Conflict of Interest Declaration
The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors were recused from the discussion as they declared a conflict of interest: not applicable. The following Task Force members and other authors declared an intellectual conflict of interest and this was acknowledged and managed by the Task Force Chairs and Conflict of Interest committees: not applicable.
Task Force Synthesis Citation
Nabecker S, Farquharson B, Eastwood K, Greif R, Schnaubelt S, Lennertz J, Alghaith A, Leslie B, Yeung J, Cheng A, Abelairas-Gomez C, on behalf of the International Liaison Committee on Resuscitation Education, Implementation, and Teams Task Force. Mental health and supportive interventions in healthcare professionals involved in cardiac arrests: Task Force Synthesis of a Scoping Review [Internet] Brussels, Belgium: International Liaison Committee on Resuscitation (ILCOR) Education, Implementation, and Teams Task Force, October 31, 2026. Available from: http://ilcor.org
Methodological Preamble
The continuous evidence evaluation process started with a scoping review of the available literature on mental health and supportive interventions in healthcare professionals involved in cardiac arrests and was conducted by members of the ILCOR Education, Implementation and Teams (EIT) Task Force.
Scoping Review
Nabecker S, Farquharson B, Eastwood K, Greif R, Schnaubelt S, Lennertz J, Alghaith A, Leslie B, Yeung J, Cheng A, Abelairas-Gomez C, on behalf of the International Liaison Committee on Resuscitation Education, Implementation, and Teams Task Force. Mental health and supportive interventions in healthcare professionals involved in cardiac arrests: A Scoping Review. In Draft.
PCC
The PCC (Population, Concept, Context)
Population: Any health care professional who responded to a cardiac arrest event
Concept: Mental health impact and supportive interventions
Context: In-hospital and out-of-hospital cardiac arrest in all contexts (adult, pediatric, neonatal)
Study Design: Randomized controlled trials (RCTs) and non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies, case series in which n≥5) are eligible for inclusion. Qualitative studies are also eligible for inclusion. Unpublished studies (e.g., conference abstracts, trial protocols), letters to editor, commentary, editorials, and studies related to trauma cardiac arrest are excluded. There will be no grey literature search performed. All languages are included as long as there is an English abstract.
Timeframe: All years from inception to 12 June 2026
Outcomes: Mental health outcomes (e.g. anxiety, depression, post-traumatic stress disorder) (critical)
Well-being: sickness, absence from work, intention to leave work, moral distress, work-related stress, burnout (important)
Physical effects (important)
Search Strategy
Articles for review are obtained by searching Web of Science, PubMed, PsycINFO, Medline, Cochrane, Embase, for all entries from database inception to 12 June 2026. The search strategy combined free-text keywords and controlled vocabulary terms relating to healthcare professionals, cardiac arrest/resuscitation, and psychological outcomes/support interventions. MeSH terms included headings such as ‘Health Personnel’, ‘Physician’s, ‘Nurses’, ‘Heart Arrest’, ‘Cardiopulmonary Resuscitation’, ‘Defibrillation’, ‘Mental Health’, ‘Anxiety’, ‘Depression’, and ‘Stress Disorders’, ‘Post-Traumati’c, alongside relevant keyword synonyms and variants.
Example:
Ovid MEDLINE(R) ALL <1946 to June 12, 2026>
1 Health personnel/ or Physicians/ or Physician assistants/ or Students, medical/ or exp Nurses/ or exp Nursing staff/ or Students, nursing/ or exp Emergency responders/ 451518
2 ((health* or medic* or hospital*) adj1 (personnel* or worker* or provider* or professional* or staff*)).ti,ab. 336132
3 (nurs* or nursing).ti,ab. 600664
4 (paramedic* or paramedical* or paramedicin* or firefighter* or police).ti,ab. 35688
5 (physician* or doctor* or feldsher* or fellow* or resident* or surgeon*).ti,ab. 1219741
6 (prehospital* or "pre-hospital*").ti,ab. 26139
7 ((student* or learner*) adj1 (nurs* or medical*)).ti,ab. 96654
8 (emergenc* adj1 medical* adj1 technic*).ti,ab. 1480
9 (respond* adj1 (emergenc* or first*)).ti,ab. 5346
10 (emt or hcp or hcw).ti. 6337
11 or/1-10 2202925
12 Heart arrest/ or Out-of-hospital cardiac arrest/ or exp Resuscitation/ or exp Cardiopulmonary resuscitation/ or Defibrillators/ 141332
13 ((heart* or cardiac* or cardio*) adj2 (arrest* or attack*)).ti,ab. 68674
14 ("sudden heart death" or "sudden cardiac death" or (sudden adj1 death)).ti,ab. 44818
15 (resuscitat* or "code blue").ti,ab. 86828
16 ((basic* or advanc*) adj2 "life support*").ti,ab. 7728
17 ((heart* or cardiac*) adj1 massage*).ti,ab. 1455
18 (respiration* adj2 (artificial* or mechanic*)).ti,ab. 2062
19 defibrillat*.ti,ab. 34617
20 (ohca or ihca or cpr or aed).ti. 3971
21 or/12-20 280411
22 Mental health/ or Anxiety/ or Depression/ or Stress, Psychological/ or Stress Disorders, Post-Traumatic/ or Grief/ or Psychological Distress/ or Psychological well-Being/ or Resilience, psychological/ 508559
23 (mental* adj2 (effect or effects or affect* or impact* or health)).ti,ab. 301885
24 (wellness or wellbeing or "well being" or resilien*).ti. 74058
25 (recover* adj2 psychological*).ti,ab. 1079
26 (stress* adj2 (psychologic* or emotion* or individual* or disorder* or experience* or situation*)).ti,ab. 103501
27 (anxious* or anxiet* or depress* or grief or distress* or harm*).ti. 380334
28 (("mental health" or psychologic*) adj2 (therap* or support* or interven*)).ti,ab. 46201
29 ((traumatic* or psychologic* or work* or job or profession* or occupation*) adj2 stress*).ti,ab. 65743
30 "post traumatic stress*".ti,ab. 24300
31 ptsd.ti. 9769
32 or/22-31 1026234
33 11 and 21 and 32 1140
34 limit 33 to (guideline or meta analysis or practice guideline or "review" or "scoping review" or "systematic review") 172
35 33 not 34 968
36 (20250828* or 20250829* or 20250830* or 20250831* or 202509* or 202510* or 202511* or 202512* or 2026*).dt,ez,da. 1707023
37 33 and 36 66
Inclusion and Exclusion Criteria
Inclusion Criteria: all studies describing mental health and supportive interventions for healthcare professionals who responded to cardiac arrest across all settings (in/out-of-hospital) and patient populations (adult, pediatric, neonatal).
Exclusion Criteria: Studies exploring mental health and supportive interventions where participation in cardiac arrest resuscitation was only one factor amongst several others (e.g., long term mental health, PTSD, anxiety, depression of emergency medical services personnel or staff members in the emergency department).
Data Tables
EIT 6316 Data Tables October2026
Task Force Insights
1. Why this topic was reviewed
In 2025, the EIT task force conducted a scoping review on the impact of support on mental health in co-survivors of cardiac arrest patients. However, no relevant studies were identified.16 Consequently, the task force expanded the scope of the review to include healthcare professionals involved in cardiac arrest resuscitation across all settings (in and out-of hospital) and patient populations (adult, pediatric, neonatal).
Work-related stress has increased significantly over the past few decades, especially among professionals working in high-stress environments such as healthcare.17 Healthcare professionals are also regularly exposed to emotionally demanding situations while delivering complex medical care and treatment to patients.18 Performing cardiopulmonary resuscitation (CPR), for example, has been associated with acute post-traumatic stress symptoms6 that, if persistent, may culminate in mental disorders and other chronic conditions.19
Despite this psychological and emotional burden, data about the psychological impact of participating in cardiac arrest resuscitations is lacking. It is unclear if there are any effective post-resuscitation psychological supports available and their impact on the long-term wellbeing of healthcare professionals. Emerging literature suggests that structured psychological support interventions may reduce stress exhaustion and have a protective effect on longer-term mental health.6,20 However, the quality and consistency of evidence remain variable, and no formal evidence synthesis has been conducted specifically for post-cardiac arrest support in healthcare professionals.
In 2023, the publication ‘Ten steps to improve in-hospital cardiac arrest care and outcomes’ highlighted the importance of healthcare professionals’ well-being, with Step 10 emphasizing the responsibility of healthcare systems to support staff involved in resuscitation care.21 Given this increasing awareness within resuscitation systems of care, a scoping review of this topic is both timely and necessary.
2. Narrative summary of evidence identified
The literature search retrieved 5508 citations, after duplicate removal, 4698 studies were screened, 63 full texts were assessed, and 15 studies were included. There was one descriptive study1, six cross-sectional studies5,7,9,10,12,13, four qualitative studies2,8,14,15, and four mixed-methods studies.3,4,6,11 Nine studies reported mental health outcomes after adult cardiopulmonary resuscitation1-9, five studies reported mental health outcomes specifically after attending cardiac arrests in patients with a do-not-attempt-resuscitation order or after patient death10-14, and one study reported mental health outcomes after resuscitation of extremely premature infants.15 Studies were conducted in the following settings: four with critical care nurses1,4,5,11, three with doctors and nurses from different departments6,7,9, two in the emergency department2,13, three with Emergency Medical Services10,12,14, one with internal medicine residents3, one with novice nurses8, and one with neonatal nurses.15
Across included studies, responding to cardiac arrests and performing cardiopulmonary resuscitation was consistently associated with elevated rates of post-traumatic stress symptoms, post-traumatic stress disorder (PTSD), and general psychological stress.1-15 PTSD rates ranged from 5% to 11.2% in quantitative surveys.6,7,13 One study reported an overall PTSD prevalence of 11.2% among healthcare professionals6, while another found that 9.6% screened positive for PTSD and an additional 46.7% experienced between 1 and 5 trauma symptoms.7 In specific sub-populations, 7% of internal medicine residents3 and 19.4% of pediatric emergency/ICU nurses11 met thresholds for probable PTSD or high impact on the Impact of Event Scale (IES). Qualitatively, professionals described intrusive visual images, intrusive thoughts, CPR-related nightmares, avoidance, and hyperarousal.3,4,11
Beyond PTSD, high levels of general post-code stress, burnout, and secondary traumatic stress were widely documented.1,5,9,10 One study observed moderate overall post-code stress (59.98%), moderate burnout, and moderate-to-high secondary traumatic stress among intensive care unit (ICU) nurses1, demonstrating that post-code stress significantly predicted increases in burnout (
Specific clinical scenarios exacerbated psychological and moral burden. Studies investigating resuscitations involving do-not-attempt-resuscitation (DNACPR) orders, unsuccessful outcomes, or pediatric/neonatal patients highlighted distinct stressors.10-15 Unclear DNACPR directives and ethical dilemmas surrounding resuscitation attempts were major sources of emotional distress.4,12,13 One study observed that 30% of emergency medical technicians (EMTs) transporting do-not-resuscitate out-of-hospital cardiac arrest (OHCA/DNACPR) patients experienced high emotional stress.12 High stress was strongly associated with family physician transport orders (AOR 4.74, 95% CI: 2.35-9.56) and prehospital defibrillation (AOR 20.7, 95% CI 3.10-137.9), and high-stressed EMTs were significantly more likely to perform "slow codes - a controversial medical practice where a healthcare team responds to a patient in cardiac arrest with deliberately delayed, half-hearted, or incomplete resuscitation efforts" (76% vs. 61%).12 In hospital settings, performing a "slow code" (adjusted OR 5.09, 95% CI 1.68-17.87) and holding ethical concerns regarding the practice were strong predictors of high emotional stress.13
Resuscitations involving children or extremely premature infants generated unique moral and emotional trauma.11,14,15 Qualitative investigations revealed that pediatric deaths elicited intensified grief, rumination, sleep disruption, and hypervigilance due to professional empathy and suddenness of death.11,14 In neonatal ICUs, one study identified key sources of moral distress during resuscitation decision-making for extremely premature infants (22-25+6 weeks gestation), including profound uncertainty regarding long-term outcomes, questioning parent informed consent under acute distress, inter-professional conflict, and the perception of inflicting unnecessary harm or suffering on the infants.15
Psychological vulnerability varied across professional roles, clinical experience, and gender. Female healthcare professionals consistently reported higher levels of post-code stress, PTSD symptom severity, and moral distress intensity compared to their male counterparts across multiple quantitative studies.3,5,9,13 Nurses consistently demonstrated higher vulnerability to post-traumatic stress symptoms, PTSD, and moral distress than physicians.6,13 For instance, one study showed that nurses comprised 90.6% of the probable PTSD group, compared to 12.5% of doctors (
p=0.013p=0.013)6, and another study noted significantly higher moral distress scores in nurses compared to physicians (p<0.001p<0.001).13 Less experienced clinicians and junior staff were at elevated risk.6-8 One study found that Foundation Year 1 doctors and healthcare assistants (HCAs) had significantly higher Trauma Screening Questionnaire (TSQ) trauma scores and risk of PTSD compared to nurses or more senior doctors.7 Similarly, another study identified nurses with 2–5 years of experience as the most vulnerable group,6 while yet another study noted that novice nurses experienced severe emotional stress driven by inadequate knowledge reserves, skill deficits, and post-rescue psychological exhaustion.8
The psychological sequelae of CPR significantly impacted professional practice, workforce retention, and coping behaviours. Positive PTSD screening was directly associated with impaired work performance.3 One study reported that 26.0% of staff experienced a significant loss of professional confidence following cardiac arrests, 19.2% felt resentment toward returning immediately to work, and 16.3% had considered leaving healthcare employment entirely due to traumatic resuscitation experiences.7
Moral distress was prevalent when professionals felt resuscitations were futile or contrary to patient best interests.9,13,15 One study reported high total moral distress intensity (
89.6±12.489.6±12.4) and frequency (52.5±11.352.5±11.3), with moral distress frequency being directly correlated with the total number of resuscitation exposures (r=0.249,p<0.001r=0.249,p<0.001).9 Moral distress intensity and frequency were also significantly correlated with intentions to leave the clinical unit.9 While problem-focused coping was commonly utilized, passive strategies such as endurance, self-distraction, and emotion-focused coping correlated with higher perceived stress.5,6,10 Colleagues and trusted peers were overwhelmingly favored for debriefing and emotional processing.2,6,14 Conversely, staff rarely utilized formal institutional psychological services, even when available, due to stigma or reliance on informal networks.6,14
Rest periods immediately following resuscitation attempts served as a vital protective factor; staff who never took a break after an in-hospital cardiac arrest exhibited significantly higher PTSD frequency (
p=0.04p=0.04) and higher trauma screening scores (p=0.05p=0.05).7 While institutional debriefings were generally perceived as supportive (72.4% feeling more supported)7 and negatively correlated with trauma scores following non-fatal resuscitations (p=0.02p=0.02),7 findings on debriefing efficacy were mixed.5,7,13 One study highlighted a "debriefing paradox," where nurses with institutional debriefing support reported significantly lower post-code stress scores (50.5±9.250.5±9.2 vs. 53.5±9.5, p=0.00153.5±9.5, p=0.001) but paradoxically higher PTSD symptom severity scores (32.8±21.432.8±21.4 vs. 19.0±16.9, p=0.00119.0±16.9, p=0.001).5
Summary of evidence
Responding to cardiac arrests and performing cardiopulmonary resuscitation (CPR) can be associated with psychological distress among healthcare professionals. Evidence from 15 studies suggests increased rates of post-traumatic stress disorder, general post-resuscitation stress, burnout, and moral distress following involvement in resuscitation events. Subclinical trauma is widespread, with up to 46.7% of clinicians experiencing trauma symptoms. Emotional and moral distress are significantly exacerbated by ethical dilemmas around do-not-attempt-resuscitation (DNACPR) orders and pediatric or neonatal resuscitations. Female healthcare professionals, nurses, and less experienced clinicians may be particularly vulnerable. The available evidence also suggests that these psychological effects may adversely influence professional confidence, perceived work performance, and retention within the workforce, although a direct causal relationship between participation in CPR and these outcomes cannot be established. Healthcare professionals commonly report relying on informal peer support rather than formal institutional psychological services. Limited evidence suggests that immediate post-resuscitation rest breaks may help mitigate post-traumatic stress symptoms.
Healthcare organizations should recognize that healthcare professionals involved in cardiac arrest resuscitation may experience psychological distress and should consider implementing strategies to support staff well-being. Further research is needed to determine the effectiveness of specific support interventions and to identify the most effective approaches for reducing the psychological impact of resuscitation events on healthcare professionals.
3. Narrative Reporting of the task force discussions
- The task force decided to only include studies in this review that are clearly linked to cardiopulmonary resuscitation and exclude studies in which mental health is assessed but cardiopulmonary resuscitation was only one factor (e.g., long-term mental health of healthcare professionals who are regularly exposed to emergencies – EMS, personnel of an emergency department or ICU etc).
- Literature is limited, and most studies do not comment on the regularity of the cardiac arrest events the healthcare professionals responded to. Exposure could only be indirectly inferred from the study population and setting (e.g., novice nursing students compared with experienced intensive care nurses). The frequency of cardiac arrest resuscitations per provider was unknown.
- Of the 15 studies included, 9 studies reported mental health outcomes after cardiac arrest resuscitation attendance, 5 studies reported mental health outcomes specifically after attending cardiac arrest resuscitations with a do-not-resuscitate order in place or where the patient died, and 1 study reported on mental health after resuscitation of extremely premature infants. Due to the scoping review nature of the report, we decided to report all 3 categories within the same report.
- The task force acknowledges that only self-reported stress (although evaluated using validated tools) was used in the source data for this scoping review.
- Evidence specific to pediatric resuscitation was limited, with most studies reporting combined adult and pediatric populations. Only one study focused exclusively on neonatal resuscitation. Given the paucity of pediatric-specific data, mental health outcomes were not analyzed separately for adult and pediatric cardiac arrest resuscitations.
- Some studies are specifically focusing on DNACPR situations, or unsuccessful resuscitation. The task force acknowledges that the clinical context may influence the psychological impact associated with cardiopulmonary resuscitation.
- The task force acknowledges that mental health of healthcare professionals is an important healthcare concern and may represent an under-researched area within resuscitation research. This has potential implications for healthcare workforce management and healthcare delivery costs.
- The task force acknowledges a possible selection bias in the available evidence. Survey- and questionnaire-based studies may be susceptible to under-reporting, as participation may be more likely among individuals who have been either particularly affected or largely unaffected by their resuscitation experiences.
- The Task Force further acknowledges that the specific contribution of cardiopulmonary resuscitation to adverse mental health outcomes remains uncertain. Much of the available evidence originates from emergency medicine and intensive care settings, where healthcare professionals are exposed to multiple sources of psychological stress. As a result, establishing a causal relationship between participation in resuscitation efforts and mental health outcomes is challenging
Knowledge Gaps
- Amongst healthcare professionals who responded to a cardiac arrest in any setting, it remains unclear whether debriefing interventions specifically designed to reduce post-resuscitation stress and improve post-resuscitation mental health are more effective than skill-focused debriefing in improving mental health outcomes.
- Amongst healthcare professionals who respond to cardiac arrest in any setting, it is unknown whether any specific psychological interventions, compared to no intervention, improve short- or long-term mental health outcomes.
- Amongst healthcare professionals who responded to a cardiac arrest in any setting, it is unknown whether the setting (adult vs. pediatric vs. neonatal) has an impact on mental health outcomes.
- Amongst healthcare professionals who responded to cardiac arrest in any setting, it is unknown what impact mental health effects have on workforce management and cost to the healthcare system.
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