Resuscitation Council UK Guidelines 2025: what actually changed

The 2025 edition superseded 2021 on 27 October 2025. These are the differences that change what you do, and the ones most likely to be examined.

Resuscitation Council UK published Guidelines 2025 on 27 October 2025. It supersedes the 2021 edition entirely. If your revision material still cites RCUK 2021, some of it is now wrong — and the changes are exactly the sort of specific, numerical detail that examiners like.

One thing that has not moved: anaphylaxis. The emergency treatment of anaphylactic reactions guideline dates from 2021 and sits outside Guidelines 2025 — anaphylaxis is not one of the 2025 chapters. Citing "RCUK 2025" for an anaphylaxis answer is a small error that is easy to make.

Adult advanced life support

• Pulsed biphasic defibrillation is now its own energy category at 130–150 J, against ≥150 J for other biphasic waveforms. Previously these were not distinguished.
• The lateral pad goes below the armpit in the mid-axillary line.
• Calcium, sodium bicarbonate and corticosteroids are explicitly not given routinely.
• In a witnessed, monitored arrest, three stacked shocks count as the first shock for the purpose of drug timing.
• CPR-induced consciousness is addressed for the first time, and extracorporeal CPR runs through the whole edition.

Post-resuscitation care

This is where the most examinable change sits.

• PaCO₂ target 4.7–6.0 kPa.
• A dual-phase whole-body CT including CT pulmonary angiography is recommended for cause-finding, alongside echocardiography.
• Post-arrest seizures: levetiracetam or sodium valproate. No prophylaxis.
• Comatose patients arriving at 32–36 °C are not actively warmed.
• Pulse oximetry is noted to overestimate saturation in darker skin tones.

Special circumstances

• Hyperkalaemia: sodium zirconium cyclosilicate 10 g orally for removal from the body. In hyperkalaemic arrest, calcium chloride plus 50 mmol sodium bicarbonate.
• Hypothermia is staged by the Swiss system. Adrenaline intervals are 6–10 minutes between 30 and 35 °C rather than the older vague instruction to double the interval, and there are explicit ECPR transfer criteria.
• Local anaesthetic toxicity takes a reduced adrenaline dose of ≤1 µg/kg — not the standard 1 mg. This one catches people out.
• Maternal arrest adds the 4Ps to the 4Hs and 4Ts.
• Traumatic arrest: continue compressions unless they delay correction of the reversible cause.

Paediatric

• 30:2 is stated for rescuers not trained in paediatric BLS.
• Depth must never exceed 6 cm at any age.
• Defibrillation at 4 J/kg, capped at 120–200 J.
• In obesity, most resuscitation drugs are dosed from ideal body weight.

Newborn

What to do with this

If you are revising from anything written before late 2025, check every resuscitation number against the current chapter before you commit it to memory. The changes above are small in wording and large in consequence, which is precisely why they get examined.

Written for doctors preparing for postgraduate examinations. It is a revision aid, not clinical advice, and guidance changes — always work from the current guideline and your local protocols. Resus Review is independent and is not affiliated with or endorsed by the Royal College of Emergency Medicine, NICE, or Resuscitation Council UK.