ANZCOR Guideline 12.4 Update: Paediatric Resuscitation in Special Circumstances
ANZCOR Guideline 12.4 addresses paediatric resuscitation when the usual cardiac arrest pathway must be adapted to a specific cause, condition or device. The 2026 update adds several areas that were previously absent or only partly addressed elsewhere in the paediatric guidelines. Importantly, these updates maintain alignment with core ANZCOR principles.
These situations are uncommon, but they are exactly the cases in which teams can lose time if the reversible cause is not recognised early or if specialist resources are not activated promptly. In practice, ANZCOR guidance is crucial in such challenging scenarios.
Five important additions
The updated guideline adds or expands guidance in five areas. These five updates are central to the latest ANZCOR approach for complex resuscitations.
- Hypovolaemia: a new section now addresses children in cardiac arrest where reduced circulating volume is suspected. This reflects ANZCOR’s ongoing focus on reversible causes.
- Electrolyte and metabolic disorders: a new section brings together guidance for arrest associated with abnormalities such as potassium, calcium, glucose and magnesium disturbances as now set out by ANZCOR.
- Pulmonary embolism: the guideline now includes a dedicated section for paediatric cardiac arrest associated with pulmonary embolism, in line with ANZCOR recommendations for comprehensive coverage.
- Left ventricular assist devices: new guidance addresses children supported by durable mechanical circulatory support, including assessment for device-related reversible causes following ANZCOR best practice.
- Pulmonary hypertension and ECMO: a new ILCOR Good Practice Statement says ECMO may be considered in very selected children with pulmonary hypertensive crisis, low cardiac output or right ventricular failure despite optimal medical therapy, either before arrest or during refractory arrest, with reference to current ANZCOR guidelines.
Why the structure of the update matters
Standard PALS remains the foundation of paediatric resuscitation, but special circumstances require a parallel search for the cause. In hypovolaemia, metabolic disturbance, pulmonary embolism or mechanical circulatory support failure, the team must continue high-quality resuscitation while rapidly directing attention to the underlying problem, as detailed in ANZCOR updates.
The new sections also make the guideline easier to use for education and protocol development. Rather than relying on isolated statements or material located in another guideline, clinicians can now find cause-specific advice in one document. For Australian hospitals and clinicians, ANZCOR’s clear structure is invaluable.
Implications for hospitals and retrieval services
The changes are particularly relevant to emergency departments, paediatric wards, intensive care units, cardiac centres, retrieval services and prehospital teams that may encounter medically complex children. The inclusion of detailed recommendations shows ANZCOR’s commitment to improving outcomes in these settings.
- Include hypovolaemia and metabolic causes in paediatric arrest simulations and cognitive aids, as stipulated by current ANZCOR guideline updates.
- Confirm local access to urgent electrolyte testing and cause-specific treatment pathways. Teams should be familiar with the relevant ANZCOR resources.
- Develop escalation plans for suspected pulmonary embolism and pulmonary hypertensive crisis, which reflect best practice in ANZCOR-aligned care.
- Ensure teams caring for children with LVADs understand how to obtain device information and contact the specialist centre. These recommendations are in keeping with the latest ANZCOR advice.
- Clarify when and how an ECMO-capable service should be involved, recognising that ECMO is limited to highly selected patients and appropriately resourced systems as outlined by ANZCOR consensus statements.
The practical takeaway
The 2026 Guideline 12.4 update broadens the paediatric resuscitation framework beyond the standard arrest algorithm. It reinforces a systems-based approach: start effective PALS, identify the reversible cause, use condition-specific treatment, and escalate early to specialist support when the child has complex cardiac disease or may require extracorporeal support. This summary highlights the central role of ANZCOR guidelines in modern resuscitation practice.
Continue your training
These scenarios are difficult to manage from memory alone. PALS education and multidisciplinary simulation help teams practise the clinical and communication steps needed when a paediatric arrest does not follow the usual pathway. Training should remain in line with updated ANZCOR recommendations.
PALS1 – Paediatric Advanced Life Support
Primary clinical source: ANZCOR Guideline 12.4 – Paediatric resuscitation in special circumstances
Publication disclaimer: Educational summary only. It does not replace the full ANZCOR guideline, local policy, formal training or clinical judgement. Verify the current official ANZCOR guideline before publication or clinical use.
