There are many ethical issues surrounding pediatric resuscitation: When are resuscitation attempts futile? Is the ED physician obligated to provide care at the families’ insistence? How family religious beliefs play a role in decision making? What is the role of parental presence? Should procedures be performed on the recently dead? Can resuscitation research be performed without informed consent? Some of these issues have been addressed in policy statements made by professional organizations, but each question needs to be considered in discussions that occur at the local ED level In response to these varied, complex, and often highly charged issues, postresuscitation debriefing has become a vital component of the pediatric resuscitation Consider taking a few minutes for critical reflection following the completion of the resuscitation event; this has the potential to enhance teamwork and communication, and provides an opportunity to improve future performance through group reflection on the shared experience KEY POINTS The vast majority of out of hospital pediatric cardiac arrests (OHCAs) are asphyxial and both survival and neurologic outcomes are poor Recognition of impending respiratory and circulatory failure and immediate intervention can be truly lifesaving VT/VF is estimated to occur in less than 10% of pediatric OHCA IO is the preferred access for arrested patients, as well as for patients with severe hypotension or other severely ill patients where attempt at IV access is prolonged Resuscitation of newly born infants follows an algorithm with notable differences from that of older infants and children Airway management and high-quality chest compressions are the key resuscitation interventions All EDs should have program for continuous quality improvements around the care of critically ill children Strong leadership and teamwork with closed-loop communication are essential EDs should have practice simulations and skills sessions to assure competency in knowledge and critical resuscitation skills