Protocol for the Development of the Indian Guidelines for Pediatric Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care – 2026

Background: Pediatric cardiac arrest outcomes in India remain poor due to low bystander CPR rates, limited emergency medical services (EMS) responsiveness, variable hospital emergency response systems, and lack of context-specific training and guidance. While international guidelines (ILCOR, AHA, ERC) provide a strong scientific foundation, they are largely derived from high-income settings and require systematic adaptation to Indian healthcare realities. Objective: To develop India-specific, evidence-based pediatric CPR guidelines by adapting the latest global resuscitation science using a transparent, structured, and reproducible methodology. Methods: This protocol outlines a guideline development process based on the GRADE Evidence-to-Decision (EtD) framework. Priority clinical and system-level problem statements are converted into PICO questions. Evidence is synthesized from ILCOR 2025 CoSTR, AHA 2025, ERC 2025 guidelines, regional/Asian guidance, and India-/LMIC-specific systematic reviews. Where local evidence is limited or absent, structured expert consensus (Modified Delphi and Nominal Group Technique) is used. Recommendations are classified by strength and certainty, with explicit justification for Indian adaptation. Expected Output: The primary output will be the Indian Pediatric CPR Guidelines (2026), accompanied by algorithms, training materials, and implementation tools suitable for diverse Indian healthcare settings.