Optimization of Cardiopulmonary Resuscitation: Strategies for Life-Saving Outcomes

Dear Colleagues,

While advances in resuscitation and international guidelines have improved patient care, survival after cardiac arrest still varies widely across systems and hospitals. Moreover, some cardiopulmonary resuscitation practices are based on low-certainty evidence or expert consensus. This Special Issue seeks studies that optimize CPR across the chain of survival - from early recognition, bystander response and dispatch to in-hospital resuscitation, post-resuscitation care and rehabilitation. We welcome research on context-adapted protocols, patient and setting profiles that guide therapy and pathways for advanced interventions including extracorporeal life support (ECLS). We are also interested in technologies that shorten detection-to-treatment intervals and sustain CPR quality including artificial intelligence, wearables and new mobile health devices. We aim to generate pragmatic evidence that improve outcomes and inform future guideline updates.

Scope and topics 

A specific emphasis is placed on areas where resuscitation guidelines rely on low-certainty evidence or expert consensus, aiming to address these critical knowledge gaps. While the scope is broad, the focus is on optimizing existing frameworks and integrating innovations, rather than completely reinventing CPR. Topics include, but are not limited to:

• Protocols: Standard resuscitation algorithms and their adaptations for specific settings (e.g., urban vs. rural EMS; surgery vs. cardiology vs. internal medicine wards); strategies for protocol implementation and validation; criteria for the termination of resuscitation
• Profiling: Etiology and location of cardiac arrest (e.g., out-of-hospital vs. in-hospital cardiac arrest); key respiratory and cardiovascular phenotypes
• Quality: Timing of interventions, performance metrics and their impact on outcomes; analysis of outcome variability (time-of-day, inter-operator differences, available equipment, adherence to resuscitation guidelines); role of point-of-care ultrasound (POCUS), arterial blood gases (ABG) and additional laboratory tests; management of critical events
• Pharmacological strategies: Goal-directed therapy (GDT); pathophysiology-guided use of vasopressors and antiarrhythmics; novel pharmacological agents
• ECLS/eCPR: Patient eligibility criteria for ECMO and pVAD; combined strategies; logistical models (“door-to-flow” metrics, transportation strategies); anticoagulation and hemodynamic targets
• Digital Health and Wearable Technology: Smartwatch and smartphone cardiac arrest detection; bystander alerting and automated AED/first-responder geolocation; CPR quality monitoring and feedback sensors
• AI/ML: Predictive modeling; adaptive and personalized therapies; data integration; model validation

Dr. Tomasz Darocha
Guest Editor

Dr. Konrad Mendrala
Guest Editor Assistant

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