Key Points for Clinical Practice
The 2026 ILCOR consensus includes new guidance and previously established recommendations. For emergency clinicians, these are the main points worth remembering:
- Start with high-quality CPR. The retained adult targets remain 100–120 compressions/min and approximately 5 cm depth. These are strong recommendations, although the certainty of evidence is low or very low.
- Ventilate effectively, without overventilation. During adult cardiac arrest, ILCOR suggests 30:2 or 10 breaths/min during continuous compressions, with visible chest rise. Ventilation is particularly important in drowning-related arrest; the initial sequence depends on rescuer training.
- Do not give fluids routinely during undifferentiated nontraumatic cardiac arrest. Volume administration may be reasonable when pre-arrest hypovolemia is suspected. The recommendation against routine fluids is weak, based on very-low-certainty evidence.
- Avoid routine thrombolysis during cardiac arrest. This is a strong recommendation against routine use, supported by moderate-certainty evidence. Pulmonary embolism-associated cardiac arrest remains a separate clinical consideration.
- Use airway devices and ultrasound for a clear clinical purpose. Evidence does not establish that video laryngoscopy should always be preferred during CPR. Resuscitative TEE may help answer bedside questions, but improved survival or neurological outcomes have not been demonstrated.
- Pay attention to post-arrest and pediatric care. Neurological prognostication should be multimodal and account for timing and confounders. In comatose children after ROSC, active temperature management and prevention of fever above 37.5°C are strongly recommended, with low-certainty evidence.
- For immediate neonatal emergency access, UVC is preferred. Intraosseous access is a reasonable alternative when UVC placement is unsuccessful or infeasible; these recommendations are conditional and based on very-low-certainty evidence.
When reading any recommendation, consider both its strength and the certainty of evidence. A lack of sufficient evidence is not proof that an intervention is ineffective.
Resuscitation requires rapid decisions, effective interventions, and continuous reassessment. However, not every intervention is supported by the same level of evidence, and performing more interventions does not necessarily improve patient outcomes.
The 2026 International Liaison Committee on Resuscitation (ILCOR) Consensus on Science With Treatment Recommendations reviews evidence related to adult, pediatric, and neonatal resuscitation, as well as first aid, education, and resuscitation systems.
Some recommendations have been updated, while others remain unchanged following further review of the available evidence. In several areas, the evidence is still insufficient to recommend one intervention over another.
For clinicians, understanding these differences is essential. We need to know not only what is recommended, but also how strong the recommendation is, how reliable the supporting evidence is, and how it applies to the patient in front of us.
Understanding the Strength of Recommendations
ILCOR uses the GRADE approach to assess the available evidence and formulate treatment recommendations.
| Recommendation level | Interpretation |
|---|---|
| Strong recommendation | An intervention is recommended for or against use. |
| Weak or conditional recommendation | An intervention is suggested, but clinical circumstances and implementation should be considered. |
| Good practice statement (GPS) | Practical guidance based on linked or indirect evidence, without a formal GRADE rating. |
| Insufficient evidence | Available evidence does not support a treatment recommendation. This does not necessarily mean that the intervention is ineffective. |
| Evidence certainty | The confidence in the estimated treatment effect is classified as high, moderate, low, or very low. |
These categories should not be confused with the Class I, II, or III recommendation system used by the American Heart Association.
A strong recommendation may occasionally be supported by low-certainty evidence. Therefore, the strength of a recommendation and certainty of evidence should always be interpreted separately.
1. Adult Basic Life Support
Ventilation and airway management
Effective ventilation remains an important component of resuscitation. However, the most appropriate method depends on provider training, available equipment, and the circumstances of cardiac arrest.
For basic life support emergency medical services personnel who are appropriately trained, ILCOR suggests using either a supraglottic airway or bag-mask ventilation, with or without an oropharyngeal or nasopharyngeal airway.
Recommendation: Weak; very-low-certainty evidence.
For trained community responders and dispatched first responders, either supraglottic airway management or bag-mask ventilation may be supported when appropriate training has been provided.
Recommendation: Good practice statement.
Competency-based training and regular retraining are recommended for providers performing bag-mask ventilation or inserting airway devices.
Recommendation: Good practice statement.
This is clinically relevant because the effectiveness of ventilation depends not only on the selected device but also on the provider’s ability to use it correctly.
Ventilation rate and tidal volume
ILCOR suggests the following approaches for adult patients during cardiac arrest:
| Intervention | Recommendation | Strength / evidence certainty |
|---|---|---|
| Ventilation without continuous compressions | Two breaths after every 30 compressions | Weak; very low |
| Ventilation during continuous compressions | 10 breaths/min, with or without an advanced airway | Weak; very low |
| Manual ventilation | Deliver sufficient volume to produce visible chest rise | GPS |
| Measurable tidal volume | 400–600 mL, or 6–10 mL/kg ideal or predicted body weight | Weak; very low |
| Ventilation quality | Ensure effective ventilation and avoid both hypoventilation and hyperventilation | GPS |
| Adult ventilation bag | Use a standard adult bag with a maximum capacity of 1500–1600 mL | Weak; very low |
One practical consideration is the difference between bag capacity and delivered tidal volume.
Using a 1500–1600 mL ventilation bag does not mean that the entire volume should be delivered with every breath. Similarly, choosing a smaller ventilation bag does not guarantee appropriate tidal volume.
During resuscitation, attention should be directed toward effective ventilation, visible chest rise, and avoidance of excessive ventilation.
These numerical recommendations specifically apply to adult cardiac arrest. They should not be directly applied to pediatric resuscitation or ventilation after return of spontaneous circulation (ROSC).
Chest compressions
High-quality chest compressions remain a fundamental component of cardiopulmonary resuscitation.
The 2026 consensus retains several previously established recommendations.
| Parameter | Recommendation | Strength / evidence certainty |
|---|---|---|
| Adult compression rate | 100–120 compressions/min | Strong; very low |
| Adult compression depth | Approximately 5 cm | Strong; low |
| Excessive depth | Avoid compression depths greater than 6 cm in an average adult | Weak; low |
| Chest recoil | Avoid leaning on the chest and allow complete recoil | Weak; very low |
| Infant compression depth | At least one-third of the anteroposterior chest diameter, approximately 4 cm | Weak; very low |
| Child compression depth | At least one-third of the anteroposterior chest diameter, approximately 5 cm | Weak; very low |
| Compression rate in infants and children | A target of 100–120 compressions/min may be used | New GPS |
Although the adult compression targets are familiar, their continued inclusion reinforces the importance of consistent CPR quality.
During resuscitation, these parameters should be assessed continuously, particularly when compressors change or when procedures interrupt CPR.
Defibrillation and rhythm analysis
Interruptions in chest compressions can affect the quality of resuscitation. The timing of defibrillator charging is therefore an important practical consideration.
ILCOR suggests that a manual defibrillator may be charged during ongoing chest compressions, either before or after rhythm analysis.
Recommendation: Weak; very-low-certainty evidence.
Both approaches require appropriate training and a safe sequence of actions.
Recommendation: Good practice statement.
Charging the defibrillator during compressions should not be confused with delivering a shock while compressions are being performed.
For rhythm analysis using artifact-filtering algorithms during ongoing chest compressions, ILCOR recommends evaluating clinical usefulness through trials or research initiatives.
Recommendation: Good practice statement.
The available evidence does not establish a routine clinical benefit from these technologies.
Safety during resuscitation
Rescuer safety remains essential throughout the resuscitation process.
Although injuries to rescuers are uncommon, potential hazards have been described during water rescue, AED retrieval in unsafe conditions, transportation, CPR without appropriate personal protective equipment, and certain circumstances involving implanted defibrillators.
The previous broad 2020 safety statement has been withdrawn and replaced with more specific, context-dependent guidance.
Recommendation: Good practice statement.
The clinical implication is that rescuers should assess the environment and potential hazards while maintaining effective resuscitation whenever it is safe to do so.
2. Drowning-Related Cardiac Arrest
Drowning-related cardiac arrest requires particular attention to ventilation. However, the initial resuscitation approach may differ according to the training and capability of the rescuer.
The drowning recommendations included in the 2026 consensus are predominantly previously established recommendations carried forward, rather than new treatment changes.
Resuscitation in water and on boats
Trained rescuers may provide in-water ventilation when it is feasible and safe, considering the available equipment and distance from land.
Recommendation: Weak; very-low-certainty evidence.
CPR may also be performed on a boat by trained rescuers when conditions permit. If resuscitation cannot be performed safely or effectively, it may be delayed until the patient reaches land.
Recommendation: Good practice statement.
These recommendations recognise that rescuer safety and the feasibility of providing effective interventions can influence the resuscitation strategy.
Initial CPR sequence
ILCOR distinguishes between lay rescuers and trained duty responders.
For lay rescuers managing adult drowning-related cardiac arrest, a compression-first approach is recommended.
Recommendation: Good practice statement.
For healthcare professionals and trained responders, including lifeguards, ventilation-first resuscitation should be considered.
Recommendation: Good practice statement.
Trained rescuers who are able and willing to provide ventilation should include rescue breaths during CPR. When ventilation cannot be provided, chest compressions should still be performed rather than withholding CPR.
This recommendation reflects the importance of ventilation in drowning while recognising that rescuers have different levels of training and available resources.
Ventilation equipment and oxygen
Mouth-to-mouth ventilation, mouth-to-nose ventilation, and pocket-mask ventilation are supported approaches.
Recommendation: Good practice statement.
Bag-mask ventilation requires appropriate competency, ongoing retraining, and equipment maintenance. Healthcare professionals should follow advanced life support guidance when managing the airway.
During drowning-related cardiac arrest, trained providers should use the highest possible inspired oxygen concentration when oxygen is available.
Recommendation: Good practice statement.
AED use
CPR should begin while an AED is being obtained and prepared. Defibrillation should be provided when the device is ready and indicates that a shock is required.
Recommendation: Good practice statement.
ILCOR also recommends implementing public-access defibrillation programmes for out-of-hospital cardiac arrest.
Recommendation: Strong; low-certainty evidence.
The practical message is that ventilation should remain an important consideration in drowning-related cardiac arrest, while AED use and other components of CPR should not be unnecessarily delayed.
3. Adult Advanced Life Support
Thrombolysis during cardiac arrest
ILCOR recommends against the routine administration of thrombolytic therapy during cardiac arrest.
Recommendation: Strong against; moderate-certainty evidence.
This recommendation applies to routine use and should not be interpreted as a recommendation against thrombolysis in patients with suspected or confirmed pulmonary embolism-associated cardiac arrest.
Existing guidance for pulmonary embolism-related cardiac arrest remains unchanged.
The distinction is important. Thrombolysis should not be added routinely to undifferentiated cardiac arrest, but a specific suspected cause may justify a different management approach.
Intramuscular epinephrine
The available evidence is insufficient to recommend adding intramuscular epinephrine to standard intra-arrest management.
Recommendation: Weak statement of insufficient evidence; very-low-certainty evidence.
This does not establish that intramuscular administration is ineffective. It indicates that current evidence does not support incorporating it into standard cardiac arrest treatment.
Fluid administration during CPR
Fluid administration is frequently considered during resuscitation. However, the presence of cardiac arrest alone does not establish a need for volume replacement.
ILCOR suggests avoiding routine intravascular volume administration during undifferentiated nontraumatic cardiac arrest.
Recommendation: Weak against; very-low-certainty evidence.
When hypovolemia is suspected to have been present before cardiac arrest, volume administration may be reasonable.
Recommendation: Good practice statement.
This distinction is particularly relevant in emergency care. Fluid administration should be guided by the suspected mechanism of cardiac arrest rather than provided routinely.
ILCOR also recommends against the use of hydroxyethyl starch during CPR or after ROSC.
Recommendation: Strong against; very-low-certainty evidence.
For the immediate post-ROSC period, there is insufficient direct evidence to recommend a specific volume strategy in undifferentiated nontraumatic cardiac arrest.
Similarly, the available evidence does not support a specific volume administration strategy during traumatic cardiac arrest.
Recommendation: No treatment recommendation in either setting.
These evidence gaps should not be interpreted as evidence that all fluid strategies have equivalent effects.
Video versus direct laryngoscopy
Airway management during cardiac arrest should minimise interruption of resuscitation while providing effective ventilation and airway protection.
ILCOR found insufficient evidence to recommend video laryngoscopy preferentially over direct laryngoscopy during CPR.
Recommendation: Weak statement of insufficient evidence; very-low-certainty evidence.
However, video laryngoscopy may be reasonable when the equipment is available and the operator is appropriately trained, particularly to improve procedural success and reduce inadvertent esophageal intubation.
Recommendation: Good practice statement.
The selection of an airway device should consider operator competency, equipment availability, and procedural circumstances.
The absence of evidence supporting the superiority of video laryngoscopy does not mean that clinicians should stop using a device with which they are experienced and competent.
Oxygen administration during CPR
ILCOR continues to suggest using the highest possible inspired oxygen concentration during cardiac arrest.
Recommendation: Weak; very-low-certainty evidence. Unchanged from 2020.
This recommendation applies to the intra-arrest period and should not be used as a target for oxygen administration after ROSC.
Resuscitative transesophageal echocardiography
Transesophageal echocardiography (TEE) has been increasingly investigated as a method of cardiac assessment during ongoing resuscitation.
TEE may help identify potentially reversible pathology, assess the location of chest compressions, and provide information about cardiac function without interrupting chest compressions.
However, most available evidence is observational. A clear improvement in survival or favourable neurological outcomes has not been established.
Evidence status: Scoping review; no new treatment recommendation or good practice statement.
For clinicians using point-of-care ultrasound, the important distinction is between obtaining diagnostic information and demonstrating improvement in patient outcomes.
TEE may provide useful information during resuscitation, but its clinical value depends on whether that information can appropriately influence management.
Training should therefore focus on image acquisition, recognition of limitations, the clinical question being investigated, and the potential consequence for treatment.
Neurological prognostication after cardiac arrest
Neurological prognostication is an important and sensitive component of post-cardiac arrest care.
The 2026 consensus reproduces several previously established recommendations and identifies areas requiring updated systematic reviews.
These recommendations should not be interpreted as newly validated prognostic thresholds.
| Assessment | Recommendation | Strength / evidence certainty |
|---|---|---|
| Somatosensory evoked potentials | Bilaterally absent N20 responses may contribute to predicting poor neurological outcome when combined with other indicators | Weak; very low |
| Electroencephalography | Highly malignant EEG patterns may contribute to prognostication in comatose patients who are not under sedation | Weak; very low |
| EEG background reactivity | Absence of reactivity should not be used alone to predict poor outcome | Weak; very low |
| Pupillary light reflex | Assess at ≥72 hours after ROSC | Weak; very low |
| Quantitative pupillometry | May contribute to prognostication at ≥72 hours after ROSC | Weak; low |
| Corneal reflexes | Bilateral absence at ≥72 hours after ROSC may contribute to prognostication | Weak; very low |
| Myoclonus | May be considered within seven days in combination with other tests; EEG should assess associated epileptiform activity | Weak; very low |
| Neuron-specific enolase | May contribute within 72 hours when combined with other assessments; no consensus threshold is provided | Weak; very low |
| Other biomarkers | The existing suggestion against using GFAP, tau, or neurofilament light chain to predict poor outcome is retained | Weak; very low |
| Brain imaging | CT grey-to-white matter ratio, diffusion-weighted MRI, and apparent diffusion coefficient on MRI may contribute to prognostication | Weak; very low |
The main clinical concern is the inappropriate use of a single finding to determine prognosis.
Sedation, timing of assessment, and other confounding factors can affect interpretation. Therefore, prognostication should be based on a multimodal assessment rather than an isolated examination finding, imaging result, biomarker, or EEG feature.
These recommendations should not be converted into a stand-alone decision algorithm for withdrawal of life-sustaining treatment.
4. Pediatric Life Support
Ventilation during pediatric cardiac arrest
Ventilation requirements in infants and children differ from those in adults. During pediatric resuscitation with an advanced airway, ILCOR recommends using an age-appropriate physiological ventilation rate.
Recommendation: Good practice statement.
Ventilation rate and the adequacy of delivered tidal volume should be monitored, and hypoventilation should be avoided.
Recommendation: Good practice statement.
However, current evidence is insufficient to recommend specific upper limits for ventilation rate, tidal volume, inspiratory time, or positive end-expiratory pressure during pediatric cardiac arrest.
Evidence status: No treatment recommendation for these specific parameters.
This uncertainty is important when applying protocols developed primarily for adults to pediatric patients.
Epinephrine during pediatric cardiac arrest
ILCOR suggests using epinephrine during pediatric out-of-hospital cardiac arrest.
Recommendation: Weak; very-low-certainty evidence.
Epinephrine is also recommended during pediatric in-hospital cardiac arrest.
Recommendation: Good practice statement.
For nonshockable cardiac arrest, the first dose should be administered as early as possible.
Recommendation: Weak; very-low-certainty evidence. Existing guidance retained.
For shockable cardiac arrest, evidence is insufficient to recommend a specific time for the first epinephrine dose.
There is also insufficient evidence to determine the optimal interval between subsequent doses.
Evidence status: No recommendation for either timing question.
The evidence is also insufficient to recommend adding intramuscular epinephrine to standard intra-arrest management.
Evidence status: Insufficient evidence; no formal recommendation-strength or certainty label provided for this pediatric statement.
Temperature management after ROSC
Active temperature management is recommended for comatose infants and children after return of spontaneous circulation following either in-hospital or out-of-hospital cardiac arrest.
Recommendation: Strong; low-certainty evidence.
ILCOR also recommends preventing central body temperature from exceeding 37.5°C.
Recommendation: Strong; low-certainty evidence.
Two previously studied temperature management strategies may be followed:
- Maintain a temperature of 32–34°C for 48 hours, followed by gradual rewarming and maintenance at 36–37.5°C, for a total of 120 hours.
- Maintain a temperature of 36–37.5°C for a total of 120 hours.
Recommendation: Weak; low-certainty evidence.
These strategies are based on published THAPCA protocols. Available evidence does not establish the superiority of one strategy over the other.
From a clinical perspective, preventing fever has stronger recommendation support than selecting one of these two specific temperature strategies.
Post-cardiac arrest hypotension
Observational studies have identified an association between hypotension after pediatric cardiac arrest and worse clinical outcomes.
However, this association does not establish that a particular intervention or vasoactive medication improves outcomes.
Evidence status: No new treatment recommendation.
Management should therefore consider the patient’s clinical condition and physiological response, while recognising the limits of the available evidence.
5. Neonatal Life Support
Emergency vascular access
Establishing vascular access during neonatal resuscitation can be challenging, particularly immediately after birth.
ILCOR suggests using an umbilical venous catheter (UVC) as the preferred route for emergency vascular access immediately after birth.
Recommendation: Conditional; very-low-certainty evidence.
When UVC insertion is unsuccessful or not feasible, intraosseous access may be a reasonable alternative.
Recommendation: Conditional; very-low-certainty evidence.
After the immediate newborn period, when the umbilical vein is no longer patent, intraosseous access is considered a reasonable method of emergency vascular access.
Recommendation: Conditional; very-low-certainty evidence.
The evidence is insufficient to recommend peripheral intravenous access specifically during neonatal cardiac arrest or bradycardia.
Evidence status: No treatment recommendation.
These recommendations support selecting a feasible route according to the stage of neonatal resuscitation and availability of appropriate access.
Respiratory function monitoring during training
Respiratory function monitors may help trainees assess the quality of mask ventilation during neonatal resuscitation simulation.
ILCOR suggests using these devices as an adjunct to improve neonatal mask-ventilation skills when resources permit.
Recommendation: Conditional; very-low-certainty evidence.
It is important to distinguish evidence obtained from simulation training from evidence demonstrating improvement in clinical outcomes.
Improved ventilation performance during manikin training does not establish that routine clinical use of respiratory function monitors improves neonatal survival or other patient outcomes.
Positive-pressure ventilation
Effective ventilation remains a major component of neonatal resuscitation.
The review of positive-pressure ventilation strategies did not produce a new graded recommendation.
Previously established guidance to use pressures sufficient to improve heart rate or produce chest expansion remains relevant.
Evidence status: Scoping review; existing guidance retained without a new GRADE rating.
The evidence also highlights changes in lung mechanics during neonatal transition and uncertainty regarding optimal ventilation settings.
Reported pressures from individual studies should therefore not be adopted as universal settings for all newborns.
6. Resuscitation Education, Training, and Team Performance
Resuscitation outcomes depend not only on the selection of appropriate interventions but also on the ability of healthcare providers and rescuers to perform them effectively.
Training family members and likely rescuers
ILCOR recommends providing basic life support training to individuals who are likely to encounter adults or children at increased risk of out-of-hospital cardiac arrest.
These individuals may include family members, caregivers, and other likely rescuers.
Recommendation: Strong; low-certainty evidence.
Healthcare professionals should encourage and direct these individuals toward appropriate BLS training.
Recommendation: Good practice statement.
This is particularly relevant for patients with known conditions that increase the risk of cardiac arrest outside the hospital.
Training methods
Several previously established recommendations regarding CPR education have been retained.
| Educational approach | Recommendation | Strength / evidence certainty |
|---|---|---|
| Instructor-led versus self-directed digital education | Either approach may be used for CPR and AED skill acquisition in adults and high-school-aged learners older than ten years | Retained weak; very low |
| Digital education where instructor-led training is limited | May be used when conventional training is inaccessible or broad training coverage is required | Retained weak; very low |
| Spaced learning | Training distributed over multiple sessions may be used instead of a single concentrated session | Retained weak; very low |
| Gamification | May be incorporated into resuscitation education | Retained weak; very low |
| Rapid-cycle deliberate practice | May be included in BLS and ALS training | Retained weak; very low |
These recommendations suggest that different training methods may be appropriate depending on the available resources, learners, and educational objectives.
However, improvements in training performance should not automatically be interpreted as evidence of improved patient outcomes.
In-hospital cardiac arrest teams
ILCOR also reviewed terminology and team composition in in-hospital cardiac arrest.
The scoping reviews identified differences in the terminology used to describe responders and resuscitation teams internationally.
Current evidence does not establish one universally optimal team composition or leadership model.
Evidence status: Scoping reviews; no new treatment recommendations.
For emergency departments and hospitals, this does not reduce the importance of organised resuscitation teams.
Clearly assigned roles, effective communication, and regular team training remain reasonable implementation priorities.
However, the available evidence does not establish that one professional group or specialty should universally lead every resuscitation team.
7. First Aid Recommendations
Opioid poisoning
ILCOR supports both virtual and in-person educational programmes for improving knowledge and preparedness related to opioid poisoning, particularly when training is combined with naloxone distribution.
Recommendation: Good practice statement.
Virtual education may also improve access to training in underserved communities, with or without naloxone distribution.
Recommendation: Good practice statement.
For an unconscious patient who is not breathing normally, CPR should be started without delay.
In suspected opioid-related respiratory or circulatory arrest, lay rescuers should administer naloxone when available.
Recommendation: Good practice statement.
Naloxone administration should not delay essential resuscitation interventions.
Caustic-agent exposure
For caustic-agent attacks, ILCOR recommends immediate irrigation of the affected areas with copious amounts of water or saline.
Recommendation: Good practice statement.
The emphasis is on early decontamination to reduce continued exposure.
Recognition of concussion by lay responders
Early recognition of possible concussion is important, particularly in sports and community settings.
ILCOR suggests assessing three factors:
- Whether an injury occurred.
- Whether the mechanism could have involved the head.
- Whether there has been a change in mental status.
When all three factors are present, the individual should be removed from the activity and emergency medical services should be activated, or assessment by an appropriately qualified professional should be arranged.
Recommendation: Good practice statement.
When concussion remains uncertain, removal from activity should be considered until the individual can be assessed by a qualified clinician.
Recommendation: Good practice statement.
These questions are intended to assist recognition by lay responders. They are not a validated clinical decision rule for excluding concussion or determining readiness to return to activity.
Pulse oximetry
Pulse oximetry can provide useful information, but measurements must be interpreted alongside the clinical assessment.
Users should understand the limitations of pulse oximetry, and readings should not replace direct physical examination.
Recommendation: Good practice statement.
This reinforces an important clinical principle: a numerical measurement should be interpreted in the context of the patient’s overall condition.
Recovery position
For individuals with reduced responsiveness from a nontraumatic cause who do not require immediate resuscitative intervention, the recovery position may be considered.
Recommendation: Weak; very-low-certainty evidence.
Airway patency, breathing, and responsiveness should be reassessed continuously.
If positioning compromises clinical assessment or raises concern for positional asphyxia, the individual should be placed supine and reassessed.
Recommendation: Good practice statement.
The recovery position should not replace ongoing monitoring or delay resuscitation when the patient’s condition deteriorates.
Pediatric extremity bleeding
For life-threatening extremity bleeding in children, ILCOR suggests using a manufactured windlass tourniquet.
Recommendation: Weak; very-low-certainty evidence.
When the affected limb is too small to permit effective tourniquet application, direct pressure should be used, with or without a haemostatic dressing.
Recommendation: Good practice statement.
There is insufficient evidence to recommend for or against other types of pediatric tourniquets.
Evidence status: No treatment recommendation.
Thermal burns
Immediate cooling with running water is recommended for thermal burns.
Recommendation: Strong; very-low-certainty evidence.
However, the available evidence does not establish a specific optimal duration of cooling.
Evidence status: Insufficient evidence to recommend a precise cooling duration.
In young children, excessive body cooling should be avoided, and the patient should be monitored for hypothermia.
Recommendation: Good practice statement.
The practical approach is to initiate cooling promptly while considering the patient’s age, extent of injury, and risk of systemic hypothermia.
What Should We Take Into Our Daily Practice?
The 2026 ILCOR consensus provides several useful points for clinicians involved in emergency care and resuscitation.
First, established resuscitation interventions should be performed correctly and consistently. High-quality chest compressions, effective ventilation, timely defibrillation, and appropriate airway management remain central components of resuscitation.
Second, additional interventions should have a defined clinical indication. Routine fluid administration or thrombolytic therapy during undifferentiated cardiac arrest is not supported merely because conventional resuscitation has been unsuccessful. The suspected mechanism of arrest and potential reversible causes should guide treatment.
Third, diagnostic information and improved clinical outcomes are not equivalent. Technologies such as resuscitative TEE may provide useful findings, but further evidence is required to establish whether their use improves survival or neurological outcomes.
Finally, a recommendation should be interpreted according to both its strength and the certainty of the supporting evidence. A recommendation based on very-low-certainty evidence should not be presented as if its clinical benefit has been firmly established.
A Practical Approach for the Next Resuscitation
During resuscitation, I would suggest keeping four questions in mind:
- What problem are we treating? Identify the immediate physiological disturbance and possible reversible causes.
- Why are we choosing this intervention? Consider its indication and the evidence supporting its use.
- What response do we expect? Define the physiological or clinical improvement that should follow.
- How will we reassess the patient? Evaluate the response and reconsider the management plan when the expected improvement does not occur.
When reviewing a new guideline or recommendation, one additional question is equally important:
How strong is the recommendation, and how certain is the evidence?
Conclusion
The 2026 ILCOR consensus reinforces several established resuscitation practices and provides additional guidance in selected areas. At the same time, it identifies important gaps in the evidence, particularly regarding ventilation strategies, fluid administration, airway devices, neurological prognostication, and the clinical impact of newer technologies.
For emergency physicians and other clinicians involved in resuscitation, the findings support an approach based on effective basic interventions, identification of reversible causes, and repeated clinical assessment.
The absence of strong evidence for an intervention should not be confused with evidence of no benefit. Similarly, the availability of a technology or treatment does not establish that it improves patient outcomes.
The aim is not simply to perform more interventions during resuscitation, but to select appropriate interventions, understand their limitations, and assess their effects on the patient.
Reference
Bray JE, et al. 2026 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations. Circulation. 2026.
https://doi.org/10.1161/CIR.0000000000001473
Editorial note: This article discusses both updated and previously established ILCOR recommendations. Recommendation strength and evidence certainty are presented separately. The article is a clinical interpretation of the supplied consensus summary, not an independent reappraisal of the primary evidence.
