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Guidelines Process

Authors
Gavin Perkins
Published 27 October 2025
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  • The International Liaison Committee on Resuscitation (ILCOR) includes representation from the American Heart Association (AHA), the European Resuscitation Council (ERC), the Heart and Stroke Foundation of Canada (HSFC), the Australian and New Zealand Committee on Resuscitation (ANZCOR), the Inter-American Heart Foundation (IAHF), Indian Resuscitation Council Federation (IRCF), International Federation of Red Cross and Red Crescent, Resuscitation Council of Asia (RCA) and the Resuscitation Councils of Southern Africa (RCSA).  
  • ILCOR is organised into six Task Forces which cover the major domains of resuscitation science and practice – Basic Life Support, Advanced Life Support, Paediatric Life Support, Neonatal Life Support, First Aid and Education, Implementation and teams.  
  • ILCOR is responsible for the production of the International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR), which member organisations subsequently use to develop guidelines.
  • ILCOR has continued with its commitment to a continuous evidence-evaluation process, which began in 2015, with topics prioritised for review by the task forces and with CoSTR updates published annually.  
  • For the 2025 CoSTR, the ILCOR task forces undertook three types of evidence evaluation: systematic reviews (n=96), scoping reviews (n=43), and evidence updates (112), which covered over 250 topics in total.  Further information on the methodological approach is summarised in the Methodology and Conflict of Interest Management: 2025 International Liaison Committee on Resuscitation Consensus on Science with Treatment Recommendations. This document also describes ILCOR’s approach to managing conflict of interest.  
  • Treatment recommendations were developed based on findings from systematic reviews which were conducted in accordance with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The findings from each systematic review were presented to the task force, and the task force drafted the summary CoSTR. Each treatment recommendation indicated the strength of the recommendation and the certainty of the evidence.
  • All ILCOR CoSTR updates were open for public comment before final publication. 
  • The ERC guideline development process followed the principles of the Institute of Medicine Quality Standards for Clinical Practice Guidelines and the Guideline International Network Recommendations.
  • Full information of the approach used are available in the Executive Summary of the ERC guidelines.
  • In brief, guideline writing groups were appointed following review of conflict of interests, to ensure a balance of expertise, multi-professional representation, diversity and geography. Content experts from sister professional societies were also invited to participate. The ERC policy for management of conflict of interest was adhered to throughout the guideline development process.  
  • The ERC guidelines are based on the ILCOR 2025 CoSTR.
  • For the ERC Guidelines, the ILCOR recommendations were supplemented by focused literature reviews undertaken by the ERC Writing Groups for those topics not reviewed in the 2025 ILCOR CoSTR.
  • When required, the guidelines were informed by the expert consensus of the writing group’s membership.
  • The ERC guidelines were drafted and agreed upon by the Writing Group members before posting for a two-week public consultation period. Post consultation and review, revised guidelines were approved for publication by the ERC General Assembly. 
  • The RCUK guidelines are distilled from the ERC guidelines and, where necessary, supplemented by focused literature reviews. The RCUK Guidelines Working Group was established to review each section to ensure relevance and alignment to UK practice. Each section was reviewed by a working group including RCUK experts as well as representatives from other professional and public organisations. No further public consultation was carried out as there were no material changes, and the guidelines had already been subjected to public scrutiny as part of the ILCOR and ERC process. Guidelines were reviewed for adherence to current UK practice and to include specific UK systems. RCUK completed an impact assessment review on the final documents.
  • The RCUK guidelines adhere to the principles outlined by the National Institute for Health and Care Excellence (NICE) Guidelines Development Process Manual, to ensure quality, consistency and transparency.
  • The guidelines process includes:
    • Systematic reviews with grading of the quality of evidence and strength of recommendations.
    • The involvement of stakeholders from around the world, including members of the public, cardiac arrest survivors and stakeholder organisations.
    • An equality and impact assessment considering the UK context.  

RCUK is committed to promoting equality, eliminating unlawful discrimination and actively considering the implications of its guidance for human rights. It aims to comply fully with the Equality Act (2010).

Download the Guidelines impact assessment. 

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