ANZCOR has released the updated Guideline 12.2 – Paediatric Advanced Life Support (PALS), introducing several important changes across airway management, CPR delivery, monitoring, and family-centred care in paediatric resuscitation.
Key updates in this release include:
• Earlier commencement of CPR for unresponsive infants and children with absent or agonal breathing
• Updated guidance supporting immediate chest compressions while awaiting bag-mask ventilation equipment
• Preference for bag-mask ventilation initially in out-of-hospital paediatric cardiac arrest, with advanced airway insertion only where expertise and conditions allow minimal interruption to CPR
• New recommendation supporting cuffed tracheal tubes for emergency intubation in infants (>28 days and >3kg) and children
• Updated ventilation rate guidance after placement of a secure airway
• Stronger recommendation for the two-thumb encircling chest compression technique in infants
• Reduced initial crystalloid bolus recommendation for hypovolaemic arrest to 10 mL/kg
• Recommendation for anterior-posterior defibrillation pad placement in infants and children
• Reinforcement of a single-shock defibrillation strategy followed by immediate CPR
• New guidance supporting use of ETCO₂ monitoring and invasive blood pressure targets during paediatric cardiac arrest where available
• Expanded recommendations supporting family presence during resuscitation, including development of formal institutional policies and staff education
The updated guideline reflects evolving international evidence with a continued focus on minimising interruptions to CPR, improving physiologic monitoring during resuscitation, and supporting both patient and family-centred care.
These changes represent a significant evolution in contemporary paediatric advanced life support practice across both pre-hospital and hospital settings.
Read the full guideline update here:
Guideline 12.2 – Paediatric Advanced Life Support (PALS)
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