Personalization in Cardiopulmonary Resuscitation: The Way Forward?

Cardiopulmonary resuscitation (CPR) has traditionally followed standardized, algorithm-based protocols designed to ensure quality and generate a large pool of a broad cadre of providers capable of delivering effective resuscitation. While this model has improved survival rates, it overlooks the considerable variability in patient physiology, arrest etiology, and treatment response. A growing body of clinical insight and research supports the concept of personalized CPR, in which resuscitative efforts are tailored to the real-time physiological and contextual needs of the patient. The key principle of personalized CPR is the integration of continuous physiologic monitoring—such as diastolic blood pressure (DBP), end-tidal carbon dioxide (EtCO 2 ), coronary perfusion pressure (CPP), and regional cerebral oxygen saturation (rSO 2 )—to guide compression mechanics, vasopressor timing, and defibrillation. These metrics allow clinicians to dynamically adjust interventions to maximize systemic perfusion and cardiac output. This strategy is most feasible in critical care settings, where invasive monitoring is carried out on a routine basis and experienced personnel are readily available. Hemodynamic-directed resuscitation, particularly using CPP or diastolic pressure as primary targets, has been associated with improved return of spontaneous circulation and superior intra-arrest physiology. Transesophageal echocardiography has demonstrated value in guiding chest compression placement to optimize stroke volume. Advanced feedback technologies and automated compression devices further enhance precision and consistency during resuscitation. Personalized CPR goes beyond physiologic monitoring. In cases of refractory cardiac arrest (CA), the use of extracorporeal membrane oxygenation (ECMO) as a resuscitative adjunct offers a highly individualized intervention aimed at restoring circulation in patients unresponsive to conventional management efforts. Emerging evidence suggests that early ECMO initiation in carefully selected patients can improve survival and neurological recovery, particularly in CA caused by reversible etiologies. Training and system design are also integral components of personalized resuscitation. Simulation-based training programs are essential to equip code teams with the skills to interpret physiological data, apply advanced technologies, and make real-time decisions under pressure. A tiered, hierarchical model of care—beginning with universal basic life support and progressing to advanced, patient-specific interventions—ensures structured implementation while allowing adaptability across settings. Despite these advances, widespread adoption of personalized CPR remains constrained by resource availability, lack of formalized guidelines, and variability in infrastructure. Most implementation has been confined to high-resource environments, and further research is needed to validate outcomes and standardize protocols for broader use. While challenges remain, early clinical experience and technological progress suggest that this approach holds substantial promise for improving the precision, effectiveness, and outcomes of CPR.