Post-ROSC Paediatric Care: Key Changes in ANZCOR Guideline 12.5
Return of spontaneous circulation is a major milestone, but it is not the end of paediatric resuscitation. The period after ROSC is vulnerable to recurrent instability, secondary organ injury and neurological complications. ANZCOR Guideline 12.5 provides the framework for care after circulation has been restored, and the 2026 update strengthens several elements of that framework.
Transfer to the right level of care
The updated guideline states that infants and children with ROSC after cardiorespiratory arrest should be admitted to a facility with the resources required for post-cardiac arrest care. The wording is broader than the previous description and supports a whole-system view of post-arrest management, including monitoring, organ support, neurological care and access to paediatric critical care expertise.
A higher blood pressure target
ANZCOR now recommends targeting a systolic or mean arterial blood pressure above the 10th percentile for age after ROSC. The previous guideline referred to maintaining systolic blood pressure above the fifth percentile. This change reinforces the need to identify and treat post-arrest hypotension promptly, using age-appropriate targets rather than a single adult value.
Targeted oxygenation and ventilation
The updated guidance recommends measuring arterial carbon dioxide after ROSC and targeting normocapnia, while allowing adjustment for patients in whom a standard target may not be appropriate, such as those with chronic lung disease, congenital heart disease or raised intracranial pressure.
It also recommends measuring arterial oxygen and selecting a target appropriate to the child’s condition. Where arterial oxygen measurement is not immediately available, an oxygen saturation target of 94% to 99% may be a reasonable alternative. The practical message is to avoid both inadequate oxygen delivery and unnecessary hyperoxia, with treatment titrated to reliable monitoring.
EEG, seizures and neurological prognostication
Continuous electroencephalogram monitoring should be considered within the first 24 hours after arrest, and seizures should be treated when they occur. Routine prophylactic anti-seizure medication is not advised.
The update also strengthens the approach to prognosis. No single test should be used in isolation to predict either a good or poor neurological outcome. Clinicians should combine clinical assessment, physiological data and appropriate investigations over time.
Debriefing is part of post-arrest care
ANZCOR now suggests post-event debriefing after paediatric cardiac arrest in all settings. Debriefing supports clinical learning, identifies system issues and gives teams a structured opportunity to reflect on communication, equipment, role allocation and decision-making.
Turning the update into a post-ROSC bundle
Services can use the guideline changes to build or revise a standard post-ROSC checklist. Key elements should include destination and retrieval planning, continuous monitoring, age-based blood pressure goals, controlled oxygenation and ventilation, glucose and temperature management, seizure surveillance, repeated neurological assessment, family communication and team debriefing.
The value of a checklist is not to replace clinical judgement. It is to reduce omissions during a fast transition from active resuscitation to complex critical care.
The practical takeaway
The 2026 update makes clear that post-arrest care must be deliberate, monitored and multidisciplinary. Achieving ROSC starts the next phase of resuscitation: protecting perfusion, controlling oxygen and carbon dioxide, detecting seizures, avoiding premature prognostic conclusions and ensuring the child reaches an appropriately resourced service.
Continue your training
PALS training should include the transition from arrest management to post-ROSC stabilisation, not stop at the first palpable pulse. Structured simulation helps clinicians practise that transition under pressure.
PALS1 – Paediatric Advanced Life Support
Primary clinical source: ANZCOR Guideline 12.5 – Management after Return of Spontaneous Circulation (ROSC)
Publication disclaimer: Educational summary only. It does not replace the full ANZCOR guideline, local policy, formal training or clinical judgement. Verify the current official guideline before publication or clinical use.
