Resuscitation Council UK 2025 Guidelines: What’s Actually Changed?

Resuscitation Council UK 2025 Guidelines: What’s Actually Changed?

Every five years, Resuscitation Council UK (RCUK) updates its guidelines to reflect the latest international science and UK data. The 2025 Resuscitation Guidelines, published on 27 October 2025, align with the 2025 ILCOR Consensus and ERC guidelines and will be implemented in courses from January 2026.

For UK ambulance and pre-hospital clinicians, this isn’t a complete overhaul of resuscitation as we know it but there are some important shifts in emphasis, especially around:

  • How early we recognise and respond to deterioration

  • How we train people (from school kids to call handlers to clinicians)

  • What we focus on during and after resuscitation

  • How we integrate first aid into the chain of survival

Let’s break down the key updates, with a focus on what they mean in clinical practice.

Big-Picture Themes: Evolution, Not Revolution

RCUK’s Executive Summary of the main changes since the 2021 Guidelines pulls out several overarching themes:

  • Earlier, broader education – resuscitation teaching from age 4–6, repeated annually through school, and tailored training for healthcare staff and ambulance call handlers.

  • Systems thinking – stronger national focus on mandatory CPR training, first responder schemes, AED networks, and organised post-arrest care across regions.

  • Equity and inclusivity – more attention to health inequalities, skin-tone bias (especially in newborn assessment), and access to training/resources.

  • Survivorship & ethics – more emphasis on what happens after ROSC, including rehabilitation and co-survivor support, and on person-centred decision-making before and during emergencies.

For context, the guidelines summarise current UK data: around 115,000 out-of-hospital cardiac arrests (OHCA) are reported to ambulance services each year, with resuscitation attempted in roughly 43,000. Survival to 30 days remains around 9–10% overall, and outcomes are poorer in more deprived and ethnically diverse communities.

Adult Basic Life Support: The Big Practical Change

The Adult Basic Life Support (BLS) section is where most lay and first responder changes sit – and they’re highly relevant for pre-hospital practice and public-facing education.

1. Call 999 for any unresponsive person – before you analyse breathing

Previously, rescuers were guided to check for normal breathing first and then call for help. The 2025 guidelines now state:

Call 999 for any unresponsive person straight away, then assess breathing while you’re waiting for the call to be answered.

Call handlers are expected to support recognition of abnormal breathing and guide telephone CPR. This:

  • Speeds up the activation of EMS and first responders

  • Reduces hesitation caused by uncertainty about “agonal” vs “normal” breathing

  • Better utilises call-handlers as clinical support at the very start of the chain

2. Telephone-assisted CPR and AED use are front and centre

There’s stronger emphasis on:

  • Call handlers actively coaching CPR and AED use

  • Linking callers to nearby registered AEDs via The Circuit and first responder apps

  • Recognising the emotional impact on lay rescuers and the need for post-event support

3. Core CPR mechanics are unchanged – but re-emphasised

  • Rate 100–120/min, depth 5–6 cm, full recoil, minimal interruptions

  • Chest-compression-only CPR is fine for untrained or unwilling rescuers

  • Rescue breaths remain recommended for those trained and willing

For clinicians, the BLS message is clearer and simpler to teach: “If they’re unresponsive, phone 999 first, then follow the call handler.

Adult Advanced Life Support: Same Algorithm, Sharper Focus

RCUK are explicit: there are no major changes to the core Adult ALS algorithm compared to 2021.

However, there are some important shifts in emphasis:

1. Greater focus on effective ventilation

The 2025 ALS guidance reiterates the primacy of:

  • Early recognition and prevention of arrest

  • High-quality compressions and rapid defibrillation

But there’s now more explicit emphasis on:

  • Delivering effective ventilations (avoiding hypoxia and hypo/hypercapnia)

  • Using appropriate airways and ventilation strategies tailored to the setting

  • Correct defibrillation pad placement and optimisation of defib technique

2. Adrenaline strategy unchanged, ECPR refined

  • Adrenaline remains recommended early in non-shockable rhythms and after the third shock in shockable rhythms.

  • Extracorporeal CPR (ECPR) is explicitly acknowledged as an option in specialist centres when conventional CPR is failing, with clearer selection criteria in the special circumstances section (e.g. refractory VF, hypothermia, selected toxin or thrombotic causes).

3. Prevention & debriefing

There’s a stronger push for:

  • Early warning scores and escalation systems in hospital

  • Identifying cardiovascular risk and inherited conditions in the community

  • Data-driven debriefing after arrests to improve team performance

  • Recognition and management of CPR-induced consciousness, including appropriate sedation and analgesia

For pre-hospital teams, this reinforces what many services already strive for: early ALS, strong team dynamics, and robust debriefing as standard.

Special Circumstances: ECPR, Hypothermia, Pregnancy & More

The special circumstances chapter again builds on the idea that the standard ALS algorithm remains the foundation – with context-specific tweaks for:

  • Trauma and major haemorrhage

  • Pregnancy (including resuscitative hysterotomy / perimortem C-section)

  • Hypothermia (including selective ECPR)

  • Thrombosis (PE, coronary thrombosis)

  • Toxins, overdose and poisoning

  • Obesity, haemodialysis, sport, theatre/operative settings

There’s increased emphasis on:

  • Rapid recognition of reversible causes beyond ischaemic heart disease

  • Ethical preparedness (especially for high-risk, resource-intensive interventions)

  • Simulation as a tool to rehearse rare, high-stakes scenarios

Post-Resuscitation Care: Avoid Fever, Structure Your ABC

The 2025 Post-resuscitation Care guidance is closely aligned with ERC/ESICM recommendations and tightens up several key areas.

Key points include:

  • Structured ABC approach after ROSC – airway protection, controlled oxygenation, normocapnia, and haemodynamic targets

    • Suggested blood pressure goals: SBP > 100 mmHg or MAP 60–65 mmHg

  • Coronary angiography prioritised for ST-elevation MI or strong suspicion of coronary occlusion

  • Whole-body CT recommended to identify non-coronary causes in appropriate patients

Temperature management has shifted towards:

  • Fever prevention – avoid temp > 37.5°C for 36–72 hours rather than strict deep hypothermia protocols

  • No routine use of neuroprotective drugs

Seizure management recommendations favour levetiracetam or sodium valproate, and prognostication is explicitly multi-modal and delayed:

  • Neurological prognostication ≥72 hours post-ROSC, combining exam, EEG, biomarkers, and imaging to avoid falsely pessimistic predictions.

There’s also clear guidance about:

  • Separating prognostication from decisions about withdrawal of life-sustaining therapy

  • Considering organ donation for patients who die after ROSC

  • Providing structured follow-up and rehabilitation within three months for survivors and co-survivors

Paediatric Life Support: Earlier Recognition, Broader Scope

The 2025 Paediatric Life Support (PLS) guidance focuses heavily on early recognition of critical illness and team activation, supported by structured ABCDE assessment tools.

Key updates include:

  • Clearer emphasis on early ABCDE-based assessment and escalation pathways

  • Refined recommendations for:

    • High-quality chest compressions

    • Ventilation and airway management

    • Weight-based drug dosing and defibrillation

    • Management of shock, arrhythmias, and reversible causes

  • Highlighting ECPR as an option for selected paediatric cases in specialist centres

A new paediatric special circumstances chapter covers scenarios such as:

  • Trauma

  • Asthma

  • Drowning

  • Hypothermia

Plus an explicit section on paediatric post-resuscitation care, extending the chain of survival into recovery and follow-up.

Newborn Resuscitation & Transition: Less About Colour, More About Physiology

The newborn resuscitation and transition guidance has some noticeable changes that are particularly important from an equity perspective.

1. Less emphasis on skin colour

Assessment now prioritises:

  • Heart rate

  • Breathing

  • Tone

  • Response to stimulation

Skin colour is recognised as subjective and unreliable across different skin tones, which is a big step forwards in tackling diagnostic bias.

2. Airway & drug changes

  • Stronger recommendations for two-person jaw thrust, early supraglottic airway use, and video laryngoscopywhere available

  • Adrenaline intervals standardised to every 4 minutes

  • Sodium bicarbonate is no longer recommended in newborn resuscitation

3. Beyond the delivery room

The guidance now explicitly includes out-of-hospital newborn life support, with practical advice for:

  • Home births and unexpected births outside hospital

  • Ambulance care, including thermal protection, airway support, and safe transfer

  • Telemedicine support where feasible

Post-resus care emphasises temperature control, glucose management, documentation, early prognostication, and sensitive communication with parents, including palliative approaches when appropriate.

First Aid: A Brand-New Chapter

One of the headline additions is a completely new First Aid chapter – now recognised as the first link in the chain of survival.

RCUK now:

  • Defines first aid broadly as help provided by anyone, in any situation

  • Emphasises:

    • Early help and quick 999 activation

    • Scene safety and self-protection

    • A structured ABCDE approach for assessment

The chapter covers first aid for:

  • Life-threatening conditions that may lead to cardiac arrest (e.g. severe bleeding, anaphylaxis, asthma, chest pain, opioid overdose)

  • Time-critical conditions where first aid can reduce morbidity (e.g. stroke, hypoglycaemia, trauma, drowning)

  • Environmental emergencies (heat stroke, hypothermia, snake bites, concussion, etc.)

Interventions are kept simple and stepwise, including:

  • Recovery position

  • Tourniquets and haemorrhage control

  • Adrenaline autoinjectors

  • Naloxone where available

There’s also a strong message about making first aid training inclusive and accessible – addressing barriers like anxiety, language, and cost, and encouraging community-focused approaches.

Ethics & “Systems Saving Lives”: More Than Just an Algorithm

Two other sections worth calling out:

Ethics

The ethics guidance pushes for:

  • Person-centred, early conversations about emergency and future care

  • Clear documentation (e.g. ReSPECT forms) accessible across settings

  • Training and policies to support consistent decision-making

  • Offering families the option to be present during resuscitation, with appropriate support

  • Embedding ethical simulation into education, including how and when to terminate resuscitation in line with patient values and clinical reality

Systems Saving Lives

The Systems Saving Lives section scales things up to population level:

  • Mandatory CPR training proposed for:

    • Schoolchildren (from age 4, annually)

    • Certain student groups

    • Drivers and others in key public roles

  • Better integration of:

    • First responder apps

    • AED registries (like The Circuit)

    • Regional networks for post-arrest care

  • Robust quality-improvement programmes in hospitals and ambulance services

  • Long-term survivorship care and co-survivor support, not just “survival to discharge”

What Does This Mean for You as a Pre-Hospital Clinician?

If you’re working on an ambulance, in BASICS/ECT, or other pre-hospital roles, the 2025 updates mainly sharpen and extend what you already do:

  • BLS messaging becomes simpler – teach the public: “If they’re unresponsive, phone 999 immediately and start CPR with the call handler.”

  • ALS algorithms are familiar, but with:

    • More emphasis on effective ventilation and pad placement

    • Clearer framing of ECPR as a specialist, selective rescue option

  • Post-ROSC care guidance supports your handover priorities – structured ABC, BP and oxygen targets, early imaging/angiography in the right patients.

  • Paeds & newborn guidance improves early recognition, reduces skin-tone bias, and explicitly includes out-of-hospital newborn resus, which is directly relevant to ambulance care.

  • First aid is now “officially” part of the chain of survival – strengthening the case for community training, school visits, and public education campaigns.

Final Thoughts

The 2025 RCUK Guidelines are less about rewriting the algorithm and more about:

  • Starting education earlier

  • Tightening the science around what we already do

  • Tackling inequality and bias

  • Extending the chain of survival from first aid through to long-term survivorship

For day-to-day clinicians, the key is to:

  1. Read the official executive summary and your local implementation guidance

  2. Update teaching, training, and patient information to reflect the new BLS, first aid, newborn, and post-ROSC emphases

  3. Keep advocating for systems that support early recognition, rapid response, and proper support after cardiac arrest

You can read the full guideline set and the official executive summary directly via Resuscitation Council UK’s website.

If you’re refreshing your resus knowledge, keep your Reversible Causes Card close — your quick-reference tool for running the H’s and T’s during cardiac arrest.

 

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