evidence.346-348 A further SysRev or ScopRev is not currently

7 warranted.

8 Treatment Recommendations (2024)

9 We suggest the use of cognitive aids by healthcare providers in resuscitation (weak

10 recommendation, very low–certainty evidence).

11 We do not recommend the use of cognitive aids for lay providers initiating CPR (weak

12 recommendation, low-certainty evidence).

13 We did not examine the use of cognitive aids in health professional or lay rescuer training

14 in resuscitation, so no recommendation for or against can be made.

15 Provider Workload and Stress During Resuscitation (EIT 6401, ScopRev 2024, EvUp 2025)

16 A ScopRev was completed for 2024,349 and details can be found in the 2024 CoSTR

17 summary.231,232 The complete EvUp is provided in Appendix B.

18 Population, Intervention, Comparator, Outcome, Study Design, and Time Frame

19 • Population: Health care providers performing resuscitation on patients in cardiac arrest in

20 clinical settings or on manikins in a simulated setting

21 • Exposure: Presence of any factors that would possibly impact the healthcare provider’s

22 perceived workload or stress

23 • Comparison: Absence of the specific factor

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1 • Outcomes: Objective or subjective measures of workload and stress experienced by

2 healthcare providers during resuscitations

3 • Study design: In addition to standard criteria, unpublished studies (eg, conference

4 abstracts, trial protocols), letters, editorials, comments, case reports, grey literature, and

5 social media were eligible for inclusion.

6 • Time frame: February 2, 2024, to October 2, 2024

7 Summary of Evidence

8 This EvUp found 2 new RCTs in a simulation setting (1 in neonatal resuscitation, the

9 other in adult simulation). The evidence in these studies did not add to that already known, and

10 therefore a new SysRev is not warranted.

11 Stepwise Approach to Skills Training in Resuscitation (EIT 6402, SysRev 2023, EvUp 2025)

12 A SysRev was conducted for 2023,350 and details of that review can be found in the 2023

13 CoSTR summary.4,5 The complete EvUp is provided in Appendix B.

14 Population, Intervention, Comparator, Outcome, and Time Frame

15 • Population: Adults and children undertaking skills training related to resuscitation and

16 First Aid in any educational setting

17 • Intervention: Approaches to skills teaching that are not the Peyton 4-steps approach,

18 including approaches without distinct stages, or modified Peyton 4-steps approaches with

19 more or less than 4 steps, or with delivering 1 or more steps by alternative methods (eg,

20 video)

21 • Comparator: Peyton’s 4-steps approach for skills teaching

22 • Outcomes:

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1 – Improved educational outcomes: skill performance after end of course; skill

2 performance at end of course; participants’ confidence to perform the skill on

3 patients; participants’ preference of teaching method

4 – Patient outcomes: skills performed appropriately on real patient after the course.

5 – Additional outcomes: teachers’ preference of teaching method; side effects of

6 teaching.

7 • Time frame: January 1, 2022, to November 20, 2024

8 Summary of Evidence

9 One new RCT was found351, which does not add new evidence to that already known. A

10 SysRev is not currently warranted.

11 Treatment Recommendations (2023)

12 We suggest that stepwise training should be the method of choice for skills training in

13 resuscitation (weak recommendation, very low–certainty evidence).

14 Immersive Technologies: Virtual Reality, Augmented Reality (EIT 6405, SysRev 2024,

15 EvUp 2025)

16 A SysRev was conducted for 2024,352 and details of that review can be found in the 2024

17 CoSTR summary.231,232 The complete EvUp is provided in Appendix B.

18 Population, Intervention, Comparator, Outcome, and Time Frame

19 • Population: All laypersons and health care providers in any educational setting.

20 • Intervention: Immersive technologies (virtual reality, augmented reality, mixed reality,

21 extended reality) as part of instructional design to train neonatal, pediatric, adult basic

22 and advanced life support.

23 • Comparator: Other methods of resuscitation training in basic and advanced life support

24 (eg, traditional manikin-based simulation training, other).

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1 • Outcomes: Knowledge acquisition and retention, skills acquisition and retention, skill

2 performance in real CPR, willingness to help, bystander CPR rate, and patients’ survival.

3 • Time frame: April 4, 2023, to October 10, 2024.

4 Summary of Evidence

5 No studies on augmented reality were found in this updated search. For virtual reality, 5

6 RCTs353-357 and 2 observational studies358,359 were found. The evidence identified continues to

7 support the current recommendations,360 and the certainty of this evidence remains low. The

8 current evidence update does not warrant a new SysRev.

9 Treatment Recommendations (2024)

10 We suggest the use of either augmented reality or traditional methods for basic life

11 support training of lay people and healthcare providers (weak recommendation, very low–

12 certainty evidence).

13 We suggest against the use of virtual reality-only for basic and advanced life support

14 training of lay people and healthcare providers (weak recommendation, very low–certainty

15 evidence).

16 Blended Learning Approach for Life Support Education (EIT 6409, SysRev 2022, EvUp

17 2025)

18 A SysRev was conducted for 2022,361 and details of that review can be found in the 2020

19 CoSTR.6.7 An EvUp was done in 2025.12,13 The complete EvUp is provided in Appendix B.

20 Population, Intervention, Comparator, Outcome, and Time Frame

21 • Population: Participants undertaking an accredited life support course (eg BLS, ALS,

22 pediatric advanced life support)

23 • Intervention: Blended learning approach

24 • Comparator: Non blended learning approach

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1 • Outcomes:

2 – Clinical outcomes: Survival (Critical) and neurological outcome.

3 – Knowledge acquisition (end of course, 6 months, 1 year).

4 – Skills acquisition (end of course, 6 months, 1 year).

5 – Participant satisfaction (end of course).

6 – Implementation outcomes (cost, time needed).

7 • Time frame: Jan 1, 2021, to Jun 19, 2024

8 Summary of Evidence

9 No relevant studies were identified and no new SysRev is indicated.

10 Treatment Recommendations (2022)

11 We recommend blended-learning as opposed to a nonblended approach for life support

12 training when resources and accessibility permit its implementation (strong recommendation,

13 very low–certainty evidence).

14 Gamified Learning Versus Other Forms of Nongamified Learning (EIT 6412, SysRev 2024,

15 EvUp 2025)

16 A SysRev was done for 2024362 and details can be found in the 2024 CoSTR

17 summary.231,232 The complete EvUp is provided in Appendix B.

18 Population, Intervention, Comparator, Outcome, and Time Frame

19 • Population: Learners training in basic or advanced life support

20 • Intervention: Instruction using gamified learning (use of game-like elements in the

21 context of training (eg point systems, intergroup competition, leaderboards, scaffolded

22 learning with increasing challenge, medals or badges)

23 • Comparator: Traditional instruction or other forms of nongamified learning

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1 • Outcomes:

2 – Educational outcomes: skill (eg CPR performance, other procedural performance,

3 scores in scenarios, time to task performance) immediately following training (eg end

4 of course), at 3 months, 6 months, 1 year. Knowledge eg test scores immediately

5 following training (eg end of course), at 3 months, 6 months, 1 year. Attitudes:

6 Participant satisfaction, learner preference, learner confidence

7 – Clinical outcomes: change in healthcare practitioner behavior at resuscitation in case

8 of real cardiac arrest (CPR quality, time to task completion, teamwork/crisis resource

9 management)

10 – Patient outcomes: ROSC, survival to hospital discharge; neurologic intact survival

11 – Process: costs and resources utilization

12 • Time frame: February 1, 2024, to October 30, 2024

13 Summary of Evidence

14 Three new RCTs have been identified.363-365Including these studies would not alter the

15 strength of the existing recommendation, therefore no new SysRev is warranted.

16 Treatment Recommendations (2024)

17 We suggest the use of gamified learning be considered as a component of resuscitation

18 training for all types of BLS and ALS courses (weak recommendation, very low–certainty

19 evidence).

20 Scripted Debriefing Versus Nonscripted Debriefing (EIT 6413, ScopRev 2024, EvUp 2025)

21 A ScopRev was conducted for 2024366 and is included in the 2024 CoSTR

22 summary.231,232 The complete EvUp is provided in Appendix B.

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1 Population, Intervention, Comparator, Outcome, and Time Frame

2 • Population: Health care professionals or laypeople receiving resuscitation training

3 (primary), and instructors teaching resuscitation courses (secondary)

4 • Intervention: Debriefing with a cognitive aid, checklist, script or tool

5 • Comparator: Debriefing without the use of a cognitive aid, checklist, script or tool

6 • Outcomes:

7 – Primary population: Patient outcomes: improved resuscitation performance in clinical

8 environments; improved learning outcomes (knowledge and skill acquisition and

9 retention); satisfaction of learning.

10 – Secondary population: quality of teaching/debriefing; workload/ cognitive load of

11 instructor/ debriefer

12 • Time frame: January 1 to October 10, 2024

13 Summary of Evidence

14 As there were no new studies identified, this evidence update does not warrant a SysRev.

15 Treatment Recommendations (2024)

16 Consider using debriefing scripts to support instructors during debriefing in resuscitation

17 programs because they may improve learning and performance. Instructors need to ensure they

18 have a complete understanding of how the debriefing script should be used (good practice

19 statement).

20 Rapid Cycle Deliberate Practice in Resuscitation Training (EIT 6414, SysRev 2024, EvUp

21 2025)

22 A SysRev was conducted for 2024,367 and details can be found in the 2024 CoSTR

23 summary.231,232 The complete EvUp is provided in Appendix B.

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1 Population, Intervention, Comparator, Outcome, and Time Frame

2 • Population: Learners in training for BLS or ALS

3 • Intervention: Instruction that uses rapid cycle deliberate practice

4 • Comparator: Traditional instruction or other forms of learning without rapid cycle

5 deliberate practice

6 • Outcomes: Knowledge acquisition and retention, skills acquisition and retention, skill

7 performance in real CPR, attitudes, willingness to help, and patients’ survival

8 • Time frame: September 1, 2022, to October 30, 2024

9 Summary of Evidence

10 This update found 2 additional RCTs that do not change available evidence.368,369

11 Therefore, a new SysRev is not warranted.

12 Treatment Recommendations (2024)

13 We suggest that it may be reasonable to include rapid cycle deliberate practice in BLS

14 and ALS training (weak recommendation, very low–certainty evidence).

15 Team Competencies in Resuscitation Training (EIT 6415, SysRev 2024, EvUp 2025)

16 A SysRev was conducted for 2024,370 and details can be found in the 2024 CoSTR

17 summary.231,232 The complete EvUp is provided in Appendix B.

18 Population, Intervention, Comparator, Outcome, Study Design, and Time Frame

19 • Population: Learners undertaking life support training in any setting

20 • Intervention: Life support training with a specific emphasis on team competencies

21 training

22 • Comparator: Life support training without specific emphasis on team competencies

23 training

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1 • Outcomes: Patient survival (actual resuscitation), CPR skill performance at course

2 completion (simulation), CPR skill performance (in actual resuscitation and simulation)

3 <1 year and ≥1 year of course completion; CPR quality (simulation) (at course

4 completion, <1 year and ≥1 year of course completion); confidence (at course completion

5 and <1 year and ≥1 year of course completion), teamwork competencies (in actual

6 resuscitation and simulation) (at course completion, <1 year and ≥1 year of course

7 completion); resources (time, equipment, cost).

8 • Study design: In addition to the standard criteria, studies evaluating scoring systems (no

9 relevant outcome), and studies with self-assessment as the only outcome were excluded.

10 • Time frame: August 30, 2023, to November 6, 2024

11 Summary of Evidence

12 The 2 new studies identified are consistent in supporting previous findings; however,

13 they do not substantially change the weight of evidence.371,372 Therefore, a further SysRev or

14 ScopRev is not warranted.

15 Treatment Recommendations (2024)

16 We suggest that teaching teamwork competencies be included in BLS and all kinds of

17 advanced life support training (weak recommendation, very low quality of evidence).

18 Topics Not Included in the 2025 Review

19 • EIT 6100 Resuscitation training in low-income countries (ScopRev in 2020,373 task

20 force statement 2023)374

21 • EIT 6408 Spaced Learning (SyR 2020,375 EvUp from 2022 in Appendix B available)

22

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1 APPENDIXES

2
3

4
5

6 References

7 1. International Liaison Committee on Resuscitation. ILCOR website. Accessed February

8 20, 2023. https://www.ilcor.org/

9 2. Morley et al. Methodology and Conflict of Interest Management: 2025 International

10 Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science

11 With Treatment Recommendations. Circulation. 2025:placeholder.

12 3. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y,

13 Glasziou P, DeBeer H, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles

14 and summary of findings tables. J Clin Epidemiol. 2011;64:383-394. doi:

15 10.1016/j.jclinepi.2010.04.026

16 4. Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR,

17 Smyth M, Scholefield BR, et al. 2023 International Consensus on Cardiopulmonary

18 Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations:

19 Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support;

20 Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

21 Resuscitation. 2024;195:109992. doi: 10.1016/j.resuscitation.2023.109992

22 5. Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR,

23 Smyth M, Scholefield BR, et al. 2023 International Consensus on Cardiopulmonary

24 Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations:

25 Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support;

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1 Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

2 Circulation. 2023;148:e187-e280. doi: 10.1161/cir.0000000000001179

3 6. Ko YC, Hsieh MJ, Schnaubelt S, Matsuyama T, Cheng A, Greif R. Disparities in

4 layperson resuscitation education: A scoping review. Am J Emerg Med. 2023;72:137-146. doi:

5 10.1016/j.ajem.2023.07.033

6 7. Munot S, Rugel EJ, Bray J, Redfern J, Yang G, Ngo L, Bauman A, Dang QM, Rock Z,

7 Marschner S, et al. Examining training and attitudes to basic life support in multi-ethnic

8 communities residing in New South Wales, Australia: A mixed-methods investigation. BMJ

9 Open. 2023;13:e073481. doi: 10.1136/bmjopen-2023-073481

10 8. Qin Z, Zheng S, Liu C, Ren Y, Wang R, Zhang S, Gu X, Li Y, Yan X, Xu T. The

11 knowledge, training, and willingness of first year students in Xuzhou, China to perform

12 bystander cardiopulmonary resuscitation: a cross-sectional study. Front Public Health.

13 2024;12:1444970. doi: 10.3389/fpubh.2024.1444970

14 9. Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E,

15 Hsieh MJ, Iwami T, et al. Education, Implementation, and Teams: 2020 International Consensus

16 on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment

17 Recommendations. Resuscitation. 2020;156:A188-a239. doi:

18 10.1016/j.resuscitation.2020.09.014

19 10. Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E,

20 Hsieh MJ, Iwami T, et al. Education, Implementation, and Teams: 2020 International Consensus

21 on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment

22 Recommendations. Circulation. 2020;142:S222-s283. doi: 10.1161/cir.0000000000000896

23 11. Bray J, Nehme Z, Nguyen A, Lockey A, Finn J. A systematic review of the impact of

24 emergency medical service practitioner experience and exposure to out of hospital cardiac arrest

25 on patient outcomes. Resuscitation. 2020;155:134-142. doi: 10.1016/j.resuscitation.2020.07.025

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1 12. Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J,

2 Cheng A, Drennan IR, Liley HG, et al. 2022 International Consensus on Cardiopulmonary

3 Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations:

4 Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support;

5 Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

6 Resuscitation. 2022;181:208-288. doi: 10.1016/j.resuscitation.2022.10.005

7 13. Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J,

8 Cheng A, Drennan IR, Liley HG, et al. 2022 International Consensus on Cardiopulmonary

9 Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations:

10 Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support;

11 Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

12 Circulation. 2022;146:e483-e557. doi: 10.1161/cir.0000000000001095

13 14. Benedict A, Pournami F, Prithvi AK, Nandakumar A, Prabhakar J, Jain N. Basic Life

14 Support Guidance for Caregivers of NICU Graduates: Evaluation of Skill Transfer after

15 Training. Journal of Child Science. 2022;12:e119-e124. doi: 10.1055/s-0042-1757147

16 15. Brooks M, Jacobs L, Cazzell M. Impact of emergency management in a simulated home

17 environment for caregivers of children who are tracheostomy dependent. J Spec Pediatr Nurs.

18 2022;27:e12366. doi: 10.1111/jspn.12366

19 16. Citolino Filho CM, Nogueira LS, Gomes VM, Polastri TF, Timerman S. Effectiveness of

20 cardiopulmonary resuscitation training in the teaching of family members of cardiac patients.

21 Rev Esc Enferm USP. 2022;56:e20210459. doi: 10.1590/1980-220X-REEUSP-2021-0459en

22 17. Macken WL, Clarke N, Nadeem M, Coghlan D. Life After the Event: A Review of Basic

23 Life Support Training for Parents Following Apparent Life-Threatening Events and Their

24 Experience and Practices Following Discharge. Ir Med J. 2017;110:572.

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
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1 18. McLeod KA, Fern E, Clements F, McGowan R. Prescribing an automated external

2 defibrillator for children at increased risk of sudden arrhythmic death. Cardiol Young.

3 2017;27:1271-1279. doi: 10.1017/s1047951117000026

4 19. Patocka C, Lockey A, Lauridsen KG, Greif R. Impact of accredited advanced life support

5 course participation on in-hospital cardiac arrest patient outcomes: A systematic review. Resusc

6 Plus. 2023;14:100389. doi: 10.1016/j.resplu.2023.100389

7 20. Schnaubelt S, Veigl C, Snijders E, Abelairas Gómez C, Neymayer M, Anderson N,

8 Nabecker S, Greif R. Tailored Basic Life Support Training for Specific Layperson Populations-A

9 Scoping Review. J Clin Med. 2024;13 doi: 10.3390/jcm13144032

10 21. Ko YC, Hsieh MJ, Cheng A, Lauridsen KG, Sawyer TL, Bhanji F, Greif R. Faculty

11 Development Approaches for Life Support Courses: A Scoping Review. J Am Heart Assoc.

12 2022;11:e025661. doi: 10.1161/jaha.122.025661

13 22. Kiyozumi T, Ishigami N, Tatsushima D, Araki Y, Yoshimura Y, Saitoh D. Instructor

14 Development Workshops for Advanced Life Support Training Courses Held in a Fully Virtual

15 Space: Observational Study. JMIR Serious Games. 2022;10:e38952. doi: 10.2196/38952

16 23. Nabecker S, Balmer Y, van Goor S, Greif R. Piloting a Basic Life Support instructor

17 course: A short report. Resusc Plus. 2022;12:100325. doi: 10.1016/j.resplu.2022.100325

18 24. Iserbyt P, Madou T. The effect of content knowledge and repeated teaching on teaching

19 and learning basic life support: a cluster randomised controlled trial. Acta Cardiol. 2022;77:616-

20 625. doi: 10.1080/00015385.2021.1969109

21 25. Madou T, Depaepe F, Ward P, Iserbyt P. The role of specialised content knowledge in

22 teaching basic life support. Health Education Journal. 2023;82:555-568. doi:

23 10.1177/00178969231174685

24 26. Nabecker S CA, Breckwoldt J, de Raad T, Lennertz J, Alghaith A, Greif R, on behalf of

25 the Resuscitation Education, Implementation and Teams Task Force. Debriefing of clinical
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1 resuscitation performance: EIT 6307 TF SR. 2024. Updated. Accessed 14 January.

2 https://costr.ilcor.org/document/debriefing-of-clinical-resuscitation-performance-eit-6307-tf-sr

3 27. Bleijenberg E, Koster RW, de Vries H, Beesems SG. The impact of post-resuscitation

4 feedback for paramedics on the quality of cardiopulmonary resuscitation. Resuscitation.

5 2017;110:1-5. doi: 10.1016/j.resuscitation.2016.08.034

6 28. Couper K, Kimani PK, Abella BS, Chilwan M, Cooke MW, Davies RP, Field RA, Gao F,

7 Quinton S, Stallard N, et al. The System-Wide Effect of Real-Time Audiovisual Feedback and

8 Postevent Debriefing for In-Hospital Cardiac Arrest: The Cardiopulmonary Resuscitation

9 Quality Improvement Initiative. Crit Care Med. 2015;43:2321-2331. doi:

10 10.1097/CCM.0000000000001202

11 29. Couper K, Kimani PK, Davies RP, Baker A, Davies M, Husselbee N, Melody T, Griffiths

12 F, Perkins GD. An evaluation of three methods of in-hospital cardiac arrest educational

13 debriefing: The cardiopulmonary resuscitation debriefing study. Resuscitation. 2016;105:130-

14 137. doi: 10.1016/j.resuscitation.2016.05.005

15 30. Couper K, Mason AJ, Gould D, Nolan JP, Soar J, Yeung J, Harrison D, Perkins GD. The

16 impact of resuscitation system factors on in-hospital cardiac arrest outcomes across UK

17 hospitals: An observational study. Resuscitation. 2020;151:166-172. doi:

18 10.1016/j.resuscitation.2020.04.006

19 31. Edelson DP, Litzinger B, Arora V, Walsh D, Kim S, Lauderdale DS, Vanden Hoek TL,

20 Becker LB, Abella BS. Improving in-hospital cardiac arrest process and outcomes with

21 performance debriefing. Arch Intern Med. 2008;168:1063-1069. doi:

22 10.1001/archinte.168.10.1063

23 32. Malik AO, Nallamothu BK, Trumpower B, Kennedy M, Krein SL, Chinnakondepalli

24 KM, Hejjaji V, Chan PS. Association Between Hospital Debriefing Practices With Adherence to

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 91

1 Resuscitation Process Measures and Outcomes for In-Hospital Cardiac Arrest. Circ Cardiovasc

2 Qual Outcomes. 2020;13:e006695. doi: 10.1161/CIRCOUTCOMES.120.006695

3 33. Wolfe H, Zebuhr C, Topjian AA, Nishisaki A, Niles DE, Meaney PA, Boyle L, Giordano

4 RT, Davis D, Priestley M, et al. Interdisciplinary ICU cardiac arrest debriefing improves survival

5 outcomes*. Crit Care Med. 2014;42:1688-1695. doi: 10.1097/CCM.0000000000000327

6 34. Heydarzadeh MM, A.; Azizi, S.; Hamedi, A.; Alavi, SS. Impact of video-recorded

7 debriefing and neonatal resuscitation program workshops on short-term outcomes and quality of

8 neonatal resuscitation. Iranian Journal of Neonatology. 2020;2020 Jun: 11(2)

9 35. Skare C, Boldingh AM, Kramer-Johansen J, Calisch TE, Nakstad B, Nadkarni V,

10 Olasveengen TM, Niles DE. Video performance-debriefings and ventilation-refreshers improve

11 quality of neonatal resuscitation. Resuscitation. 2018;132:140-146. doi:

12 10.1016/j.resuscitation.2018.07.013

13 36. Skare C, Calisch TE, Saeter E, Rajka T, Boldingh AM, Nakstad B, Niles DE, Kramer-

14 Johansen J, Olasveengen TM. Implementation and effectiveness of a video-based debriefing

15 programme for neonatal resuscitation. Acta Anaesthesiol Scand. 2018;62:394-403. doi:

16 10.1111/aas.13050

17 37. Andersen LW, Berg KM, Chase M, Cocchi MN, Massaro J, Donnino MW. Acute

18 respiratory compromise on inpatient wards in the United States: Incidence, outcomes, and factors

19 associated with in-hospital mortality. Resuscitation. 2016;105:123-129. doi:

20 https://dx.doi.org/10.1016/j.resuscitation.2016.05.014

21 38. Maharaj R, Raffaele I, Wendon J. Rapid response systems: a systematic review and meta-

22 analysis. Critical care (London, England). 2015;19:254. doi: https://dx.doi.org/10.1186/s13054-

23 015-0973-y

24 39. Winters BD. Rapid response systems: Going beyond cardiac arrest and mortality. Critical

25 Care Medicine. 2013;41:911-912. doi: https://dx.doi.org/10.1097/CCM.0b013e3182770fec

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 92

1 40. Allan KA Y, J, Flaim B, Aves T, Olejarz M, Cheng A, Kishibe T, Greif R on behalf of

2 the International Liaison Committee on Resuscitation from rom the Education Implementation

3 Teams Task Force (EIT). . Medical Emergency Systems/ Rapid Response Teams for adult in-

4 hospital patients: EIT 6309 TF SR. 2024. Updated. Accessed 14 January.

5 https://costr.ilcor.org/document/medical-emergency-systems-rapid-response-teams-for-adult-in-

6 hospital-patients-eit-6309-tf-sr

7 41. Al-Omari A, Al Mutair A, Aljamaan F. Outcomes of rapid response team implementation

8 in tertiary private hospitals: a prospective cohort study. International journal of emergency

9 medicine. 2019;12:31. doi: https://dx.doi.org/10.1186/s12245-019-0248-5

10 42. Jones D, Bellomo R, Bates S, Warrillow S, Goldsmith D, Hart G, Opdam H, Gutteridge

11 G. Long term effect of a medical emergency team on cardiac arrests in a teaching hospital.

12 Critical care (London, England). 2005;9:R808-815. doi: https://dx.doi.org/10.1186/cc3906

13 43. Jones D, George C, Hart GK, Bellomo R, Martin J. Introduction of medical emergency

14 teams in Australia and New Zealand: a multi-centre study. Critical care (London, England).

15 2008;12:R46. doi: https://dx.doi.org/10.1186/cc6857

16 44. Kenward G, Castle N, Hodgetts T, Shaikh L. Evaluation of a medical emergency team

17 one year after implementation. Resuscitation. 2004;61:257-263. doi:

18 https://dx.doi.org/10.1016/j.resuscitation.2004.01.021

19 45. Oh TK, Kim S, Lee DS, Min H, Choi YY, Lee EY, Yun M-A, Lee YJ, Hon PS, Kim K,

20 et al. A rapid response system reduces the incidence of in-hospital postoperative

21 cardiopulmonary arrest: a retrospective study. Un systeme de reponse rapide diminue l'incidence

22 des arrets cardiopulmonaires postoperatoires en milieu hospitalier : une etude retrospective.

23 2018;65:1303-1313. doi: https://dx.doi.org/10.1007/s12630-018-1200-5

24 46. Rothschild JM, Woolf S, Finn KM, Friedberg MW, Lemay C, Furbush KA, Williams

25 DH, Bates DW. A controlled trial of a rapid response system in an academic medical center.
© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 93

1 Joint Commission journal on quality and patient safety. 2008;34:417-365. doi:

2 https://dx.doi.org/10.1016/s1553-7250(08)34052-5

3 47. Shah SK, Cardenas VJ, Jr., Kuo Y-F, Sharma G. Rapid response team in an academic

4 institution: does it make a difference? Chest. 2011;139:1361-1367. doi:

5 https://dx.doi.org/10.1378/chest.10-0556

6 48. Yang E, Lee H, Lee S-M, Kim S, Ryu HG, Lee HJ, Lee J, Oh S-Y. Effectiveness of a

7 daytime rapid response system in hospitalized surgical ward patients. Acute and critical care.

8 2020;35:77-86. doi: https://dx.doi.org/10.4266/acc.2019.00661

9 49. Chen J, Ou L, Hillman K, Parr M, Flabouris A, Green M. Impact of a standardised rapid

10 response system on clinical outcomes of female patients: an interrupted time series approach.

11 BMJ open quality. 2022;11 doi: https://dx.doi.org/10.1136/bmjoq-2021-001614

12 50. Aitken LM, Chaboyer W, Vaux A, Crouch S, Burmeister E, Daly M, Joyce C. Effect of a

13 2-tier rapid response system on patient outcome and staff satisfaction. Australian critical care :

14 official journal of the Confederation of Australian Critical Care Nurses. 2015;28:107-115. doi:

15 https://dx.doi.org/10.1016/j.aucc.2014.10.044

16 51. Al-Qahtani S, Al-Dorzi HM, Tamim HM, Hussain S, Fong L, Taher S, Al-Knawy BA,

17 Arabi Y. Impact of an intensivist-led multidisciplinary extended rapid response team on hospital-

18 wide cardiopulmonary arrests and mortality. Critical care medicine. 2013;41:506-517. doi:

19 https://dx.doi.org/10.1097/CCM.0b013e318271440b

20 52. Bader MK, Neal B, Johnson L, Pyle K, Brewer J, Luna M, Stalcup C, Whittaker M,

21 Ritter M. Rescue me: saving the vulnerable non-ICU patient population. Joint Commission

22 journal on quality and patient safety. 2009;35:199-205. doi: https://dx.doi.org/10.1016/s1553-

23 7250(09)35027-8

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 94

1 53. Baxter AD, Cardinal P, Hooper J, Patel R. Rapid response systems - The real merit of

2 MERIT? [9]. Critical Care Medicine. 2008;36:655-656. doi:

3 https://dx.doi.org/10.1097/CCM.0B013E3181629FDD

4 54. Beitler JR, Link N, Bails DB, Hurdle K, Chong DH. Reduction in hospital-wide mortality

5 following implementation of a rapid response team: A long-term cohort study. Critical Care.

6 2011:R269. doi: https://dx.doi.org/10.1186/cc10547

7 55. Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart GK, Opdam H, Silvester W,

8 Doolan L, Gutteridge G. A prospective before-and-after trial of a medical emergency team.

9 Medical Journal of Australia. 2003;179:283-287. doi: https://dx.doi.org/10.5694/j.1326-

10 5377.2003.tb05548.x

11 56. Benson L, Mitchell C, Link M, Carlson G, Fisher J. Using an advanced practice nursing

12 model for a rapid response team. Joint Commission journal on quality and patient safety.

13 2008;34:743-747. doi: https://dx.doi.org/10.1016/s1553-7250(08)34097-5

14 57. Bhonagiri D, Lander H, Green M, Straney L, Jones D, Pilcher D. Reduction of in-hospital

15 cardiac arrest rates in intensive care-equipped New South Wales hospitals in association with

16 implementation of Between the Flags rapid response system. Internal medicine journal.

17 2021;51:375-384. doi: https://dx.doi.org/10.1111/imj.14812

18 58. Bristow PJ, Hillman KM, Chey T, Daffurn K, Jacques TC, Norman SL, Bishop GF,

19 Simmons EG. Rates of in-hospital arrests, deaths and intensive care admissions: the effect of a

20 medical emergency team. The Medical journal of Australia. 2000;173:236-240. doi:

21 https://dx.doi.org/10.5694/j.1326-5377.2000.tb125627.x

22 59. Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a

23 medical emergency team on reduction of incidence of and mortality from unexpected cardiac

24 arrests in hospital: preliminary study. BMJ (Clinical research ed). 2002;324:387-390. doi:

25 https://dx.doi.org/10.1136/bmj.324.7334.387
© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 95

1 60. Chan PS, Khalid A, Longmore LS, Berg RA, Kosiborod M, Spertus JA. Hospital-wide

2 code rates and mortality before and after implementation of a rapid response team. JAMA.

3 2008;300:2506-2513. doi: https://dx.doi.org/10.1001/jama.2008.715

4 61. Chen J, Ou L, Flabouris A, Hillman K, Bellomo R, Parr M. Impact of a standardized

5 rapid response system on outcomes in a large healthcare jurisdiction. Resuscitation.

6 2016;107:47-56. doi: https://dx.doi.org/10.1016/j.resuscitation.2016.07.240

7 62. Chen J, Ou L, Hillman K, Flabouris A, Bellomo R, Hollis SJ, Assareh H. The impact of

8 implementing a rapid response system: a comparison of cardiopulmonary arrests and mortality

9 among four teaching hospitals in Australia. Resuscitation. 2014;85:1275-1281. doi:

10 https://dx.doi.org/10.1016/j.resuscitation.2014.06.003

11 63. Dacey MJ, Mirza ER, Wilcox V, Doherty M, Mello J, Boyer A, Gates J, Brothers T,

12 Baute R. The effect of a rapid response team on major clinical outcome measures in a

13 community hospital. Critical care medicine. 2007;35:2076-2082. doi:

14 https://dx.doi.org/10.1097/01.ccm.0000281518.17482.ee

15 64. Davis DP, Aguilar SA, Graham PG, Lawrence B, Sell RE, Minokadeh A, Husa RD. A

16 novel configuration of a traditional rapid response team decreases non-intensive care unit arrests

17 and overall hospital mortality. Journal of hospital medicine. 2015;10:352-357. doi:

18 https://dx.doi.org/10.1002/jhm.2338

19 65. DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL. Use of

20 medical emergency team responses to reduce hospital cardiopulmonary arrests. Quality & safety

21 in health care. 2004;13:251-254. doi: https://dx.doi.org/10.1136/qhc.13.4.251

22 66. Frost SA, Chapman A, Aneman A, Chen J, Parr MJ, Hillman K. Hospital outcomes

23 associated with introduction of a two-tiered response to the deteriorating patient. Critical care

24 and resuscitation : journal of the Australasian Academy of Critical Care Medicine. 2015;17:77-

25 82.
© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 96

1 67. Gao H, Harrison DA, Parry GJ, Daly K, Subbe CP, Rowan K. The impact of the

2 introduction of critical care outreach services in England: a multicentre interrupted time-series

3 analysis. Critical care (London, England). 2007;11:R113. doi: https://dx.doi.org/10.1186/cc6163

4 68. Goncales PDS, Polessi JA, Bass LM, Santos GdPD, Yokota PKO, Laselva CR,

5 Fernandes Junior C, Cendoroglo Neto M, Estanislao M, Teich V, et al. Reduced frequency of

6 cardiopulmonary arrests by rapid response teams. Einstein (Sao Paulo, Brazil). 2012;10:442-448.

7 doi: https://dx.doi.org/10.1590/s1679-45082012000400009

8 69. Gong X-Y, Wang Y-G, Shao H-Y, Lan P, Yan R-S, Pan K-H, Zhou J-C. A rapid

9 response team is associated with reduced overall hospital mortality in a Chinese tertiary hospital:

10 a 9-year cohort study. Annals of translational medicine. 2020;8:317. doi:

11 https://dx.doi.org/10.21037/atm.2020.02.147

12 70. Hatler C, Mast D, Bedker D, Johnson R, Corderella J, Torres J, King D, Plueger M.

13 Implementing a rapid response team to decrease emergencies outside the ICU: one hospital's

14 experience. Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses.

15 2009;18:84-126.

16 71. Jolley J, Bendyk H, Holaday B, Lombardozzi KAK, Harmon C. Rapid response teams:

17 do they make a difference? Dimensions of critical care nursing : DCCN. 2007;26:253-252. doi:

18 https://dx.doi.org/10.1097/01.DCC.0000297401.67854.78

19 72. Jung B, Daurat A, De Jong A, Chanques G, Mahul M, Monnin M, Molinari N, Jaber S.

20 Rapid response team and hospital mortality in hospitalized patients. Intensive care medicine.

21 2016;42:494-504. doi: https://dx.doi.org/10.1007/s00134-016-4254-2

22 73. Kim Y, Lee DS, Min H, Choi YY, Lee EY, Song I, Park JS, Cho Y-J, Jo YH, Yoon HI, et

23 al. Effectiveness Analysis of a Part-Time Rapid Response System During Operation Versus

24 Nonoperation. Critical care medicine. 2017;45:e592-e599. doi:

25 https://dx.doi.org/10.1097/CCM.0000000000002314
© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 97

1 74. Kollef MH, Heard K, Chen Y, Lu C, Martin N, Bailey T. Mortality and Length of Stay

2 Trends Following Implementation of a Rapid Response System and Real-Time Automated

3 Clinical Deterioration Alerts. American journal of medical quality : the official journal of the

4 American College of Medical Quality. 2017;32:12-18. doi:

5 https://dx.doi.org/10.1177/1062860615613841

6 75. Konrad D, Jaderling G, Bell M, Granath F, Ekbom A, Martling C-R. Reducing in-

7 hospital cardiac arrests and hospital mortality by introducing a medical emergency team.

8 Intensive care medicine. 2010;36:100-106. doi: https://dx.doi.org/10.1007/s00134-009-1634-x

9 76. Lee HY, Lee J, Lee S-M, Kim S, Yang E, Lee HJ, Lee H, Ryu HG, Oh S-Y, Ha EJ, et al.

10 Effect of a rapid response system on code rates and in-hospital mortality in medical wards. Acute

11 and critical care. 2019;34:246-254. doi: https://dx.doi.org/10.4266/acc.2019.00668

12 77. Lighthall GK, Parast LM, Rapoport L, Wagner TH. Introduction of a rapid response

13 system at a United States veterans affairs hospital reduced cardiac arrests. Anesthesia and

14 analgesia. 2010;111:679-686. doi: https://dx.doi.org/10.1213/ANE.0b013e3181e9c3f3

15 78. Lim SY, Park SY, Park HK, Kim M, Park HY, Lee B, Lee JH, Jung EJ, Jeon K, Park C-

16 M, et al. Early impact of medical emergency team implementation in a country with limited

17 medical resources: a before-and-after study. Journal of critical care. 2011;26:373-378. doi:

18 https://dx.doi.org/10.1016/j.jcrc.2010.08.019

19 79. Ludikhuize J, Brunsveld-Reinders AH, Dijkgraaf MGW, Smorenburg SM, de Rooij

20 SEJA, Adams R, de Maaijer PF, Fikkers BG, Tangkau P, de Jonge E. Outcomes Associated With

21 the Nationwide Introduction of Rapid Response Systems in The Netherlands. Critical care

22 medicine. 2015;43:2544-2551. doi: https://dx.doi.org/10.1097/CCM.0000000000001272

23 80. Medina-Rivera B, Campos-Santiago Z, Palacios AT, Rodriguez-Cintron W. The effect of

24 the medical emergency team on unexpected cardiac arrest and death at the VA Caribbean

25 Healthcare System: A retrospective study. Critical Care and Shock. 2010;13:98-105.

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 98

1 81. Menon VP, Prasanna P, Edathadathil F, Balachandran S, Moni M, Sathyapalan D, Pai

2 RD, Singh S. A Quality Improvement Initiative to Reduce "Out-of-ICU" Cardiopulmonary

3 Arrests in a Tertiary Care Hospital in India: A 2-Year Learning Experience. Quality management

4 in health care. 2018;27:39-49. doi: https://dx.doi.org/10.1097/QMH.0000000000000160

5 82. Moon A, Cosgrove JF, Lea D, Fairs A, Cressey DM. An eight year audit before and after

6 the introduction of modified early warning score (MEWS) charts, of patients admitted to a

7 tertiary referral intensive care unit after CPR. Resuscitation. 2011;82:150-154. doi:

8 https://dx.doi.org/10.1016/j.resuscitation.2010.09.480

9 83. Moroseos T, Bidwell K, Rui L, Fuhrman L, Gibran NS, Honari S, Pham TN. Rapid

10 response team implementation on a burn surgery/acute care ward. Journal of burn care &

11 research : official publication of the American Burn Association. 2014;35:21-27. doi:

12 https://dx.doi.org/10.1097/BCR.0b013e3182a2acae

13 84. Noyes AM, Gluck JA, Madison D, Madison B, Madison T, Coleman CI, Mather J,

14 Kluger J. Reduction of Cardiac Arrests: The Experience of a Novel Service Centric Medical

15 Emergency Team. Connecticut medicine. 2015;79:13-18.

16 85. Offner PJ, Heit J, Roberts R. Implementation of a rapid response team decreases cardiac

17 arrest outside of the intensive care unit. The Journal of trauma. 2007;62:1223-1228. doi:

18 https://dx.doi.org/10.1097/TA.0b013e31804d4968

19 86. Park Y, Ahn J-J, Kang BJ, Lee YS, Ha S-O, Min J-S, Cho W-H, Na S-H, Lee D-H, Park

20 S-Y, et al. Rapid Response Systems Reduce In-Hospital Cardiopulmonary Arrest: A Pilot Study

21 and Motivation for a Nationwide Survey. Korean journal of critical care medicine. 2017;32:231-

22 239. doi: https://dx.doi.org/10.4266/kjccm.2017.00024

23 87. Rothberg MB, Belforti R, Fitzgerald J, Friderici J, Keyes M. Four years' experience with

24 a hospitalist-led medical emergency team: an interrupted time series. Journal of hospital

25 medicine. 2012;7:98-103. doi: https://dx.doi.org/10.1002/jhm.953

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 99

1 88. Sabahi M, Fanaei SA, Ziaee SA, Falsafi FS. Efficacy of a rapid response team on

2 reducing the incidence and mortality of unexpected cardiac arrests. Trauma monthly.

3 2012;17:270-274. doi: https://dx.doi.org/10.5812/traumamon.4170

4 89. Santamaria J, Tobin A, Holmes J. Changing cardiac arrest and hospital mortality rates

5 through a medical emergency team takes time and constant review. Critical care medicine.

6 2010;38:445-450. doi: https://dx.doi.org/10.1097/CCM.0b013e3181cb0ff1

7 90. Sarani B, Palilonis E, Sonnad S, Bergey M, Sims C, Pascual JL, Schweickert W. Clinical

8 emergencies and outcomes in patients admitted to a surgical versus medical service.

9 Resuscitation. 2011;82:415-418. doi: https://dx.doi.org/10.1016/j.resuscitation.2010.12.005

10 91. Segon A, Ahmad S, Segon Y, Kumar V, Friedman H, Ali M. Effect of a rapid response

11 team on patient outcomes in a community-based teaching hospital. Journal of graduate medical

12 education. 2014;6:61-64. doi: https://dx.doi.org/10.4300/JGME-D-13-00165.1

13 92. Simmes FM, Schoonhoven L, Mintjes J, Fikkers BG, van der Hoeven JG. Incidence of

14 cardiac arrests and unexpected deaths in surgical patients before and after implementation of a

15 rapid response system. Annals of intensive care. 2012;2:20. doi: https://dx.doi.org/10.1186/2110-

16 5820-2-20

17 93. Vazquez R, Gheorghe C, Grigoriyan A, Palvinskaya T, Amoateng-Adjepong Y,

18 Manthous CA. Enhanced end-of-life care associated with deploying a rapid response team: a

19 pilot study. Journal of hospital medicine. 2009;4:449-452. doi:

20 https://dx.doi.org/10.1002/jhm.451

21 94. Viana MV, Nunes DSL, Teixeira C, Vieira SRR, Torres G, Brauner JS, Muller H, Butelli

22 TCD, Boniatti MM. Changes in cardiac arrest profiles after the implementation of a Rapid

23 Response Team. Modificacoes no perfil de paradas cardiacas apos implantacao de um Time de

24 Resposta Rapida. 2021;33:96-101. doi: https://dx.doi.org/10.5935/0103-507X.20210010

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 100

1 95. Young AM, Strobel RJ, Rotar E, Norman A, Henrich M, Mehaffey JH, Brady W, Teman

2 NR. Implementation of a non-intensive-care unit medical emergency team improves failure to

3 rescue rates in cardiac surgery patients. Journal of Thoracic and Cardiovascular Surgery.

4 2023;165:1861-1872.e1865. doi: https://dx.doi.org/10.1016/j.jtcvs.2022.07.015

5 96. Yousaf M, Bano S, Attaur-Rehman M, Nazar CMJ, Qadeer A, Khudaidad S, Hussain

6 SW. Comparison of Hospital-Wide Code Rates and Mortality Before and After the

7 Implementation of a Rapid Response Team. Cureus. 2018;10:e2043. doi:

8 https://dx.doi.org/10.7759/cureus.2043

9 97. Haegdorens F, Van Bogaert P, Roelant E, De Meester K, Misselyn M, Wouters K,

10 Monsieurs KG. The introduction of a rapid response system in acute hospitals: A pragmatic

11 stepped wedge cluster randomised controlled trial. Resuscitation. 2018;129:127-134. doi:

12 https://dx.doi.org/10.1016/j.resuscitation.2018.04.018

13 98. Jeddian A, Hemming K, Lindenmeyer A, Rashidian A, Sayadi L, Jafari N, Malekzadeh

14 R, Marshall T. Evaluation of a critical care outreach service in a middle-income country: A

15 stepped wedge cluster randomized trial and nested qualitative study. Journal of critical care.

16 2016;36:212-217. doi: https://dx.doi.org/10.1016/j.jcrc.2016.07.018

17 99. Piquette D, Fowler RA. Do medical emergency teams improve the outcomes of in-

18 hospital patients? CMAJ Canadian Medical Association Journal. 2005;173:599-600. doi:

19 https://dx.doi.org/10.1503/cmaj.051005

20 100. Jamous SE, Kouatly I, Irani J, Badr LK. Implementing a Rapid Response Team: A

21 Quality Improvement Project in a Low- to Middle-Income Country. Dimensions of critical care

22 nursing : DCCN. 2023;42:171-178. doi: https://dx.doi.org/10.1097/DCC.0000000000000584

23 101. Song I-A, Lee Y-K, Park J-W, Kim J-K, Koo K-H. Effectiveness of rapid response

24 system in patients with hip fractures. Injury. 2021;52:1841-1845. doi:

25 https://dx.doi.org/10.1016/j.injury.2021.04.029
© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 101

1 102. Braithwaite RS, DeVita MA, Mahidhara R, Simmons RL, Stuart S, Foraida M. Use of

2 medical emergency team (MET) responses to detect medical errors. Quality & safety in health

3 care. 2004;13:255-259. doi: https://dx.doi.org/10.1136/qhc.13.4.255

4 103. Institute for Healthcare Improvement. Improvement Areas. Accessed 14 January.

5 http://www.ihi.org/Topics/RapidResponseTeams/Pages/default.aspx

6 104. DeVita MA, Smith GB, Adam SK, Adams-Pizarro I, Buist M, Bellomo R, Bonello R,

7 Cerchiari E, Farlow B, Goldsmith D, et al. "Identifying the hospitalised patient in crisis"-A

8 consensus conference on the afferent limb of Rapid Response Systems. Resuscitation.

9 2010;81:375-382. doi: https://dx.doi.org/10.1016/j.resuscitation.2009.12.008

10 105. Ko YC BJ, Lee TY, Lockey A, Cheng A, Greif R on behalf of the International Liaison

11 Committee on Resuscitation Education, Implementation and Teams Task Force (EIT) Life

12 Support Task Force. EIT 6310 System Performance Improvement: EIT 6310 TF SR. 2024.

13 Updated. Accessed 14 January. https://costr.ilcor.org/document/eit-6310-system-performance-

14 improvement-eit-6310-tf-sr

15 106. Auricchio A, Caputo ML, Baldi E, Klersy C, Benvenuti C, Cianella R, De Ferrari GM,

16 Moccetti T. Gender-specific differences in return-to-spontaneous circulation and outcome after

17 out-of-hospital cardiac arrest: Results of sixteen-year-state-wide initiatives. Resusc Plus.

18 2020;4:100038. doi: 10.1016/j.resplu.2020.100038

19 107. Blewer AL, Ho AFW, Shahidah N, White AE, Pek PP, Ng YY, Mao DR, Tiah L, Chia

20 MY, Leong BS, et al. Impact of bystander-focused public health interventions on

21 cardiopulmonary resuscitation and survival: a cohort study. Lancet Public Health. 2020;5:e428-

22 e436. doi: 10.1016/s2468-2667(20)30140-7

23 108. Dong X, Wang L, Xu H, Ye Y, Zhou Z, Zhang L. Effect of a Targeted Ambulance

24 Treatment Quality Improvement Programme on Outcomes from Out-of-Hospital Cardiac Arrest:

25 A Metropolitan Citywide Intervention Study. J Clin Med. 2022;12 doi: 10.3390/jcm12010163

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 102

1 109. Freedman AJ, Madsen EC, Lowrie L. Establishing a Quality Improvement Program for

2 Pediatric In-hospital Cardiac Arrest. Pediatr Qual Saf. 2023;8:e706. doi:

3 10.1097/pq9.0000000000000706

4 110. Kim GW, Lee DK, Kang BR, Jeong WJ, Lee CA, Oh YT, Kim YJ, Park SM. A

5 multidisciplinary approach for improving the outcome of out-of-hospital cardiac arrest in South

6 Korea. Eur J Emerg Med. 2020;27:46-53. doi: 10.1097/mej.0000000000000612

7 111. Kim GW, Moon HJ, Lim H, Kim YJ, Lee CA, Park YJ, Lee KM, Woo JH, Cho JS, Jeong

8 WJ, et al. Effects of Smart Advanced Life Support protocol implementation including CPR

9 coaching during out-of-hospital cardiac arrest. Am J Emerg Med. 2022;56:211-217. doi:

10 10.1016/j.ajem.2022.03.050

11 112. Kim JY, Cho H, Park JH, Song JH, Moon S, Lee H, Yang HJ, Tolles J, Bosson N, Lewis

12 RJ. Application of the "Plan-Do-Study-Act" Model to Improve Survival after Cardiac Arrest in

13 Korea: A Case Study. Prehosp Disaster Med. 2020;35:46-54. doi: 10.1017/s1049023x19005156

14 113. Lee DE, Ryoo HW, Moon S, Park JH, Shin SD. Effect of citywide enhancement of the

15 chain of survival on good neurologic outcomes after out-of-hospital cardiac arrest from 2008 to

16 2017. PLoS One. 2020;15:e0241804. doi: 10.1371/journal.pone.0241804

17 114. Li T, Essex K, Ebert D, Levinsky B, Gilley C, Luo D, Alper E, Barbara P, Rolston DM,

18 Berkowitz J, et al. Resuscitation Quality Improvement® (RQI®) HeartCode Complete®

19 program improves chest compression rate in real world out-of hospital cardiac arrest patients.

20 Resuscitation. 2023;188:109833. doi: 10.1016/j.resuscitation.2023.109833

21 115. Lin HY, Chien YC, Lee BC, Wu YL, Liu YP, Wang TL, Ko PC, Chong KM, Wang HC,

22 Huang EP, et al. Outcomes of out-of-hospital cardiac arrests after a decade of system-wide

23 initiatives optimising community chain of survival in Taipei city. Resuscitation. 2022;172:149-

24 158. doi: 10.1016/j.resuscitation.2021.12.027

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 103

1 116. Lyngby RM, Quinn T, Oelrich RM, Nikoletou D, Gregers MCT, Kjølbye JS, Ersbøll AK,

2 Folke F. Association of Real-Time Feedback and Cardiopulmonary-Resuscitation Quality

3 Delivered by Ambulance Personnel for Out-of-Hospital Cardiac Arrest. J Am Heart Assoc.

4 2023;12:e029457. doi: 10.1161/jaha.123.029457

5 117. McCoy C, Keshvani N, Warsi M, Brown LS, Girod C, Chu ES, Hegde AA. Empowering

6 telemetry technicians and enhancing communication to improve in-hospital cardiac arrest

7 survival. BMJ Open Qual. 2023;12 doi: 10.1136/bmjoq-2022-002220

8 118. Nehme Z, Ball J, Stephenson M, Walker T, Stub D, Smith K. Effect of a resuscitation

9 quality improvement programme on outcomes from out-of-hospital cardiac arrest. Resuscitation.

10 2021;162:236-244. doi: 10.1016/j.resuscitation.2021.03.007

11 119. Riyapan S, Sanyanuban P, Chantanakomes J, Roongsaenthong P, Somboonkul B,

12 Rangabpai W, Thirawattanasoot N, Pansiritanachot W, Phinyo N, Konwitthayasin P, et al.

13 Enhancing survival outcomes in developing emergency medical service system: Continuous

14 quality improvement for out-of-hospital cardiac arrest. Resusc Plus. 2024;19:100683. doi:

15 10.1016/j.resplu.2024.100683

16 120. Vaillancourt C, Charette M, Lanos C, Godbout J, Buhariwalla H, Dale-Tam J, Nemnom

17 MJ, Brehaut J, Wells G, Stiell I. Multi-phase implementation of automated external defibrillator

18 use by nurses during in-hospital cardiac arrest and its impact on survival. Resuscitation.

19 2024;197:110148. doi: 10.1016/j.resuscitation.2024.110148

20 121. Adabag S, Hodgson L, Garcia S, Anand V, Frascone R, Conterato M, Lick C, Wesley K,

21 Mahoney B, Yannopoulos D. Outcomes of sudden cardiac arrest in a state-wide integrated

22 resuscitation program: Results from the Minnesota Resuscitation Consortium. Resuscitation.

23 2017;110:95-100. doi: 10.1016/j.resuscitation.2016.10.029

24 122. Anderson ML, Nichol G, Dai D, Chan PS, Thomas L, Al-Khatib SM, Berg RA, Bradley

25 SM, Peterson ED. Association between hospital process composite performance and patient
© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 104

1 outcomes after in-hospital cardiac arrest care. JAMA Cardiology. 2016;1:37-45. doi:

2 10.1001/jamacardio.2015.0275

3 123. Bradley SM, Huszti E, Warren SA, Merchant RM, Sayre MR, Nichol G. Duration of

4 hospital participation in Get With the Guidelines-Resuscitation and survival of in-hospital

5 cardiac arrest. Resuscitation. 2012;83:1349-1357. doi: 10.1016/j.resuscitation.2012.03.014

6 124. Couper K, Kimani PK, Abella BS, Chilwan M, Cooke MW, Davies RP, Field RA, Gao F,

7 Quinton S, Stallard N, et al. The system-wide effect of real-time audiovisual feedback and

8 postevent debriefing for in-hospital cardiac arrest: The cardiopulmonary resuscitation quality

9 improvement initiative. Critical Care Medicine. 2015;43:2321-2331. doi:

10 10.1097/CCM.0000000000001202

11 125. Davis DP, Graham PG, Husa RD, Lawrence B, Minokadeh A, Altieri K, Sell RE. A

12 performance improvement-based resuscitation programme reduces arrest incidence and increases

13 survival from in-hospital cardiac arrest. Resuscitation. 2015;92:63-69. doi:

14 10.1016/j.resuscitation.2015.04.008

15 126. Del Rios M, Weber J, Pugach O, Nguyen H, Campbell T, Islam S, Stein Spencer L,

16 Markul E, Bunney EB, Vanden Hoek T. Large urban center improves out-of-hospital cardiac

17 arrest survival. Resuscitation. 2019;139:234-240. doi: 10.1016/j.resuscitation.2019.04.019

18 127. Ewy GA, Sanders AB. Alternative Approach to Improving Survival of Patients With Out-

19 of-Hospital Primary Cardiac Arrest. Journal of the American College of Cardiology.

20 2013;61:113-118. doi: 10.1016/j.jacc.2012.06.064

21 128. Grunau B, Kawano T, Dick W, Straight R, Connolly H, Schlamp R, Scheuermeyer FX,

22 Fordyce CB, Barbic D, Tallon J, et al. Trends in care processes and survival following

23 prehospital resuscitation improvement initiatives for out-of-hospital cardiac arrest in British

24 Columbia, 2006-2016. Resuscitation. 2018;125:118-125. doi:

25 10.1016/j.resuscitation.2018.01.049
© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 105

1 129. Hopkins CL, Burk C, Moser S, Meersman J, Baldwin C, Youngquist ST. Implementation

2 of pit crew approach and cardiopulmonary resuscitation metrics for out-of-hospital cardiac arrest

3 improves patient survival and neurological outcome. Journal of the American Heart Association.

4 2016;5 doi: 10.1161/JAHA.115.002892

5 130. Hostler D, Everson-Stewart S, Rea TD, Stiell IG, Callaway CW, Kudenchuk PJ, Sears

6 GK, Emerson SS, Nichol G. Effect of real-time feedback during cardiopulmonary resuscitation

7 outside hospital: prospective, cluster-randomised trial. Bmj. 2011;342:d512-d512. doi:

8 10.1136/bmj.d512

9 131. Hubner P, Lobmeyr E, Wallmüller C, Poppe M, Datler P, Keferböck M, Zeiner S,

10 Nürnberger A, Zajicek A, Laggner A, et al. Improvements in the quality of advanced life support

11 and patient outcome after implementation of a standardized real-life post-resuscitation feedback

12 system. Resuscitation. 2017;120:38-44. doi: 10.1016/j.resuscitation.2017.08.235

13 132. Hunt EA, Jeffers J, McNamara L, Newton H, Ford K, Bernier M, Tucker EW, Jones K,

14 O’Brien C, Dodge P, et al. Improved cardiopulmonary resuscitation performance with CODE

15 ACES2: A resuscitation quality bundle. Journal of the American Heart Association. 2018;7 doi:

16 10.1161/JAHA.118.009860

17 133. Hwang WS, Park JS, Kim SJ, Hong YS, Moon SW, Lee SW. A system-wide approach

18 from the community to the hospital for improving neurologic outcomes in out-of-hospital cardiac

19 arrest patients. Eur J Emerg Med. 2017;24:87-95. doi: 10.1097/mej.0000000000000313

20 134. Kim YT, Shin SD, Hong SO, Ahn KO, Ro YS, Song KJ, Hong KJ. Effect of national

21 implementation of utstein recommendation from the global resuscitation alliance on ten steps to

22 improve outcomes from Out-of-Hospital cardiac arrest: A ten-year observational study in Korea.

23 BMJ Open. 2017;7 doi: 10.1136/bmjopen-2017-016925

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 106

1 135. Knight LJ, Gabhart JM, Earnest KS, Leong KM, Anglemyer A, Franzon D. Improving

2 code team performance and survival outcomes: implementation of pediatric resuscitation team

3 training. Crit Care Med. 2014;42:243-251. doi: 10.1097/CCM.0b013e3182a6439d

4 136. Lyon RM, Clarke S, Milligan D, Clegg GR. Resuscitation feedback and targeted

5 education improves quality of pre-hospital resuscitation in Scotland. Resuscitation. 2012;83:70-

6 75. doi: 10.1016/j.resuscitation.2011.07.016

7 137. Nehme Z, Bernard S, Cameron P, Bray JE, Meredith IT, Lijovic M, Smith K. Using a

8 Cardiac Arrest Registry to Measure the Quality of Emergency Medical Service Care.

9 Circulation: Cardiovascular Quality and Outcomes. 2015;8:56-66. doi:

10 10.1161/circoutcomes.114.001185

11 138. Olasveengen TM, Tomlinson A-E, Wik L, Sunde K, Steen PA, Myklebust H, Kramer-

12 Johansen J. A Failed Attempt to Improve Quality of Out-of-Hospital CPR Through Performance

13 Evaluation. Prehospital Emergency Care. 2009;11:427-433. doi: 10.1080/10903120701536628

14 139. Park JH, Shin SD, Ro YS, Song KJ, Hong KJ, Kim TH, Lee EJ, Kong SY.

15 Implementation of a bundle of Utstein cardiopulmonary resuscitation programs to improve

16 survival outcomes after out-of-hospital cardiac arrest in a metropolis: A before and after study.

17 Resuscitation. 2018;130:124-132. doi: 10.1016/j.resuscitation.2018.07.019

18 140. Pearson DA, Darrell Nelson R, Monk L, Tyson C, Jollis JG, Granger CB, Corbett C,

19 Garvey L, Runyon MS. Comparison of team-focused CPR vs standard CPR in resuscitation from

20 out-of-hospital cardiac arrest: Results from a statewide quality improvement initiative.

21 Resuscitation. 2016;105:165-172. doi: 10.1016/j.resuscitation.2016.04.008

22 141. Spitzer CR, Evans K, Buehler J, Ali NA, Besecker BY. Code blue pit crew model: A

23 novel approach to in-hospital cardiac arrest resuscitation. Resuscitation. 2019;143:158-164. doi:

24 10.1016/j.resuscitation.2019.06.290

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 107

1 142. Sporer K, Jacobs M, Derevin L, Duval S, Pointer J. Continuous Quality Improvement

2 Efforts Increase Survival with Favorable Neurologic Outcome after Out-of-hospital Cardiac

3 Arrest. Prehosp Emerg Care. 2017;21:1-6. doi: 10.1080/10903127.2016.1218980

4 143. Stub D, Schmicker RH, Anderson ML, Callaway CW, Daya MR, Sayre MR, Elmer J,

5 Grunau BE, Aufderheide TP, Lin S, et al. Association between hospital post-resuscitative

6 performance and clinical outcomes after out-of-hospital cardiac arrest. Resuscitation.

7 2015;92:45-52. doi: 10.1016/j.resuscitation.2015.04.015

8 144. van Diepen S, Girotra S, Abella BS, Becker LB, Bobrow BJ, Chan PS, Fahrenbruch C,

9 Granger CB, Jollis JG, McNally B, et al. Multistate 5-Year Initiative to Improve Care for Out-of-

10 Hospital Cardiac Arrest: Primary Results From the HeartRescue Project. J Am Heart Assoc.

11 2017;6 doi: 10.1161/JAHA.117.005716

12 145. Weston BW, Jasti J, Lerner EB, Szabo A, Aufderheide TP, Colella MR. Does an

13 individualized feedback mechanism improve quality of out-of-hospital CPR? Resuscitation.

14 2017;113:96-100. doi: 10.1016/j.resuscitation.2017.02.004

15 146. Ko YC, Hsieh MJ, Ma MH, Bigham B, Bhanji F, Greif R. The effect of system

16 performance improvement on patients with cardiac arrest: A systematic review. Resuscitation.

17 2020;157:156-165. doi: 10.1016/j.resuscitation.2020.10.024

18 147. Barnard EBG, Sandbach DD, Nicholls TL, Wilson AW, Ercole A. Prehospital

19 determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac

20 arrest. Emergency Medicine Journal. 2019;36:333. doi: 10.1136/emermed-2018-208165

21 148. Bjornsson HM, Bjornsdottir GG, Olafsdottir H, Mogensen BA, Mogensen B,

22 Thorgeirsson G. Effect of replacing ambulance physicians with paramedics on outcome of

23 resuscitation for prehospital cardiac arrest. European Journal of Emergency Medicine. 2021;28

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 108

1 149. Dickinson ET, Schneider RM, Verdile VP. The impact of prehospital physicians on out-

2 of-hospital nonasystolic cardiac arrest. Prehospital Emergency Care. 1997;1:132-135. doi:

3 10.1080/10903129708958805

4 150. Goto Y, Funada A, Goto Y. Impact of prehospital physician-led cardiopulmonary

5 resuscitation on neurologically intact survival after out-of-hospital cardiac arrest: A nationwide

6 population-based observational study. Resuscitation. 2019;136:38-46. doi:

7 https://doi.org/10.1016/j.resuscitation.2018.11.014

8 151. Goto Y, Maeda T, Nakatsu-Goto Y. Neurological outcomes in patients transported to

9 hospital without a prehospital return of spontaneous circulation after cardiac arrest. Critical

10 Care. 2013;17:R274. doi: 10.1186/cc13121

11 152. Hatakeyama T, Kiguchi T, Sera T, Nachi S, Ochiai K, Kitamura T, Ogura S, Otomo Y,

12 Iwami T. Physician’s presence in pre-hospital setting improves one-month favorable

13 neurological survival after out-of-hospital cardiac arrest: A propensity score matching analysis of

14 the JAAM-OHCA Registry. Resuscitation. 2021;167:38-46. doi:

15 https://doi.org/10.1016/j.resuscitation.2021.08.010

16 153. Nakajima S, Matsuyama T, Watanabe M, Komukai S, Kandori K, Okada A, Okada Y,

17 Kitamura T, Ohta B. Prehospital Physician Presence for Patients With out-of-Hospital Cardiac

18 Arrest Undergoing Extracorporeal Cardiopulmonary Resuscitation: A Multicenter,

19 Retrospective, Nationwide Observational Study in Japan (The JAAM–OHCA registry). Current

20 Problems in Cardiology. 2023;48:101600. doi: https://doi.org/10.1016/j.cpcardiol.2023.101600

21 154. Boulton AJ, Edwards R, Gadie A, Clayton D, Leech C, Smyth MA, Brown T, Yeung J.

22 Prehospital critical care beyond advanced life support for out-of-hospital cardiac arrest: A

23 systematic review. Resuscitation Plus. 2025;21:100803. doi:

24 https://doi.org/10.1016/j.resplu.2024.100803

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 109

1 155. Boulton AJ ER, Gadie A, Clayton D, Smyth MA, Brown T, Yeung J on behalf of the

2 International Liaison Committee on Resuscitation EIT Life Support Task Force. Prehospital

3 critical care for out-of-hospital cardiac arrest: EIT 6313 TFSR. 2024. Updated. Accessed 14

4 January. https://costr.ilcor.org/document/prehospital-critical-care-for-out-of-hospital-cardiac-

5 arrest-eit-tfsr

6 156. Bujak K, Nadolny K, Trzeciak P, Gałązkowski R, Ładny J, Gąsior M. Does the presence

7 of physician-staffed emergency medical services improve the prognosis in out-of-hospital

8 cardiac arrest? A propensity score matching analysis. Polish Heart Journal (Kardiologia

9 Polska). 2022;80:685-692. doi: {}

10 157. Obara T, Yumoto T, Nojima T, Hongo T, Tsukahara K, Matsumoto N, Yorifuji T, Nakao

11 A, Elmer J, Naito H. Association of Prehospital Physician Presence During Pediatric Out-of-

12 Hospital Cardiac Arrest With Neurologic Outcomes. Pediatric Critical Care Medicine. 2023;24

13 158. Olasveengen TM, Lund-Kordahl I, Steen PA, Sunde K. Out-of hospital advanced life

14 support with or without a physician: Effects on quality of CPR and outcome. Resuscitation.

15 2009;80:1248-1252. doi: https://doi.org/10.1016/j.resuscitation.2009.07.018

16 159. Pemberton K, Franklin RC, Bosley E, Watt K. Pre-hospital predictors of long-term

17 survival from out-of-hospital cardiac arrest. Australasian Emergency Care. 2023;26:184-192.

18 doi: https://doi.org/10.1016/j.auec.2022.10.006

19 160. Sato N, Matsuyama T, Akazawa K, Nakazawa K, Hirose Y. Benefits of adding a

20 physician-staffed ambulance to bystander-witnessed out-of-hospital cardiac arrest: a community-

21 based, observational study in Niigata, Japan. BMJ Open. 2019;9:e032967. doi:

22 10.1136/bmjopen-2019-032967

23 161. von Vopelius-Feldt J, Coulter A, Benger J. The impact of a pre-hospital critical care team

24 on survival from out-of-hospital cardiac arrest. Resuscitation. 2015;96:290-295. doi:

25 https://doi.org/10.1016/j.resuscitation.2015.08.020
© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 110

1 162. von Vopelius-Feldt J, Morris RW, Benger J. The effect of prehospital critical care on

2 survival following out-of-hospital cardiac arrest: A prospective observational study.

3 Resuscitation. 2020;146:178-187. doi: https://doi.org/10.1016/j.resuscitation.2019.08.008

4 163. Yasunaga H, Horiguchi H, Tanabe S, Akahane M, Ogawa T, Koike S, Imamura T.

5 Collaborative effects of bystander-initiated cardiopulmonary resuscitation and prehospital

6 advanced cardiac life support by physicians on survival of out-of-hospital cardiac arrest: a

7 nationwide population-based observational study. Critical Care. 2010;14:R199. doi:

8 10.1186/cc9319

9 164. Cheng A, Brown LL, Duff JP, Davidson J, Overly F, Tofil NM, Peterson DT, White ML,

10 Bhanji F, Bank I, et al. Improving Cardiopulmonary Resuscitation With a CPR Feedback Device

11 and Refresher Simulations (CPR CARES Study): A Randomized Clinical Trial. JAMA

12 Pediatrics. 2015;169:137-144. doi: 10.1001/jamapediatrics.2014.2616

13 165. Cheng A, Duff JP, Kessler D, Tofil NM, Davidson J, Lin Y, Chatfield J, Brown LL, Hunt

14 EA. Optimizing CPR performance with CPR coaching for pediatric cardiac arrest: A randomized

15 simulation-based clinical trial. Resuscitation. 2018;132:33-40. doi:

16 10.1016/j.resuscitation.2018.08.021

17 166. Hunt EA, Jeffers J, McNamara L, Newton H, Ford K, Bernier M, Tucker EW, Jones K,

18 O'Brien C, Dodge P, et al. Improved Cardiopulmonary Resuscitation Performance With CODE

19 ACES(2): A Resuscitation Quality Bundle. J Am Heart Assoc. 2018;7:e009860. doi:

20 10.1161/jaha.118.009860

21 167. Lauridsen KG BE, Nabecker S, Lin Y, Donoghue A, Duff J, Cheng A on behalf of the

22 International Liaison Committee on Resuscitation Education, Implementation, and Teams Task

23 Force. . CPR Coaching during adult and pediatric cardiac arrest: EIT 6314 TF SR. 2024.

24 Updated. Accessed 14 January. https://costr.ilcor.org/document/cpr-coaching-during-adult-and-

25 pediatric-cardiac-arrest-eit-6314-tf-sr
© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 111

1 168. Badke CM, Friedman ML, Harris ZL, McCarthy-Kowols M, Tran S. Impact of an

2 untrained CPR Coach in simulated pediatric cardiopulmonary arrest: A pilot study. Resuscitation

3 plus. 2020;4:100035-100035. doi: 10.1016/j.resplu.2020.100035

4 169. Buyck M, Shayan Y, Gravel J, Hunt EA, Cheng A, Levy A. CPR coaching during cardiac

5 arrest improves adherence to PALS guidelines: a prospective, simulation-based trial.

6 Resuscitation Plus. 2021;5:100058-100058. doi: https://doi.org/10.1016/j.resplu.2020.100058

7 170. Infinger AE, Vandeventer S, Studnek JR. Introduction of performance coaching during

8 cardiopulmonary resuscitation improves compression depth and time to defibrillation in out-of-

9 hospital cardiac arrest. Resuscitation. 2014;85:1752-1758. doi:

10 10.1016/j.resuscitation.2014.09.016

11 171. Jones KA, Jani KH, Jones GW, Nye ML, Duff JP, Cheng A, Lin Y, Davidson J, Chatfield

12 J, Tofil N, et al. Using natural language processing to compare task-specific verbal cues in

13 coached versus noncoached cardiac arrest teams during simulated pediatrics resuscitation. AEM

14 education and training. 2021;5:e10707-e10707. doi: 10.1002/aet2.10707

15 172. Kessler DO, Grabinski Z, Shepard LN, Jones SI, Lin Y, Duff J, Tofil NM, Cheng A.

16 Influence of Cardiopulmonary Resuscitation Coaching on Interruptions in Chest Compressions

17 During Simulated Pediatric Cardiac Arrest. Pediatric Critical Care Medicine. 2021;22:345-353.

18 doi: 10.1097/PCC.0000000000002623

19 173. Tofil NM, Cheng A, Lin Y, Davidson J, Hunt EA, Chatfield J, MacKinnon L, Kessler D.

20 Effect of a Cardiopulmonary Resuscitation Coach on Workload During Pediatric

21 Cardiopulmonary Arrest: A Multicenter, Simulation-Based Study. Pediatric critical care

22 medicine : a journal of the Society of Critical Care Medicine and the World Federation of

23 Pediatric Intensive and Critical Care Societies. 2020;21:e274-e281. doi:

24 10.1097/PCC.0000000000002275

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 112

1 174. Lauridsen KG, Krogh K, Müller SD, Schmidt AS, Nadkarni VM, Berg RA, Bach L, Dodt

2 KK, Maack TC, Møller DS, et al. Barriers and facilitators for in-hospital resuscitation: A

3 prospective clinical study. Resuscitation. 2021;164:70-78. doi:

4 10.1016/j.resuscitation.2021.05.007

5 175. Leary M, Schweickert W, Neefe S, Tsypenyuk B, Falk SA, Holena DN. Improving

6 Providers' Role Definitions to Decrease Overcrowding and Improve In-Hospital Cardiac Arrest

7 Response. American journal of critical care : an official publication, American Association of

8 Critical-Care Nurses. 2016;25:335-339. doi: 10.4037/ajcc2016195

9 176. Pallas JD, Smiles JP, Zhang M. Cardiac Arrest Nurse Leadership (CANLEAD) trial: a

10 simulation-based randomised controlled trial implementation of a new cardiac arrest role to

11 facilitate cognitive offload for medical team leaders. Emergency medicine journal : EMJ.

12 2021;38:572-578. doi: 10.1136/emermed-2019-209298

13 177. Pfeiffer S, Lauridsen KG, Wenger J, Hunt EA, Haskell S, Atkins DL, Duval-Arnould JM,

14 Knight LJ, Cheng A, Gilfoyle E, et al. Code Team Structure and Training in the Pediatric

15 Resuscitation Quality International Collaborative. Pediatric Emergency Care. 2021;37:E431-

16 E435. doi: 10.1097/PEC.0000000000001748 LK -

17 https://soeg.kb.dk/discovery/openurl?institution=45KBDK_KGL&vid=45KBDK_KGL:KGL&?

18 sid=Elsevier&sid=EMBASE&issn=15351815&id=doi:10.1097%2FPEC.0000000000001748&at

19 itle=Code+Team+Structure+and+Training+in+the+Pediatric+Resuscitation+Quality+Internation

20 al+Collaborative&stitle=Pediatr.+Emerg.+Care&title=Pediatric+Emergency+Care&volume=37

21 &issue=8&spage=E431&epage=E435&aulast=Pfeiffer&aufirst=Stephen&auinit=S.&aufull=Pfei

22 ffer+S.&coden=PECAE&isbn=&pages=E431-E435&date=202

23 178. Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E,

24 Hsieh MJ, Iwami T, et al. Education, Implementation, and Teams: 2020 International Consensus

25 on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 113

1 Recommendations. Resuscitation. 2020;156:A188-A239. doi:

2 10.1016/j.resuscitation.2020.09.014

3 179. Smyth MA, Gunson I, Coppola A, Johnson S, Greif R, Lauridsen KG, Taylor-Philips S,

4 Perkins GD. Termination of Resuscitation Rules and Survival Among Patients With Out-of-

5 Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis. JAMA network open.

6 2024;7:e2420040-e2420040. doi: 10.1001/jamanetworkopen.2024.20040

7 180. Lauridsen KG AK, Greif R - on behalf of the International Liaison Committee on

8 Resuscitation Education, Implementation and Teams Task Force. Out-of-hospital cardiac arrest

9 termination of resuscitation (TOR) rules - Systematic Review of diagnostic accuracy: EIT 6303

10 (EIT642) TF SR. 2025. Updated. Accessed 14 January. https://costr.ilcor.org/document/out-of-

11 hospital-cardiac-arrest-termination-of-resuscitation-tor-rules-systematic-review-of-diagnostic-

12 accuracy-eit-6303-eit642-tf-sr

13 181. Glober NK, Lardaro T, Christopher S, Tainter CR, Weinstein E, Kim D. Validation of the

14 NUE Rule to Predict Futile Resuscitation of Out-of-Hospital Cardiac Arrest. Prehospital

15 Emergency Care. 2021;25:706-711. doi: 10.1080/10903127.2020.1831666

16 182. Harris MI, Crowe RP, Anders J, D'Acunto S, Adelgais KM, Fishe J. Applying a set of

17 termination of resuscitation criteria to paediatric out-of-hospital cardiac arrest. Resuscitation.

18 2021;169:175-181. doi: 10.1016/j.resuscitation.2021.09.015

19 183. House M, Gray J, McMeekin P. Reducing the futile transportation of out-of-hospital

20 cardiac arrests: a retrospective validation. British paramedic journal. 2018;3:1-6. doi:

21 10.29045/14784726.2018.09.3.2.1

22 184. Hreinsson JP, Thorvaldsson AP, Magnusson V, Fridriksson BT, Libungan BG, Karason

23 S. Identifying out-of-hospital cardiac arrest patients with no chance of survival: An independent

24 validation of prediction rules. Resuscitation. 2020;146:19-25. doi:

25 10.1016/j.resuscitation.2019.11.001
© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 114

1 185. Hsu S-H, Sun J-T, Huang EP-C, Nishiuchi T, Song KJ, Leong B, Rahman NHNA,

2 Khruekarnchana P, Naroo GY, Hsieh M-J, et al. The predictive performance of current

3 termination-of-resuscitation rules in patients following out-of-hospital cardiac arrest in Asian

4 countries: A cross-sectional multicentre study. PloS one. 2022;17:e0270986-e0270986. doi:

5 10.1371/journal.pone.0270986

6 186. Jabre P, Bougouin W, Dumas F, Carli P, Antoine C, Jacob L, Dahan B, Beganton F,

7 Empana J-P, Marijon E, et al. Early Identification of Patients With Out-of-Hospital Cardiac

8 Arrest With No Chance of Survival and Consideration for Organ Donation. Annals of internal

9 medicine. 2016;165:770-778. doi: 10.7326/M16-0402

10 187. Lin Y-Y, Lai Y-Y, Chang H-C, Lu C-H, Chiu P-W, Kuo Y-S, Huang S-P, Chang Y-H,

11 Lin C-H. Predictive performances of ALS and BLS termination of resuscitation rules in out-of-

12 hospital cardiac arrest for different resuscitation protocols. BMC emergency medicine.

13 2022;22:53-53. doi: 10.1186/s12873-022-00606-8

14 188. Matsui S, Kitamura T, Kurosawa H, Kiyohara K, Tanaka R, Sobue T, Nitta M.

15 Application of adult prehospital resuscitation rules to pediatric out of hospital cardiac arrest.

16 Resuscitation. 2023;184:109684-109684. doi: 10.1016/j.resuscitation.2022.109684

17 189. Park SY, Lim D, Ryu JH, Kim YH, Choi B, Kim SH. Modification of termination of

18 resuscitation rule with compression time interval in South Korea. Scientific reports.

19 2023;13:1403-1403. doi: 10.1038/s41598-023-28789-5

20 190. Smits RLA, Sødergren STF, van Schuppen H, Folke F, Ringh M, Jonsson M, Motazedi

21 E, van Valkengoed IGM, Tan HL. Termination of resuscitation in out-of-hospital cardiac arrest

22 in women and men: An ESCAPE-NET project. Resuscitation. 2023;185:109721-109721. doi:

23 10.1016/j.resuscitation.2023.109721

24 191. Khan KA, Petrou S, Smyth M, Perkins GD, Slowther A-M, Brown T, Madan JJ.

25 Comparative cost-effectiveness of termination of resuscitation rules for patients transported in

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 115

1 cardiac arrest. Resuscitation. 2024;201:110274-110274. doi:

2 10.1016/j.resuscitation.2024.110274

3 192. Nazeha N, Mao DR, Hong D, Shahidah N, Chua ISY, Ng YY, Leong BSH, Tiah L, Chia

4 MYC, Ng WM, et al. Cost-effectiveness analysis of a 'Termination of Resuscitation' protocol for

5 the management of out-of-hospital cardiac arrest. Resuscitation. 2024;202:110323-110323. doi:

6 10.1016/j.resuscitation.2024.110323

7 193. Shetty P, Ren Y, Dillon D, McLeod A, Nishijima D, Taylor SL. Derivation of a clinical

8 decision rule for termination of resuscitation in non-traumatic pediatric out-of-hospital cardiac

9 arrest. Resuscitation. 2024;204:110400-110400. doi: 10.1016/j.resuscitation.2024.110400

10 194. Bobrow BJ, Spaite DW, Berg RA, Stolz U, Sanders AB, Kern KB, Vadeboncoeur TF,

11 Clark LL, Gallagher JV, Stapczynski JS, et al. Chest compression-only CPR by lay rescuers and

12 survival from out-of-hospital cardiac arrest. Jama. 2010;304:1447-1454. doi:

13 10.1001/jama.2010.1392

14 195. Kitamura T, Kiyohara K, Sakai T, Matsuyama T, Hatakeyama T, Shimamoto T, Izawa J,

15 Fujii T, Nishiyama C, Kawamura T, et al. Public-Access Defibrillation and Out-of-Hospital

16 Cardiac Arrest in Japan. N Engl J Med. 2016;375:1649-1659. doi: 10.1056/NEJMsa1600011

17 196. Rea TD, Eisenberg MS, Culley LL, Becker L. Dispatcher-assisted cardiopulmonary

18 resuscitation and survival in cardiac arrest. Circulation. 2001;104:2513-2516. doi:

19 10.1161/hc4601.099468

20 197. Ringh M, Rosenqvist M, Hollenberg J, Jonsson M, Fredman D, Nordberg P, Järnbert-

21 Pettersson H, Hasselqvist-Ax I, Riva G, Svensson L. Mobile-phone dispatch of laypersons for

22 CPR in out-of-hospital cardiac arrest. N Engl J Med. 2015;372:2316-2325. doi:

23 10.1056/NEJMoa1406038

24 198. Matsuyama T SA, Zace D, Olaussen A, Lockey A, Greif R - on behalf of the

25 International Liaison Committee on Resuscitation Education, Implementation and Teams Task

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 116

1 Force. Community Initiatives to promote BLS implementation: EIT 6306 TF ScR. 2024.

2 Updated. Accessed 14 January. https://costr.ilcor.org/document/community-initiatives-to-

3 promote-bls-implementation-eit-6306-tf-scr

4 199. Becker L, Vath J, Eisenberg M, Meischke H. The impact of television public service

5 announcements on the rate of bystander cpr. Prehospital Emergency Care. 1999;3:353-356. doi:

6 10.1080/10903129908958968

7 200. Bergamo C, Bui QM, Gonzales L, Hinchey P, Sasson C, Cabanas JG. TAKE10: A

8 community approach to teaching compression-only CPR to high-risk zip codes. Resuscitation.

9 2016;102:75-79. doi: https://doi.org/10.1016/j.resuscitation.2016.02.019

10 201. Boland LL, Formanek MB, Harkins KK, Frazee CL, Kamrud JW, Stevens AC, Lick CJ,

11 Yannopoulos D. Minnesota Heart Safe Communities: Are community-based initiatives

12 increasing pre-ambulance CPR and AED use? Resuscitation. 2017;119:33-36. doi:

13 https://doi.org/10.1016/j.resuscitation.2017.07.031

14 202. Cone DC, Burns K, Maciejewski K, Dziura J, McNally B, Vellano K. Sudden cardiac

15 arrest survival in HEARTSafe communities. Resuscitation. 2020;146:13-18. doi:

16 https://doi.org/10.1016/j.resuscitation.2019.10.029

17 203. Del Rios M, Han J, Cano A, Ramirez V, Morales G, Campbell TL, Hoek TV. Pay It

18 Forward: High School Video-based Instruction Can Disseminate CPR Knowledge in Priority

19 Neighborhoods. West J Emerg Med. 2018;19:423-429. doi: 10.5811/westjem.2017.10.35108

20 204. Eisenberg M, Damon S, Mandel L, Tewodros A, Meischke H, Beaupied E, Bennett J,

21 Guildner C, Ewell C, Gordon M. CPR Instruction by Videotape: Results of a Community

22 Project. Annals of Emergency Medicine. 1995;25:198-202. doi: https://doi.org/10.1016/S0196-

23 0644(95)70324-1

24 205. Fordyce CB, Hansen CM, Kragholm K, Dupre ME, Jollis JG, Roettig ML, Becker LB,

25 Hansen SM, Hinohara TT, Corbett CC, et al. Association of Public Health Initiatives With
© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 117

1 Outcomes for Out-of-Hospital Cardiac Arrest at Home and in Public Locations. JAMA

2 Cardiology. 2017;2:1226-1235. doi: 10.1001/jamacardio.2017.3471

3 206. Isbye DL, Rasmussen LS, Ringsted C, Lippert FK. Disseminating Cardiopulmonary

4 Resuscitation Training by Distributing 35 000 Personal Manikins Among School Children.

5 Circulation. 2007;116:1380-1385. doi: doi:10.1161/CIRCULATIONAHA.107.710616

6 207. Kim JY, Cho H, Park J-H, Song J-H, Moon S, Lee H, Yang HJ, Tolles J, Bosson N,

7 Lewis RJ. Application of the “Plan-Do-Study-Act” Model to Improve Survival after Cardiac

8 Arrest in Korea: A Case Study. Prehospital and Disaster Medicine. 2020;35:46-54. doi:

9 10.1017/S1049023X19005156

10 208. Li S, Qin C, Zhang H, Maimaitiming M, Shi J, Feng Y, Huang K, Bi Y, Wang M, Zhou

11 Q, et al. Survival After Out-of-Hospital Cardiac Arrest Before and After Legislation for

12 Bystander CPR. JAMA Network Open. 2024;7:e247909-e247909. doi:

13 10.1001/jamanetworkopen.2024.7909

14 209. Lockey AS, Brown TP, Carlyon JD, Hawkes CA. Impact of community initiatives on

15 non-EMS bystander CPR rates in West Yorkshire between 2014 and 2018. Resuscitation Plus.

16 2021;6:100115. doi: https://doi.org/10.1016/j.resplu.2021.100115

17 210. Malta Hansen C, Kragholm K, Pearson D, Tyson C, Monk L, Myers B, Nelson D, Dupre

18 M, Fosbøl E, Jollis J, et al. Association of Bystander and First-Responder Intervention With

19 Survival After Out-of-Hospital Cardiac Arrest in North Carolina, 2010-2013. JAMA.

20 2015;314:255-264. doi: 10.1001/jama.2015.7938

21 211. Møller Nielsen A, Lou Isbye D, Knudsen Lippert F, Rasmussen LS. Engaging a whole

22 community in resuscitation. Resuscitation. 2012;83:1067-1071. doi:

23 10.1016/j.resuscitation.2012.04.012

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 118

1 212. Møller Nielsen A, Isbye DL, Lippert FK, Rasmussen LS. Persisting effect of community

2 approaches to resuscitation. Resuscitation. 2014;85:1450-1454. doi:

3 https://doi.org/10.1016/j.resuscitation.2014.08.019

4 213. Nishiyama C, Kitamura T, Sakai T, Murakami Y, Shimamoto T, Kawamura T,

5 Yonezawa T, Nakai S, Marukawa S, Sakamoto T, et al. Community‐Wide Dissemination of

6 Bystander Cardiopulmonary Resuscitation and Automated External Defibrillator Use Using a 45‐

7 Minute Chest Compression–Only Cardiopulmonary Resuscitation Training. Journal of the

8 American Heart Association. 2019;8:e009436. doi: doi:10.1161/JAHA.118.009436

9 214. Ro YS, Shin SD, Song KJ, Hong SO, Kim YT, Lee D-W, Cho S-I. Public awareness and

10 self-efficacy of cardiopulmonary resuscitation in communities and outcomes of out-of-hospital

11 cardiac arrest: A multi-level analysis. Resuscitation. 2016;102:17-24. doi:

12 https://doi.org/10.1016/j.resuscitation.2016.02.004

13 215. Ro YS, Song KJ, Shin SD, Hong KJ, Park JH, Kong SY, Cho S-I. Association between

14 county-level cardiopulmonary resuscitation training and changes in Survival Outcomes after out-

15 of-hospital cardiac arrest over 5 years: A multilevel analysis. Resuscitation. 2019;139:291-298.

16 doi: https://doi.org/10.1016/j.resuscitation.2019.01.012

17 216. Tay PJM, Pek PP, Fan Q, Ng YY, Leong BS, Gan HN, Mao DR, Chia MYC, Cheah SO,

18 Doctor N, et al. Effectiveness of a community based out-of-hospital cardiac arrest (OHCA)

19 interventional bundle: Results of a pilot study. Resuscitation. 2020;146:220-228. doi:

20 10.1016/j.resuscitation.2019.10.015

21 217. Uber A, Sadler RC, Chassee T, Reynolds JC. Does Non-Targeted Community CPR

22 Training Increase Bystander CPR Frequency? Prehospital Emergency Care. 2018;22:753-761.

23 doi: 10.1080/10903127.2018.1459978

24 218. Wissenberg M, Lippert FK, Folke F, Weeke P, Hansen CM, Christensen EF, Jans H,

25 Hansen PA, Lang-Jensen T, Olesen JB, et al. Association of National Initiatives to Improve
© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 119

1 Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After

2 Out-of-Hospital Cardiac Arrest. JAMA. 2013;310:1377-1384. doi: 10.1001/jama.2013.278483

3 219. Scapigliati A, Zace D, Matsuyama T, Pisapia L, Saviani M, Semeraro F, Ristagno G,

4 Laurenti P, Bray JE, Greif R, et al. Community Initiatives to Promote Basic Life Support

5 Implementation-A Scoping Review. J Clin Med. 2021;10 doi: 10.3390/jcm10245719

6 220. Considine J, Eastwood K, Webster H, Smyth M, Nation K, Greif R, Dainty K, Finn J,

7 Bray J. Family presence during adult resuscitation from cardiac arrest: A systematic review.

8 Resuscitation. 2022;180:11-23. doi: 10.1016/j.resuscitation.2022.08.021

9 221. Rahmawati I, Dilaruri A, Rosmalinda, Palupi LM, Widiani E. Factors associated with

10 nurses' perceptions and self-confidence in relation to family presence during resuscitation: a

11 cross-sectional study in Indonesia. Kontakt. 2021;23:256-262. doi: 10.32725/kont.2021.050

12 222. Saifan AR, Elshatarat RA, Saleh ZT, Elhefnawy KA, Elneblawi NH, Al-Sayaghi KM,

13 Masa'Deh R, Al-Yateem N, Abdel-Aziz HR, Saleh AM. Health professionals and family

14 members during cardiopulmonary resuscitation: A qualitative study on the experience of

15 witnessing resuscitation in Jordanian critical care units. Heart & Lung: The Journal of

16 Cardiopulmonary and Acute Care. 2023;62:101-107. doi: 10.1016/j.hrtlng.2023.06.020

17 223. Waldemar A, Strömberg A, Thylén I, Bremer A. Experiences of family-witnessed

18 cardiopulmonary resuscitation in hospital and its impact on life: An interview study with cardiac

19 arrest survivors and their family members. J Clin Nurs. 2023;32:7412-7424. doi:

20 10.1111/jocn.16788

21 224. Choi YR, Yi Y. Emergency nurses' perceptions of family presence during resuscitation:

22 A thematic analysis. J Korean Acad Fundam Nurs. 2023;30:519-529. doi:

23 10.7739/jkafn.2023.30.4.519

24 225. Powers K, Duncan JM, Renee Twibell K. Family support person role during

25 resuscitation: A qualitative exploration. J Clin Nurs. 2023;32:409-421. doi: 10.1111/jocn.16248

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 120

1 226. Risson H, Beovich B, Bowles KA. Paramedic interactions with significant others during

2 and after resuscitation and death of a patient. Australas Emerg Care. 2023;26:113-118. doi:

3 10.1016/j.auec.2022.08.007

4 227. Waldemar A, Bremer A, Strömberg A, Thylen I. Family presence during in-hospital

5 cardiopulmonary resuscitation: effects of an educational online intervention on self-confidence

6 and attitudes of healthcare professionals. Eur J Cardiovasc Nurs. 2024;23:486-496. doi:

7 10.1093/eurjcn/zvad111

8 228. Rubin MA, Svensson TL, Herling SF, Jabre P, Møller AM. Family presence during

9 resuscitation. Cochrane Database Syst Rev. 2023;5:CD013619. doi:

10 10.1002/14651858.CD013619.pub2

11 229. Rubin MA, Meulengracht SES, Frederiksen KAP, Thomsen T, Møller AM. The

12 healthcare professionals' perspectives and experiences with family presence during resuscitation:

13 A qualitative evidence synthesis. Acta Anaesthesiol Scand. 2024;68:101-121. doi:

14 10.1111/aas.14323

15 230. Boulton AJ, Abelairas-Gómez C, Olaussen A, Skrifvars MB, Greif R, Yeung J. Cardiac

16 arrest centres for patients with non-traumatic cardiac arrest: A systematic review. Resuscitation.

17 2024;203:110387. doi: 10.1016/j.resuscitation.2024.110387

18 231. Greif R, Bray JE, Djärv T, Drennan IR, Liley HG, Ng KC, Cheng A, Douma MJ,

19 Scholefield BR, Smyth M, et al. 2024 International Consensus on Cardiopulmonary

20 Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations:

21 Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support;

22 Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

23 Circulation. 2024;150:e580-e687. doi: 10.1161/cir.0000000000001288

24 232. Greif R, Bray JE, Djärv T, Drennan IR, Liley HG, Ng KC, Cheng A, Douma MJ,

25 Scholefield BR, Smyth M, et al. 2024 International Consensus on Cardiopulmonary

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 121

1 Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations:

2 Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support;

3 Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

4 Resuscitation. 2024;205:110414. doi: 10.1016/j.resuscitation.2024.110414

5 233. Dicker B, Garrett N, Howie G, Brett A, Scott T, Stewart R, Perkins GD, Smith T, Garcia

6 E, Todd VF. Association between direct transport to a cardiac arrest centre and survival

7 following out-of-hospital cardiac arrest: A propensity-matched Aotearoa New Zealand study.

8 Resusc Plus. 2024;18:100625. doi: 10.1016/j.resplu.2024.100625

9 234. Price J, Rees P, Lachowycz K, Starr Z, Pareek N, Keeble TR, Major R, Barnard EBG.

10 Increased survival for resuscitated Utstein-comparator group patients conveyed directly to

11 cardiac arrest centres in a large rural and suburban population in England. Resuscitation.

12 2024;201:110280. doi: 10.1016/j.resuscitation.2024.110280

13 235. Voß F, Thevathasan T, Scholz KH, Böttiger BW, Scheiber D, Kabiri P, Bernhard M,

14 Kienbaum P, Jung C, Westenfeld R, et al. Accredited cardiac arrest centers facilitate eCPR and

15 improve neurological outcome. Resuscitation. 2024;194:110069. doi:

16 10.1016/j.resuscitation.2023.110069

17 236. Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, Zideman D,

18 Bhanji F, Andersen LW, Avis SR, et al. 2021 International Consensus on Cardiopulmonary

19 Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations:

20 Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support;

21 Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working

22 Group. Resuscitation. 2021;169:229-311. doi: 10.1016/j.resuscitation.2021.10.040

23 237. Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, Zideman D,

24 Bhanji F, Andersen LW, Avis SR, et al. 2021 International Consensus on Cardiopulmonary

25 Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations:

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 122

1 Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support;

2 Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working

3 Group. Circulation. 2022;145:e645-e721. doi: 10.1161/cir.0000000000001017

4 238. Andelius L, Malta Hansen C, Jonsson M, Gerds TA, Rajan S, Torp-Pedersen C, Claesson

5 A, Lippert F, Tofte Gregers MC, Berglund E, et al. Smartphone-activated volunteer responders

6 and bystander defibrillation for out-of-hospital cardiac arrest in private homes and public

7 locations. Eur Heart J Acute Cardiovasc Care. 2023;12:87-95. doi: 10.1093/ehjacc/zuac165

8 239. Gregers M, Andelius L, Kjoelbye JS, Grabmayr AJ, Jakobsen LK, Christensen NB.

9 Association Between Number of Volunteer Responders and Interventions Before Ambulance

10 Arrival for Cardiac Arrest. J Am Coll Cardiol. 2023;81:668-680.

11 240. Jonsson M, Berglund E, Baldi E, Caputo ML, Auricchio A, Blom MT. Dispatch of

12 Volunteer Responders to Out-of-Hospital Cardiac Arrests. J Am Coll Cardiol. 2023;82:200-210.

13 241. Siddiqui FJ, Fook-Chong S, Shahidah N, Tan CK, Poh JY, Ng WM. Technology

14 activated community first responders in Singapore: Real-world care delivery & outcome trends.

15 Resusc Plus. 2023;16

16 242. Matsuyama T, Scapigliati A, Pellis T, Greif R, Iwami T. Willingness to perform

17 bystander cardiopulmonary resuscitation: A scoping review. Resusc Plus. 2020;4:100043. doi:

18 10.1016/j.resplu.2020.100043

19 243. Lauridsen KG, Djärv T, Breckwoldt J, Tjissen JA, Couper K, Greif R. Pre-arrest

20 prediction of survival following in-hospital cardiac arrest: A systematic review of diagnostic test

21 accuracy studies. Resuscitation. 2022;179:141-151. doi: 10.1016/j.resuscitation.2022.07.041

22 244. Alao DO, Hukan Y, Mohammed N, Moin K, Sudha RK, Cevik AA, Abu-Zidan FM.

23 Validating the GO-FAR score: predicting in-hospital cardiac arrest outcomes in the Middle East.

24 Int J Emerg Med. 2024;17:161. doi: 10.1186/s12245-024-00749-4

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 123

1 245. Chen L, Justice SA, Bader AM, Allen MB. Accuracy of frailty instruments in predicting

2 outcomes following perioperative cardiac arrest. Resuscitation. 2024;200:110244. doi:

3 10.1016/j.resuscitation.2024.110244

4 246. Kim B, Hong S-I, Kim Y-J, Cho YJ, Kim WY. Predicting the probability of good

5 neurological outcome after in-hospital cardiac arrest based on prearrest factors: validation of the

6 good outcome following attempted resuscitation 2 (GO-FAR 2) score. Intern Emerg Med.

7 2023;18:1807-1813. doi: 10.1007/s11739-023-03271-2

8 247. Ren Y, Ye L, Huang X, Gao X, Yin G, Wu X, Huang W, Cao L, Xu P. Validation the

9 clinical value of good outcome following attempted resuscitation scores in Chinese populations

10 in predicting the prognosis of in-hospital cardiac arrest. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue.

11 2022;34:1238-1242. doi: 10.3760/cma.j.cn121430-20220317-00256

12 248. Lauridsen KG, Baldi E, Smyth M, Perkins GD, Greif R. Clinical decision rules for

13 termination of resuscitation during in-hospital cardiac arrest: A systematic review of diagnostic

14 test accuracy studies. Resuscitation. 2021;158:23-29. doi: 10.1016/j.resuscitation.2020.10.036

15 249. Schnaubelt S, Monsieurs KG, Fijacko N, Veigl C, Al-Hilali Z, Atiq H, Bigham BL,

16 Eastwood K, Ko YC, Matsuyama T, et al. International facets of the 'chain of survival' for out-

17 of-hospital and in-hospital cardiac arrest - A scoping review. Resusc Plus. 2024;19:100689. doi:

18 10.1016/j.resplu.2024.100689

19 250. Cummins RO, Ornato JP, Thies WH, Pepe PE. Improving survival from sudden cardiac

20 arrest: the "chain of survival" concept. A statement for health professionals from the Advanced

21 Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American

22 Heart Association. Circulation. 1991;83:1832-1847. doi: 10.1161/01.cir.83.5.1832

23 251. Ceferino L, Merino Y, Pizarro S, Moya L, Ozturk B. Placing engineering in the

24 earthquake response and the survival chain. Nat Commun. 2024;15:4298. doi: 10.1038/s41467-

25 024-48624-3
© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 124

1 252. Dünser MW, Noitz M, Tschoellitsch T, Bruckner M, Brunner M, Eichler B, Erblich R,

2 Kalb S, Knöll M, Szasz J, et al. Emergency critical care: closing the gap between onset of critical

3 illness and intensive care unit admission. Wien Klin Wochenschr. 2024;136:651-661. doi:

4 10.1007/s00508-024-02374-w

5 253. Jouffroy R, Djossou F, Neviere R, Jaber S, Vivien B, Heming N, Gueye P. The chain of

6 survival and rehabilitation for sepsis: concepts and proposals for healthcare trajectory

7 optimization. Ann Intensive Care. 2024;14:58. doi: 10.1186/s13613-024-01282-6

8 254. Lam TJR, Liu Z, Tan BY-Q, Ng YY, Tan CK, Wong XY, Venketasubramanian N, Yeo

9 LLL, Ho AFW, Ong MEH. Prehospital stroke care in Singapore. Singapore Med J. 2024; doi:

10 10.4103/singaporemedj.smj-2023-066

11 255. Latif RK, Clifford SP, Baker JA, Lenhardt R, Haq MZ, Huang J, Farah I, Businger JR.

12 Traumatic hemorrhage and chain of survival. Scand J Trauma Resusc Emerg Med. 2023;31 doi:

13 10.1186/s13049-023-01088-8

14 256. Nadarajan GD, Ong MEH. The frame of survival for cardiopulmonary resuscitation in

15 lower-resource settings. Lancet Glob Health. 2024;12:e378-e379. doi: 10.1016/s2214-

16 109x(24)00005-6

17 257. Yilmaz S, Umac GA. Can the Chain of Survival start with environment safety for special

18 circumstances? Resusc Plus. 2024;19:100717. doi: 10.1016/j.resplu.2024.100717

19 258. Schnaubelt S MK, Fijacko N, Veigl C, Al-Hilali Z, Atiq H, Bigham BL, Eastwood K, Ko

20 YC, Matsuyama T, Athieno Odakha J, Olaussen A, Greif R; on behalf of the International

21 Liaison Committee on Resuscitation Education, Implementation and Teams Task Force (EIT)

22 Life Support Task Force. EIT 6311 - International facets of the ‘Chain of Survival’: EIT 6311;

23 TF ScR. 2023. Updated. Accessed 14 January. https://costr.ilcor.org/document/eit-6311-

24 international-facets-of-the-chain-of-survival-eit-6311-tf-scr

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 125

1 259. Lin Y LA, Grief R, Donoghue A, Matsuyama T, Farquharson B, Cortegiani A, Banerjee

2 A, Cheng A on behalf of the International Liaison Committee on Resuscitation Education,

3 Implementation and Teams Task Force (EIT). CPR feedback device used in resuscitation

4 training: EIT 6404 TF SR. 2024. Updated. Accessed 14 January.

5 https://costr.ilcor.org/document/cpr-feedback-device-used-in-resuscitation-training-eit-6404-tf-sr

6 260. Cortegiani A, Russotto V, Montalto F, Iozzo P, Meschis R, Pugliesi M, Mariano D,

7 Benenati V, Raineri SM, Gregoretti C, et al. Use of a Real-Time Training Software (Laerdal

8 QCPR(R)) Compared to Instructor-Based Feedback for High-Quality Chest Compressions

9 Acquisition in Secondary School Students: A Randomized Trial. PLoS One. 2017;12:e0169591.

10 doi: 10.1371/journal.pone.0169591

11 261. Kong SYJ, Song KJ, Shin SD, Ro YS, Myklebust H, Birkenes TS, Kim TH, Park KJ.

12 Effect of real-time feedback during cardiopulmonary resuscitation training on quality of

13 performances: A prospective cluster-randomized trial. Hong Kong Journal of Emergency

14 Medicine. 2020;27:187-196. doi: 10.1177/1024907918825016

15 262. Meng XY, You J, Dai LL, Yin XD, Xu JA, Wang JF. Efficacy of a Simplified Feedback

16 Trainer for High-Quality Chest Compression Training: A Randomized Controlled Simulation

17 Study. Front Public Health. 2021;9:675487. doi: 10.3389/fpubh.2021.675487

18 263. Allan KS, Wong N, Aves T, Dorian P. The benefits of a simplified method for CPR

19 training of medical professionals: a randomized controlled study. Resuscitation. 2013;84:1119-

20 1124. doi: 10.1016/j.resuscitation.2013.03.005

21 264. Ghaderi MS, Malekzadeh J, Mazloum S, Pourghaznein T. Comparison of real-time

22 feedback and debriefing by video recording on basic life support skill in nursing students. BMC

23 Med Educ. 2023;23:62. doi: 10.1186/s12909-022-03951-1

24 265. Gonzalez-Santano D, Fernandez-Garcia D, Silvestre-Medina E, Remuinan-Rodriguez B,

25 Rosell-Ortiz F, Gomez-Salgado J, Sobrido-Prieto M, Ordas-Campos B, Martinez-Isasi S.

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 126

1 Evaluation of Three Methods for CPR Training to Lifeguards: A Randomised Trial Using

2 Traditional Procedures and New Technologies. Medicina (Kaunas). 2020;56 doi:

3 10.3390/medicina56110577

4 266. Jang TC, Ryoo HW, Moon S, Ahn JY, Lee DE, Lee WK, Kwak SG, Kim JH. Long-term

5 benefits of chest compression-only cardiopulmonary resuscitation training using real-time visual

6 feedback manikins: a randomized simulation study. Clin Exp Emerg Med. 2020;7:206-212. doi:

7 10.15441/ceem.20.022

8 267. Jiang J, Yan J, Yao D, Xiao J, Chen R, Zhao Y, Jin X. Comparison of the effects of using

9 feedback devices for training or simulated cardiopulmonary arrest. J Cardiothorac Surg.

10 2024;19:159. doi: 10.1186/s13019-024-02669-z

11 268. Kardong-Edgren SE, Oermann MH, Odom-Maryon T, Ha Y. Comparison of two

12 instructional modalities for nursing student CPR skill acquisition. Resuscitation. 2010;81:1019-

13 1024. doi: 10.1016/j.resuscitation.2010.04.022

14 269. Katipoglu B, Madziala MA, Evrin T, Gawlowski P, Szarpak A, Dabrowska A, Bialka S,

15 Ladny JR, Szarpak L, Konert A, et al. How should we teach cardiopulmonary resuscitation?

16 Randomized multi-center study. Cardiol J. 2021;28:439-445. doi: 10.5603/CJ.a2019.0092

17 270. Labuschagne MJ, Arbee A, de Klerk C, de Vries E, de Waal T, Jhetam T, Piest B, Prins J,

18 Uys S, van Wyk R, et al. A comparison of the effectiveness of QCPR and conventional CPR

19 training in final-year medical students at a South African university. Afr J Emerg Med.

20 2022;12:106-111. doi: 10.1016/j.afjem.2022.02.001

21 271. Lee PH, Lai HY, Hsieh TC, Wu WR. Using real-time device-based visual feedback in

22 CPR recertification programs: A prospective randomised controlled study. Nurse Educ Today.

23 2023;124:105755. doi: 10.1016/j.nedt.2023.105755

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 127

1 272. Lin Y, Cheng A, Grant VJ, Currie GR, Hecker KG. Improving CPR quality with

2 distributed practice and real-time feedback in pediatric healthcare providers - A randomized

3 controlled trial. Resuscitation. 2018;130:6-12. doi: 10.1016/j.resuscitation.2018.06.025

4 273. Min MK, Yeom SR, Ryu JH, Kim YI, Park MR, Han SK, Lee SH, Park SW, Park SC.

5 Comparison between an instructor-led course and training using a voice advisory manikin in

6 initial cardiopulmonary resuscitation skill acquisition. Clin Exp Emerg Med. 2016;3:158-164.

7 doi: 10.15441/ceem.15.114

8 274. Pavo N, Goliasch G, Nierscher FJ, Stumpf D, Haugk M, Breckwoldt J, Ruetzler K, Greif

9 R, Fischer H. Short structured feedback training is equivalent to a mechanical feedback device in

10 two-rescuer BLS: a randomised simulation study. Scand J Trauma Resusc Emerg Med.

11 2016;24:70. doi: 10.1186/s13049-016-0265-9

12 275. Spooner BB, Fallaha JF, Kocierz L, Smith CM, Smith SC, Perkins GD. An evaluation of

13 objective feedback in basic life support (BLS) training. Resuscitation. 2007;73:417-424. doi:

14 10.1016/j.resuscitation.2006.10.017

15 276. Suet G, Blanie A, de Montblanc J, Roulleau P, Benhamou D. External Cardiac Massage

16 Training of Medical Students: A Randomized Comparison of Two Feedback Methods to

17 Standard Training. J Emerg Med. 2020;59:270-277. doi: 10.1016/j.jemermed.2020.04.058

18 277. Sutton RM, Niles D, Meaney PA, Aplenc R, French B, Abella BS, Lengetti EL, Berg

19 RA, Helfaer MA, Nadkarni V. "Booster" training: evaluation of instructor-led bedside

20 cardiopulmonary resuscitation skill training and automated corrective feedback to improve

21 cardiopulmonary resuscitation compliance of Pediatric Basic Life Support providers during

22 simulated cardiac arrest. Pediatr Crit Care Med. 2011;12:e116-121. doi:

23 10.1097/PCC.0b013e3181e91271

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 128

1 278. Wagner M, Bibl K, Hrdliczka E, Steinbauer P, Stiller M, Gropel P, Goeral K, Salzer-

2 Muhar U, Berger A, Schmolzer GM, et al. Effects of Feedback on Chest Compression Quality: A

3 Randomized Simulation Study. Pediatrics. 2019;143 doi: 10.1542/peds.2018-2441

4 279. Zhou XL, Wang J, Jin XQ, Zhao Y, Liu RL, Jiang C. Quality retention of chest

5 compression after repetitive practices with or without feedback devices: A randomized manikin

6 study. Am J Emerg Med. 2020;38:73-78. doi: 10.1016/j.ajem.2019.04.025

7 280. Jones A, Lin Y, Nettel-Aguirre A, Gilfoyle E, Cheng A. Visual assessment of CPR

8 quality during pediatric cardiac arrest: does point of view matter? Resuscitation. 2015;90:50-55.

9 doi: 10.1016/j.resuscitation.2015.01.036

10 281. Luque-López L, Molina-Mula J. Basic life support training for the adult lay population. A

11 systematic review. Signa Vitae. 2021;17:47-61. doi: 10.22514/sv.2021.026

12 282. Eastwood K NS, Breckwoldt J, Lockey A, Greif R, on behalf of the International Liaison

13 Commitee on Resuscitation Education, Implementation and Teams Task Force. Self-directed

14 digital-based versus instructor-led cardiopulmonary resuscitation education and training in adults

15 and children: EIT 6406 TF SR. 2024. Updated. Accessed 14 December.

16 https://costr.ilcor.org/document/self-directed-digital-based-versus-instructor-led-

17 cardiopulmonary-resuscitation-education-and-training-in-adults-and-children-eit-6406-tf-sr

18 283. Ali S, Athar M, Ahmed SM. A randomised controlled comparison of video versus

19 instructor-based compression only life support training. Indian Journal of Anaesthesia.

20 2019;63:188-193.

21 284. Assadi T, Mofidi M, Rezai M, Hafezimoghadam P, Maghsoudi M, Mosaddegh R,

22 Aghdam H. The comparison between two methods of basic life support instruction: video self-

23 instruction versus traditional method. Hong kong journal of emergency medicine. 2015;22:291-

24 296.

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 129

1 285. Beskind DL, Stolz U, Thiede R, Hoyer R, Burns W, Brown J, Ludgate M, Tiutan T,

2 Shane R, McMorrow D, et al. Viewing a brief chest-compression-only CPR video improves

3 bystander CPR performance and responsiveness in high school students: A cluster randomized

4 trial. Resuscitation. 2016;104:28-33.

5 286. Chung CH, Siu AY, Po LL, Lam CY, Wong PC. Comparing the effectiveness of video

6 self-instruction versus traditional classroom instruction targeted at cardiopulmonary resuscitation

7 skills for laypersons: a prospective randomised controlled trial. Hong Kong Medical Journal.

8 2010;16:165-170.

9 287. de Vries W, Turner NM, Monsieurs KG, Bierens JJ, Koster RW. Comparison of

10 instructor-led automated external defibrillation training and three alternative DVD-based training

11 methods. Resuscitation. 2010;81:1004-1009.

12 288. Doucet L, Lammens R, Hendrickx S, Dewolf P. App-based learning as an alternative for

13 instructors in teaching basic life support to school children: a randomized control trial. Acta

14 Clinica Belgica. 2019;74:317-325.

15 289. Dracup K, Moser DK, Doering LV, Guzy PM. Comparison of cardiopulmonary

16 resuscitation training methods for parents of infants at high risk for cardiopulmonary arrest.

17 Annals of Emergency Medicine. 1998;32:170-177.

18 290. Einspruch EL, Lynch B, Aufderheide TP, Nichol G, Becker L. Retention of CPR skills

19 learned in a traditional AHA Heartsaver course versus 30-min video self-training: a controlled

20 randomized study. Resuscitation. 2007;74:476-486.

21 291. Hassan EA, Elsaman SEA. The effect of simulation-based flipped classroom on

22 acquisition of cardiopulmonary resuscitation skills: A simulation-based randomized trial. Nurs

23 Crit Care. 2023;28:344-352. doi: 10.1111/nicc.12816

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 130

1 292. Hasselager A, Bohnstedt C, Ostergaard D, Sonderskov C, Bihrmann K, Tolsgaard MG,

2 Lauritsen TLB. Improving the cost-effectiveness of laypersons' paediatric basic life support

3 skills training: A randomised non-inferiority study. Resuscitation. 2019;138:28-35.

4 293. Heard DG, Andresen KH, Guthmiller KM, Lucas R, Heard KJ, Blewer AL, Abella BS,

5 Gent LM, Sasson C. Hands-Only Cardiopulmonary Resuscitation Education: A Comparison of

6 On-Screen With Compression Feedback, Classroom, and Video Education. Annals of Emergency

7 Medicine. 2019;73:599-609.

8 294. Kim HS, Kim HJ, Suh EE. The Effect of Patient-centered CPR Education for Family

9 Caregivers of Patients with Cardiovascular Diseases. Journal of Korean Academy of Nursing.

10 2016;46:463-474.

11 295. Krogh LQ, Bjornshave K, Vestergaard LD, Sharma MB, Rasmussen SE, Nielsen HV,

12 Thim T, Lofgren B. E-learning in pediatric basic life support: a randomized controlled non-

13 inferiority study. Resuscitation. 2015;90:7-12.

14 296. Liberman M, Golberg N, Mulder D, Sampalis J. Teaching cardiopulmonary resuscitation

15 to CEGEP students in Quebec--a pilot project. Resuscitation. 2000;47:249-257.

16 297. Lynch B, Einspruch EL, Nichol G, Becker LB, Aufderheide TP, Idris A. Effectiveness of

17 a 30-min CPR self-instruction program for lay responders: a controlled randomized study.

18 Resuscitation. 2005;67:31-43.

19 298. Lynch B, Einspruch EL. With or without an instructor, brief exposure to CPR training

20 produces significant attitude change. Resuscitation. 2010;81:568-575.

21 299. Lyness AL. Effectiveness of Interactive Video to Teach CPR Theory and Skills. 1985:1-

22 17.

23 300. Mancini ME, Cazzell M, Kardong-Edgren S, Cason CL. Improving workplace safety

24 training using a self-directed CPR-AED learning program. AAOHN Journal. 2009;57:159-167;

25 quiz 168.
© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 131

1 301. Marcus M, Abdullah AA, Nor J, Tuan Kamauzaman TH, Pang NTP. Comparing the

2 effectiveness of a group-directed video instruction versus instructor-led traditional classroom

3 instruction for learning cardiopulmonary resuscitation skills among first-year medical students:

4 A prospective randomized controlled study. GMS J Med Educ. 2022;39:Doc45. doi:

5 10.3205/zma001566

6 302. Meischke HW, Rea T, Eisenberg MS, Schaeffer SM, Kudenchuk P. Training seniors in

7 the operation of an automated external defibrillator: a randomized trial comparing two training

8 methods. Annals of Emergency Medicine. 2001;38:216-222.

9 303. Nas J, Thannhauser J, Vart P, Van Geuns RJ, Muijsers HEC, Mol JQ, Aarts GWA,

10 Konijnenberg LSF, Gommans DHF, Ahoud-Schoenmakers SGAM, et al. Effect of Face-to-Face

11 vs Virtual Reality Training on Cardiopulmonary Resuscitation Quality: A Randomized Clinical

12 Trial. JAMA Cardiology. 2020;5:328-335.

13 304. Pedersen TH, Kasper N, Roman H, Egloff M, Marx D, Abegglen S, Greif R. Self-

14 learning basic life support: A randomised controlled trial on learning conditions. Resuscitation.

15 2018;126:147-153.

16 305. Raaj N, Gopichandran L, Kumar BD, Devagourou V, Sanjeev B. A Comparative Study to

17 Evaluate the Effectiveness of Mannequin Demonstration Versus Video Teaching Programme on

18 Basic Life Support to the Family Members of Adult Patients at High Risk of Cardiopulmonary

19 Arrest. International Journal of Nursing Education. 2016;8:142-147. doi: 10.5958/0974-

20 9357.2016.00141.0

21 306. Reder S, Cummings P, Quan L. Comparison of three instructional methods for teaching

22 cardiopulmonary resuscitation and use of an automatic external defibrillator to high school

23 students. Resuscitation. 2006;69:443-453.

24 307. Roppolo LP, Heymann R, Pepe P, Wagner J, Commons B, Miller R, Allen E, Horne L,

25 Wainscott MP, Idris AH. A randomized controlled trial comparing traditional training in
© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 132

1 cardiopulmonary resuscitation (CPR) to self-directed CPR learning in first year medical students:

2 The two-person CPR study. Resuscitation. 2011;82:319-325.

3 308. Todd KH, Braslow A, Brennan RT, Lowery DW, Cox RJ, Lipscomb LE, Kellermann

4 AL. Randomized, controlled trial of video self-instruction versus traditional CPR training.

5 Annals of Emergency Medicine. 1998;31:364-369.

6 309. Todd KH, Heron SL, Thompson M, Dennis R, O'Connor J, Kellermann AL. Simple CPR:

7 A randomized, controlled trial of video self-instructional cardiopulmonary resuscitation training

8 in an African American church congregation. Annals of Emergency Medicine. 1999;34:730-737.

9 310. Van Raemdonck V, Monsieurs KG, Aerenhouts D, De Martelaer K. Teaching basic life

10 support: a prospective randomized study on low-cost training strategies in secondary schools.

11 European Journal of Emergency Medicine. 2014;21:284-290.

12 311. Yeung J, Kovic I, Vidacic M, Skilton E, Higgins D, Melody T, Lockey A. The school

13 Lifesavers study-A randomised controlled trial comparing the impact of Lifesaver only, face-to-

14 face training only, and Lifesaver with face-to-face training on CPR knowledge, skills and

15 attitudes in UK school children. Resuscitation. 2017;120:138-145.

16 312. !!! INVALID CITATION !!! 244,246-256,258-268,271,272;

17 313. Cortegiani A A-GC, Nabecker S, Olaussen A, Lauridsen KG, Lin J, Ippolito M, Sawyer

18 T, Lockey A, Cheng A, Greif R on behalf of the International Liaison Committee on

19 Resuscitation Education, Implementation and Teams Task Force (EIT) Life Support Task Force.

20 In situ (workplace-based) simulation-based cardiopulmonary resuscitation training: EIT 6407 TF

21 SR. 2024. Updated. Accessed 14 December. https://costr.ilcor.org/document/in-situ-workplace-

22 based-simulation-based-cardiopulmonary-resuscitation-training-eit-6407-tf-sr

23 314. Clarke SO, Julie IM, Yao AP, Bang H, Barton JD, Alsomali SM, Kiefer MV, Al Khulaif

24 AH, Aljahany M, Venugopal S, et al. Longitudinal exploration of in situ mock code events and

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 133

1 the performance of cardiac arrest skills. BMJ Simul Technol Enhanc Learn. 2019;5:29-33. doi:

2 10.1136/bmjstel-2017-000255

3 315. Herbers MD, Heaser JA. Implementing an in Situ Mock Code Quality Improvement

4 Program. Am J Crit Care. 2016;25:393-399. doi: 10.4037/ajcc2016583

5 316. Mei Q, Zhang T, Chai J, Liu A, Liu Y, Zhu H. Application of In Situ Scenario Simulation

6 in Advanced Cardiac Life Support Training for Eight-year Medicinal Students. Xiehe Yixue

7 Zazhi. 2023;14:660-664. doi: https://doi.org/10.12290/xhyxzz.2022-0676

8 317. Sullivan NJ, Duval-Arnould J, Twilley M, Smith SP, Aksamit D, Boone-Guercio P,

9 Jeffries PR, Hunt EA. Simulation exercise to improve retention of cardiopulmonary resuscitation

10 priorities for in-hospital cardiac arrests: A randomized controlled trial. Resuscitation. 2015;86:6-

11 13. doi: https://doi.org/10.1016/j.resuscitation.2014.10.021

12 318. Hammontree J, Kinderknecht CG. An In Situ Mock Code Program in the Pediatric

13 Intensive Care Unit: A Multimodal Nurse-Led Quality Improvement Initiative. Crit Care Nurse.

14 2022;42:42-55. doi: 10.4037/ccn2022631

15 319. Knight LJ, Gabhart JM, Earnest KS, Leong KM, Anglemyer A, Franzon D. Improving

16 Code Team Performance and Survival Outcomes: Implementation of Pediatric Resuscitation

17 Team Training*. Critical Care Medicine. 2014;42:243-251. doi:

18 10.1097/CCM.0b013e3182a6439d

19 320. Kurosawa H, Ikeyama T, Achuff P, Perkel M, Watson C, Monachino A, Remy D,

20 Deutsch E, Buchanan N, Anderson J, et al. A Randomized, Controlled Trial of In Situ Pediatric

21 Advanced Life Support Recertification (“Pediatric Advanced Life Support Reconstructed”)

22 Compared With Standard Pediatric Advanced Life Support Recertification for ICU Frontline

23 Providers*. Critical Care Medicine. 2014;42:610-618. doi: 10.1097/ccm.0000000000000024

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 134

1 321. Rubio-Gurung S, Putet G, Touzet S, Gauthier-Moulinier H, Jordan I, Beissel A, Labaune

2 J-M, Blanc S, Amamra N, Balandras C, et al. In Situ Simulation Training for Neonatal

3 Resuscitation: An RCT. Pediatrics. 2014;134:e790-e797. doi: 10.1542/peds.2013-3988

4 322. Xu C, Zhang Q, Xue Y, Chow C-B, Dong C, Xie Q, Cheung P-Y. Improved neonatal

5 outcomes by multidisciplinary simulation—a contemporary practice in the demonstration area of

6 China. Frontiers in Pediatrics. 2023;11 doi: 10.3389/fped.2023.1138633

7 323. Donoghue A AK, Cortegiani A, Schnaubelt S, Cheng A, Lockey A, Greif R on behalf of

8 the International Liaison Committee on Resuscitation Education, Implementation and Teams

9 Task Force (EIT). Manikin fidelity in resuscitation education: EIT 6410 TF SR. 2024. Updated.

10 Accessed 14 December. https://costr.ilcor.org/document/manikin-fidelity-in-resuscitation-

11 education-eit-6410-tf-sr

12 324. Aqel AA, Ahmad MM. High-fidelity simulation effects on CPR knowledge, skills,

13 acquisition, and retention in nursing students. Worldviews Evid Based Nurs. 2014;11:394-400.

14 doi: 10.1111/wvn.12063

15 325. Campbell DM, Barozzino T, Farrugia M, Sgro M. High-fidelity simulation in neonatal

16 resuscitation. Paediatrics and Child Health. 2009;14:19-23. doi: 10.1093/pch/14.1.19

17 326. Cheng A, Hunt EA, Donoghue A, Nelson-McMillan K, Nishisaki A, Leflore J, Eppich

18 W, Moyer M, Brett-Fleegler M, Kleinman M, et al. Examining pediatric resuscitation education

19 using simulation and scripted debriefing: a multicenter randomized trial. JAMA Pediatr.

20 2013;167:528-536. doi: 10.1001/jamapediatrics.2013.1389

21 327. Conlon LW, Rodgers DL, Shofer FS, Lipschik GY. Impact of levels of simulation

22 fidelity on training of interns in ACLS. Hosp Pract (1995). 2014;42:135-141. doi:

23 10.3810/hp.2014.10.1150

24 328. Curran V, Fleet L, White S, Bessell C, Deshpandey A, Drover A, Hayward M, Valcour J.

25 A randomized controlled study of manikin simulator fidelity on neonatal resuscitation program

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 135

1 learning outcomes. Adv Health Sci Educ Theory Pract. 2015;20:205-218. doi: 10.1007/s10459-

2 014-9522-8

3 329. Donoghue AJ, Durbin DR, Nadel FM, Stryjewski GR, Kost SI, Nadkarni VM. Effect of

4 high-fidelity simulation on Pediatric Advanced Life Support training in pediatric house staff: a

5 randomized trial. Pediatr Emerg Care. 2009;25:139-144. doi: 10.1097/PEC.0b013e31819a7f90

6 330. Finan E, Bismilla Z, Whyte HE, Leblanc V, McNamara PJ. High-fidelity simulator

7 technology may not be superior to traditional low-fidelity equipment for neonatal resuscitation

8 training. J Perinatol. 2012;32:287-292. doi: 10.1038/jp.2011.96

9 331. Hoadley TA. Learning advanced cardiac life support: a comparison study of the effects of

10 low- and high-fidelity simulation. Nurs Educ Perspect. 2009;30:91-95.

11 332. King JM, Reising DL. Teaching advanced cardiac life support protocols: the

12 effectiveness of static versus high-fidelity simulation. Nurse Educ. 2011;36:62-65. doi:

13 10.1097/NNE.0b013e31820b5012

14 333. Lo BM, Devine AS, Evans DP, Byars DV, Lamm OY, Lee RJ, Lowe SM, Walker LL.

15 Comparison of traditional versus high-fidelity simulation in the retention of ACLS knowledge.

16 Resuscitation. 2011;82:1440-1443. doi: 10.1016/j.resuscitation.2011.06.017

17 334. Massoth C, Röder H, Ohlenburg H, Hessler M, Zarbock A, Pöpping DM, Wenk M. High-

18 fidelity is not superior to low-fidelity simulation but leads to overconfidence in medical students.

19 BMC Med Educ. 2019;19:29. doi: 10.1186/s12909-019-1464-7

20 335. McCoy CE, Rahman A, Rendon JC, Anderson CL, Langdorf MI, Lotfipour S,

21 Chakravarthy B. Randomized Controlled Trial of Simulation vs. Standard Training for Teaching

22 Medical Students High-quality Cardiopulmonary Resuscitation. West J Emerg Med. 2019;20:15-

23 22. doi: 10.5811/westjem.2018.11.39040

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 136

1 336. Nimbalkar A, Patel D, Kungwani A, Phatak A, Vasa R, Nimbalkar S. Randomized

2 control trial of high fidelity vs low fidelity simulation for training undergraduate students in

3 neonatal resuscitation. BMC Res Notes. 2015;8:636. doi: 10.1186/s13104-015-1623-9

4 337. Owen DD, McGovern SK, Murray A, Leary M, Del Rios M, Merchant RM, Abella BS,

5 Dutwin D, Blewer AL. Association of race and socioeconomic status with automatic external

6 defibrillator training prevalence in the United States. Resuscitation. 2018;127:100-104. doi:

7 10.1016/j.resuscitation.2018.03.037

8 338. Rishipathak P, Hinduja A, Sengupta N. A comparative analysis of self-efficacy in low

9 fidelity vs high fidelity simulation post advanced cardiac life support (ACLS) sessions on cardiac

10 arrest algorithm amongst EMS students of Pune, India. Indian Journal of Public Health

11 Research and Development. 2020;11:415-419. doi: 10.37506/v11/i1/2020/ijphrd/193853

12 339. Rodgers DL, Securro S, Jr., Pauley RD. The effect of high-fidelity simulation on

13 educational outcomes in an advanced cardiovascular life support course. Simul Healthc.

14 2009;4:200-206. doi: 10.1097/SIH.0b013e3181b1b877

15 340. Roh YS. Effects of high-fidelity patient simulation on nursing students' resuscitation-

16 specific self-efficacy. Comput Inform Nurs. 2014;32:84-89. doi: 10.1097/cin.0000000000000034

17 341. Settles J, Jeffries PR, Smith TM, Meyers JS. Advanced cardiac life support instruction:

18 do we know tomorrow what we know today? J Contin Educ Nurs. 2011;42:271-279. doi:

19 10.3928/00220124-20110315-01

20 342. Stellflug SM, Lowe NK. The Effect of High Fidelity Simulators on Knowledge Retention

21 and Skill Self Efficacy in Pediatric Advanced Life Support Courses in a Rural State. J Pediatr

22 Nurs. 2018;39:21-26. doi: 10.1016/j.pedn.2017.12.006

23 343. Thomas EJ, Williams AL, Reichman EF, Lasky RE, Crandell S, Taggart WR. Team

24 training in the neonatal resuscitation program for interns: teamwork and quality of resuscitations.

25 Pediatrics. 2010;125:539-546. doi: 10.1542/peds.2009-1635

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 137

1 344. Tufts LM, Hensley CA, Frazier MD, Hossino D, Domanico RS, Harris JK, Flesher SL.

2 Utilizing High-fidelity Simulators in Improving Trainee Confidence and Competency in Code

3 Management. Pediatr Qual Saf. 2021;6:e496. doi: 10.1097/pq9.0000000000000496

4 345. Nabecker S, Nation K, Gilfoyle E, Abelairas-Gomez C, Koota E, Lin Y, Greif R.

5 Cognitive aids used in simulated resuscitation: A systematic review. Resusc Plus.

6 2024;19:100675. doi: 10.1016/j.resplu.2024.100675

7 346. Nelin S, Karam S, Foglia E, Turk P, Peddireddy V, Desai J. Does the Use of an

8 Automated Resuscitation Recorder Improve Adherence to NRP Algorithms and Code

9 Documentation? Children. 2024;11

10 347. Senter-Zapata M, Neel DV, Colocci I, Alblooshi A, Alradini F, Quach B. An Advanced

11 Cardiac Life Support Application Improves Performance during Simulated Cardiac Arrest. Appl

12 Clin Inform. 2024;15:798-807.

13 348. Spencer R, Sen AI, Kessler DO, Salabay K, Compagnone T, Zhang Y. Critical Event

14 Checklists for Simulated In-Hospital Dysrhythmias in Children with Heart Disease. Pediatric

15 Cardiology. 2024;

16 349. Liu CH, Yang CW, Lockey A, Greif R, Cheng A. Factors influencing workload and

17 stress during resuscitation - A scoping review. Resusc Plus. 2024;18:100630. doi:

18 10.1016/j.resplu.2024.100630

19 350. Breckwoldt J, Cheng A, Lauridsen KG, Lockey A, Yeung J, Greif R. Stepwise approach

20 to skills teaching in resuscitation: A systematic review. Resusc Plus. 2023;16:100457. doi:

21 10.1016/j.resplu.2023.100457

22 351. Heriwardito A, Ramlan AAW, Basith A, Aristya L. Effectiveness of endotracheal

23 intubation and mask ventilation procedural skills training on second-year student using modified

24 Peyton's Four-Step approach during COVID-19 pandemic. Med Educ Online. 2023;28:2256540.

25 doi: 10.1080/10872981.2023.2256540
© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 138

1 352. Cheng A, Fijacko N, Lockey A, Greif R, Abelairas-Gomez C, Gosak L, Lin Y. Use of

2 augmented and virtual reality in resuscitation training: A systematic review. Resusc Plus.

3 2024;18:100643. doi: 10.1016/j.resplu.2024.100643

4 353. Aksoy ME, Ozkan AE, Kitapcioglu D, Usseli T. Comparing the Outcomes of Virtual

5 Reality-Based Serious Gaming and Lecture-Based Training for Advanced Life Support Training:

6 Randomized Controlled Trial. JMIR Serious Games. 2023;11

7 354. Alcázar Artero PM, Greif R, Cerón Madrigal JJ, Escribano D, Pérez Rubio MT, Alcázar

8 Artero ME, López Guardiola P, Mendoza López M, Melendreras Ruiz R, Pardo Ríos M.

9 Teaching cardiopulmonary resuscitation using virtual reality: A randomized study. Australas

10 Emerg Care. 2024;27:57-62. doi: 10.1016/j.auec.2023.08.002

11 355. Figols Pedrosa M, Barra Perez A, Vidal-Alaball J, Miro-Catalina Q, Forcada Arcarons A.

12 Use of virtual reality compared to the role-playing methodology in basic life support training: a

13 two-arm pilot community-based randomised trial. BMC Med Educ. 2023;23:50. doi:

14 10.1186/s12909-023-04029-2

15 356. Giacomini F, Querci L, Dekel B. Mixed Reality Mass or Self-directed Training for

16 Adolescents' Basic Life Support Instruction: A Prospective, Randomized Pilot Study. The Open

17 Anesthesiology Journal. 2023;17

18 357. Sungur H, Van Berlo Z, Lüwa LM. Enhancing Cardiopulmonary Resuscitation Training

19 with Mixed Reality: Improving Cardiopulmonary Resuscitation Performance and Enjoyment.

20 Cyberpsychology, Behavior, and Social Networking. 2024;27:379-386.

21 358. Pérez Rubio MT, González Ortiz JJ, López Guardiola P, Alcázar Artero PM, Soto

22 Castellón MB, Ocampo Cervantes AB, Pardo Ríos M. Realidad virtual para enseñar reanimación

23 cardiopulmonar en el Grado de Educación Primaria. Estudio comparativo. RIED Rev Iberoam

24 Educ Distancia. 2023;26:309-325. doi: 10.5944/ried.26.2.36232

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 139

1 359. Shatpattananunt B, Petpichetchian W, Pinsuwan S, Chaloempong T, Waraphok S,

2 Wongwatkit C. Development and evaluation of a virtual reality basic life support for

3 undergraduate students in Thailand: a project by Mae Fah Luang University (MFU BLiS VR).

4 BMC Med Educ. 2023;23

5 360. Lin Y LA, Greif R, Abelairas Gomez C, Gosak L, Fijacko N, Cheng A on behalf of the

6 International Liaison Committee on Resuscitation Education, Implementation and Teams Task

7 Force (EIT). Immersive technologies for resuscitation education (EIT 6405) TF SR. 2024.

8 Updated. Accessed 14 January. https://costr.ilcor.org/document/immersive-technologies-for-

9 resuscitation-education-eit-6405-tf-sr

10 361. Elgohary M, Palazzo FS, Breckwoldt J, Cheng A, Pellegrino J, Schnaubelt S, Greif R,

11 Lockey A. Blended learning for accredited life support courses - A systematic review. Resusc

12 Plus. 2022;10:100240. doi: 10.1016/j.resplu.2022.100240

13 362. Donoghue A, Sawyer T, Olaussen A, Greif R, Toft L. Gamified learning for resuscitation

14 education: A systematic review. Resusc Plus. 2024;18:100640. doi:

15 10.1016/j.resplu.2024.100640

16 363. Bilodeau C, Schmölzer GM, Cutumisu M. A randomized controlled simulation trial of a

17 neonatal resuscitation digital game simulator for labour and delivery room staff. Children

18 (Basel). 2024;11:793. doi: 10.3390/children11070793

19 364. Cutumisu M, Schmölzer GM. The effects of a digital game simulator versus a traditional

20 intervention on paramedics’ neonatal resuscitation performance. Children (Basel). 2024;11:174.

21 doi: 10.3390/children11020174

22 365. Kim K, Choi D, Shim H, Lee CA. Effects of gamification in advanced life support

23 training for clinical nurses: A cluster randomized controlled trial. Nurse Educ Today.

24 2024;140:106263. doi: 10.1016/j.nedt.2024.106263

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 140

1 366. Lin Y, Lockey A, Greif R, Cheng A. The effect of scripted debriefing in resuscitation

2 training: A scoping review. Resusc Plus. 2024;18:100581. doi: 10.1016/j.resplu.2024.100581

3 367. Abelairas-Gómez C, Cortegiani A, Sawyer T, Greif R, Donoghue A. Rapid cycle

4 deliberate practice approach on resuscitation training: A systematic review. Resusc Plus.

5 2024;18:100648. doi: 10.1016/j.resplu.2024.100648

6 368. Coelho LP, Farhat SCL, Severini RdSG, Souza ACA, Rodrigues KR, Bello FPS,

7 Schvartsman C, Couto TB. Rapid cycle deliberate practice versus postsimulation debriefing in

8 pediatric cardiopulmonary resuscitation training:a randomized controlled study. Einstein (Sao

9 Paulo). 2024;22 doi: 10.31744/einstein_journal/2024ao0825

10 369. Raper JD, Khoury CA, Marshall A, Smola R, Pacheco Z, Morris J, Zhai G, Berger S,

11 Kraemer R, Bloom AD. Rapid cycle deliberate practice training for simulated cardiopulmonary

12 resuscitation in resident education. West J Emerg Med. 2024;25:197-204. doi:

13 10.5811/westjem.17923

14 370. Farquharson B, Cortegiani A, Lauridsen KG, Yeung J, Greif R, Nabecker S. Teaching

15 team competencies within resuscitation training: A systematic review. Resusc Plus.

16 2024;19:100687. doi: 10.1016/j.resplu.2024.100687

17 371. Ohlenburg H, Arnemann PH, Hessler M, Gorlich D, Zarbock A, Friederichs H. Flipped

18 Classroom: Improved team performance during resuscitation training through interactive pre-

19 course content - a cluster-randomised controlled study. BMC Med Educ. 2024;24

20 372. Yun S, Park HA, Na SH, Yun HJ. Effects of communication team training on clinical

21 competence in Korean Advanced Life Support: A randomized controlled trial. Nurs Health Sci.

22 2024;26

23 373. Schnaubelt S, Monsieurs KG, Semeraro F, Schlieber J, Cheng A, Bigham BL, Garg R,

24 Finn JC, Greif R. Clinical outcomes from out-of-hospital cardiac arrest in low-resource settings -

25 A scoping review. Resuscitation. 2020;156:137-145. doi: 10.1016/j.resuscitation.2020.08.126

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.
 Greif 141

1 374. Schnaubelt S, Garg R, Atiq H, Baig N, Bernardino M, Bigham B, Dickson S, Geduld H,

2 Al-Hilali Z, Karki S, et al. Cardiopulmonary resuscitation in low-resource settings: a statement

3 by the International Liaison Committee on Resuscitation, supported by the AFEM, EUSEM,

4 IFEM, and IFRC. Lancet Glob Health. 2023;11:e1444-e1453. doi: 10.1016/s2214-

5 109x(23)00302-9

6 375. Yeung J, Djarv T, Hsieh MJ, Sawyer T, Lockey A, Finn J, Greif R. Spaced learning

7 versus massed learning in resuscitation - A systematic review. Resuscitation. 2020;156:61-71.

8 doi: 10.1016/j.resuscitation.2020.08.132

© 2025 American Heart Association, Inc., European Resuscitation Council, and International Liaison Committee on
Resuscitation.