It’s 02:47. Bay 6. The team is looking at you. You call the algorithm from memory — the same one you learned three years ago. You run the sequence, you call the drugs, you lead. What you don’t know is that two of those steps were quietly updated eight months ago.
That’s not a hypothetical. It’s a real possibility for any registered nurse who hasn’t checked whether the protocols they’re running on have kept pace with the evidence.
The resuscitation guidelines 2026 updates from ANZCOR aren’t a rewrite — they’re a living document revision, which is exactly what makes them easy to miss. Several guidelines under Section 11 (Adult ALS) were reviewed and updated in early 2026, incorporating ILCOR CoSTR evidence reviews from 2024 and 2025. For registered nurses in ICU, ED, CCU, and anaesthetic assist roles, these aren’t administrative footnotes — they directly affect drug sequencing, airway decisions, and post-ROSC management.
This article breaks down what changed in the ALS algorithm, medication protocols, advanced airway management, and post-resuscitation care — and what it means for your AHPRA CPD portfolio before your next renewal or credentialing review.
What Are the ANZCOR Resuscitation Guidelines 2026?
The ANZCOR resuscitation guidelines are evidence-based protocols developed by the Australian and New Zealand Committee on Resuscitation governing best-practice CPR, advanced life support, and post-resuscitation care across Australia. In 2026, several guidelines under Section 11 (Adult ALS) have been reviewed and updated, incorporating the latest ILCOR CoSTR evidence reviews through 2024-2025.
Key 2026 updates across Section 11:
- Guideline 11.2 — ALS protocols updated; ETCO2 monitoring now referenced as a trigger to pause compressions if ROSC is physiologically indicated
- Guideline 11.5 — Medications updated; IV access confirmed as preferred over IO, with IO as a reasonable alternative if IV cannot be achieved within two attempts
- Guideline 11.6 — Equipment and airway techniques updated; intubation should be deferred until after ROSC where possible to avoid compression interruptions
- Guideline 11.6.1 — Targeted oxygen therapy updated; post-ROSC SpO2 target of 90-96% reinforced; supplemental oxygen not routinely recommended without clinical indication
- Guideline 11.7 — Post-resuscitation therapy updated; seizure prophylaxis not recommended; seizure treatment mandatory; haemodynamic goal-directed care recommended post-ROSC
- Guideline 9.2.7 — Anaphylaxis first aid updated February 2026
- Guideline 14 — Acute coronary syndromes reviewed 2026; prehospital and ED focus maintained
📋 Guideline Update: Several ANZCOR Section 11 guidelines were reviewed and updated in early 2026. If your last ART or ALS certification was completed before mid-2024, your training may predate these updates. Jump to Section 6 to understand what this means for your AHPRA CPD portfolio.
What Changed in the 2026 ALS Algorithm | And Why It Matters at 3am
Out-of-hospital cardiac arrest survival in Australia sits stubbornly below 12% — and one of the reasons is the gap between what clinicians are running on and what the current cardiac arrest guidelines Australia actually recommend. Guideline 11.2 was updated as of 14 March 2026, and there are two areas where nurses working in monitored environments need to pay close attention.
Shockable Rhythms | VF and pVT Protocol Updates
The core position on immediate resumption of chest compressions after shock delivery hasn’t changed — you don’t pause for a pulse check unless there’s physiological evidence of ROSC already present. What has shifted is the explicit recognition of ETCO2 monitoring as a real-time ROSC indicator during active resuscitation.
If you have access to continuous ETCO2 monitoring, a rapid rise in end-tidal CO2 — or an organised arterial waveform if an arterial line is in situ — is now an ANZCOR-recognised basis to briefly pause compressions and check the rhythm. That’s a meaningful workflow change for ICU and ED nurses running monitored arrests with this equipment already connected. Defibrillation energy remains biphasic default at 200J, monophasic at 360J. For cardiothoracic post-surgical patients, up to three stacked shocks are permitted for the first attempt under Guideline 11.10.
A 58-year-old post-cardiac catheter patient arrests in the CCU. The senior nurse leads the response with a continuous arterial line already in situ. After the second shock, the arterial waveform shows a brief organised pulse pattern. Under 2026 ANZCOR guidance, that signal is sufficient to briefly pause compressions for rhythm analysis — rather than waiting for the standard cycle to complete. That’s the updated Guideline 11.2 ETCO2 and arterial waveform exception in practice.
Non-Shockable Rhythms | PEA and Asystole
PEA and asystole carry significantly worse outcomes than VF and pVT — the algorithm here hasn’t changed in its fundamentals, but the clinical stakes are worth stating plainly. Adrenaline 1mg IV or IO should be given as soon as feasible, then repeated every second loop of the ALS algorithm. Early adrenaline in non-shockable rhythms matters.
The 4Hs and 4Ts framework for reversible causes remains unchanged and stays the anchor point for non-shockable management. If you’re leading a code and the rhythm isn’t responding, you’re running that checklist in parallel — not after.
💡 Key Takeaway — ALS Algorithm: If you have access to continuous ETCO2 monitoring during a resus, a rapid rise in end-tidal CO2 is now an ANZCOR-recognised indicator to briefly pause compressions and check the rhythm. This is not a licence to pause routinely — it is a specific, physiologically grounded exception for monitored environments.
Medication Updates Under Guideline 11.5: What’s Current for Drug Sequencing
Guideline 11.5 is the most comprehensively evidence-supported guideline in the Section 11 update cycle — reviewed against ILCOR CoSTR evidence from 2018 through 2025. For nurses managing drug administration during codes, this is the section to be across.
IV vs IO Access: The Updated Preference Hierarchy
IV access is the confirmed preferred route during and after cardiac arrest. IO is a reasonable alternative — but only if IV cannot be achieved within two attempts. The 2026 guideline framing is explicit: rushing to IO before exhausting IV attempts is outside guideline recommendation. That’s a tightening from earlier guidance that treated IO as a more equivalent fallback, based on the 2024 ILCOR CoSTR systematic review published in Resuscitation (Vol. 205, December 2024).
💉 Key Takeaway — Medications: IV access is the preferred route. If you cannot establish IV within two attempts, IO is appropriate — but the 2026 guideline framing is clear: IO is an alternative, not an equivalent first choice.
Adrenaline and Amiodarone: Timing and Sequencing
| Drug | Rhythm | Dose | Timing |
|---|---|---|---|
| Adrenaline 1mg IV/IO | Non-shockable (PEA/asystole) | 1mg | As soon as feasible — every second loop |
| Adrenaline 1mg IV/IO | Shockable (VF/pVT) | 1mg | After 3rd shock — every second loop |
| Amiodarone IV/IO | Refractory VF/pVT | 300mg | After 3rd shock |
| Amiodarone IV/IO | Refractory VF/pVT (2nd dose) | 150mg | After 5th shock if required |
| Lignocaine IV/IO | Refractory VF/pVT | Per weight | Alternative where amiodarone unavailable |
Lignocaine remains the documented alternative to amiodarone where amiodarone is unavailable — not a routine substitute, but a clinically valid one when your crash cart doesn’t have what you need. The full drug sequencing detail and current dosing tables are available directly in the Guideline 11.5 PDF on anzcor.org.
Airway Management in 2026: What Guideline 11.6 Says About Intubation Timing
Updated as of 21 January 2026, Guideline 11.6 carries a message that runs counter to what a lot of experienced ICU and ED nurses were trained to do. If your default during a cardiac arrest has been to move toward intubation early — get the tube in, secure the airway, then manage the rhythm — the current ANZCOR position is more measured than that.
The Intubation Deferral Principle
The guideline is clear: defer intubation attempts until after ROSC where possible. The priority is uninterrupted chest compressions, and any airway intervention that risks interrupting those compressions is deprioritised until ROSC is achieved or physiologically indicated.
That applies to supraglottic airways too. SGA insertion — LMA, iGel — should also be deferred if it risks interrupting compressions. The principle isn’t device-specific. It’s compression-first, definitive airway second. The guideline also explicitly ties airway device selection to local training availability and operator competency — what works in a tertiary ICU with an experienced team is not the default for every clinical environment.
BVM and Supraglottic Airways Current Guidance
BVM remains first-line airway management during active CPR when advanced airway placement would interrupt compressions. It’s not a placeholder while you wait for someone more senior. Under current ANZCOR guidance, it is the recommended approach during arrest when compressions can’t be safely paused.
Once an advanced airway is placed — by whichever device is appropriate given the operator and the environment — ventilation continues at 6 to 10 breaths per minute without pausing compressions. One practical note if you’re working with CPR feedback devices: compressible surfaces like hospital mattresses can cause these devices to overestimate compression depth. The device reading isn’t always the compression depth being delivered to the patient.
Guideline 11.6 explicitly states that healthcare systems using advanced airways during resuscitation must address the adequacy of training, experience, and quality assurance for those performing the skill. Tube placement must be confirmed and secured without exception, and frequent retraining is required to maintain airway proficiency.
🫁 Key Takeaway — Airway: Unless ROSC has occurred or is physiologically indicated, advanced airway insertion should not interrupt chest compressions. BVM and deferral of intubation are not clinical failures — they are the current guideline-recommended approach under ANZCOR 11.6.
Post-Resuscitation Care: The 2026 Updates to Guideline 11.7 and Oxygen Therapy
ROSC is the moment the team exhales. It’s also the moment where a different set of clinical decisions takes over — and where the gap between current ANZCOR guidance and actual ward practice tends to be widest. Guidelines 11.7 and 11.6.1 were updated in February 2026, and the updates to oxygen therapy and seizure management are the ones that matter most for nurses receiving post-arrest patients.
Targeted Oxygen Therapy Guideline 11.6.1
The post-ROSC SpO2 target under current ANZCOR guidance is 90-96%. For patients with hypercapnic respiratory failure, that target narrows further to 88-92%.
Routine supplemental oxygen post-ROSC is not recommended without a clinical indication. Hyperoxia in the post-arrest period carries documented risk of cerebral injury — and it remains one of the more common practice gaps in post-resuscitation management, particularly where high-flow oxygen is a default rather than a decision. Supplemental oxygen is indicated where breathlessness, hypoxaemia, or signs of heart failure or shock are present.
A patient transferred to ICU post-arrest with SpO2 at 99% on high-flow oxygen is outside current ANZCOR guidance under Guideline 11.6.1. It’s a practice gap that updated training directly addresses.
Haemodynamic Goals and Seizure Management
Seizure prophylaxis is not recommended routinely post-cardiac arrest. Seizure treatment is mandatory if seizures occur. Prophylactic antibiotics are not recommended post-ROSC. Goal-directed haemodynamic care is recommended post-ROSC, with MAP targets guided by local protocol. Mechanical circulatory support currently has insufficient evidence to support or refute routine use. The distinction between prophylaxis and treatment on seizures is clinically significant — reaching for anticonvulsants routinely post-arrest is outside current guidance, but treating seizures aggressively when they occur is not optional.
Coronary Angiography and Underlying Cause Management
Where ST elevation or LBBB is present post-arrest, prompt consideration of angiography remains the position. The absence of ST changes doesn’t exclude coronary occlusion — clinical judgement is required, not a clear ECG as a green light to defer. Pulmonary embolism stays within the reversible cause framework.
ROSC is the beginning of post-resuscitation management, not the end of resuscitation. The interventions that follow ROSC significantly influence final neurological outcome — and the nurses managing that post-arrest window carry real clinical weight in how that outcome unfolds.
❤️ Key Takeaway — Post-ROSC: Target SpO2 90-96% post-ROSC. Routine high-flow oxygen is outside current ANZCOR guidance. Treat seizures aggressively if they occur — but do not prophylax routinely. Haemodynamic goal-directed care is recommended from the moment ROSC is achieved.
How Nurses Should Respond to These Updates: CPD, Credentialing, and Recertification
Reading about guideline updates and having a documented, auditable record of training that reflects those updates are two different things. For registered nurses managing AHPRA CPD portfolios and hospital credentialing requirements, the question isn’t just whether you know the 2026 ANZCOR changes — it’s whether your certification history shows that you do.
ANZCOR guidelines are updated on a rolling basis, and certification courses are expected to update their content within three to six months of a guideline revision. That means certifications completed before 2025 may not reflect the updated IV/IO access hierarchy under Guideline 11.5, the intubation deferral principle in Guideline 11.6, the post-ROSC oxygen targets in Guideline 11.6.1, or the seizure management positions in Guideline 11.7. The question to ask your training provider directly: “Is your course content aligned with current ANZCOR guidelines, including the 2026 Section 11 updates?”
ANZCOR-aligned resuscitation training contributes to AHPRA CPD under the category of maintaining professional knowledge and skills. For an AHPRA audit, documentation needs to be specific — certificate, provider details, and hours. A general reference to “resuscitation training” without a verifiable certificate from a registered provider won’t hold up under scrutiny.
| What AHPRA Audits Require | What to Have Ready |
|---|---|
| Certificate of completion | Issued by a registered RTO — digital, dated, named |
| Provider details | RTO name, registration number, course code |
| CPD hours | Documented against NMBA CPD registration standard |
| CPD category | Maintaining professional knowledge and skills |
| Guideline alignment | Course content current to ANZCOR at time of completion |
Credentialing requirements for ICU charge nurse, HDU, and anaesthetic assist roles are increasingly specifying external ART certification — not just internal hospital in-service completion. Hospital in-service training doesn’t always produce a portable, nationally recognised certificate, and that distinction matters when you’re applying for a role where credentialing is part of the assessment.
AHPRA renewal coming up? Don’t let an expired resuscitation certificate become a CPD audit problem. ART courses are available with same-week confirmation. [Check Available Dates →]
The resuscitation guidelines 2026 updates across Section 11 aren’t minor administrative revisions. The changes to ETCO2-guided compression pauses, the tightened IV access hierarchy, the intubation deferral principle, the post-ROSC oxygen targets, and the seizure management positions all have direct implications for how nurses practise during and after a cardiac arrest. Running on outdated protocols isn’t a reflection of poor clinical skill — it’s a reflection of training that hasn’t kept pace with the evidence. The two are easy to confuse, and an AHPRA audit or credentialing panel won’t always make the distinction.
If your last certification was completed before mid-2024, the practical step is straightforward. Find a registered provider whose course content is explicitly aligned to current ANZCOR guidelines, ask the question directly, and book a date that works around your roster. The certificate you leave with needs to be nationally recognised, digitally issued, and formatted for AHPRA CPD portfolio upload — not a printed attendance sheet from a hospital in-service that no one outside your ward will recognise.
The gap between knowing the current guidelines and having a documented, auditable record that proves it is smaller than most nurses think. A single course closes it.
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