Top Things to Know: 2025 AHA Guidelines for CPR and ECC
- A Universal Chain of Survival was developed for both pediatric and adult in-hospital and out-of-hospital cardiac arrest. A Neonatal Chain of Care was also developed to guide care for prenatal care to postnatal follow up.
- The treatment of severe foreign body airway obstruction (FBAO) has been streamlined for consistency. For both adult and pediatric patients with severe FBAO rescuers should administer alternating cycles of 5 back blows and 5 abdominal thrusts, starting with back blows.
- For infants, chest compressions should be performed using the heel of one hand or the two- thumb technique, specifically eliminating the two-finger technique for infant chest compressions.
- An emphasis was placed on policies to enhance public availability and use of naloxone for suspected opioid-related emergencies.
- Temperature control continues to be important during post-cardiac arrest care for improving neurological outcome. Updated recommendations suggest maintaining temperature control for at least 36 hours in adults who remain unresponsive to verbal commands.
- A new chapter has been developed dedicated to the Ethics of CPR and Emergency Cardiovascular Care. Foundational ethics principles, as well as contemporary ethical challenges from neonatal to geriatric age groups are addressed.
- The usefulness of double sequential external defibrillation (DSED) and vector change (VC) defibrillation have not yet been established and are not recommended. There are a number of outstanding questions about the impact of these interventions that require further investigation.
- Initial attempts at intravenous (IV) access are recommended over initial attempts at intraosseous (IO) access for adult patients in cardiac arrest. If initial IV attempts are unsuccessful, IO access should be attempted. Three large randomized trials failed to demonstrate superiority of initial IO attempts for the management of adult OHCA.
- Recommendations for predicting neurologic outcome after pediatric cardiac arrest have been added for the first time.
- Cognitive aids are recommended for healthcare professionals during resuscitation events, but not for lay rescuers.
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Citation: Del Rios M, Bartos JA, Panchal AR, Atkins DL, Cabanas JG, Cao D, Dainty KN, Dezfulian C, Donoghue AJ, Drennan IR, Elmer J, Hirsch KG, Idris AH, Joyner BL, Kamath-Rayne BD, Kleinman ME, Kurz MC, Lasa JJ, Lee HC, McBride ME, Raymond TT, Rittenberger, JC, Schexnayder SM, Szyld E, Topjian A, Wigginton JG, Previdi JK. Part 1: executive summary: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl):S284–S312. doi: 10.1161/CIR.0000000000001372
Citation: Panchal AR, Bartos JA, Wyckoff MH, Drennan IR, Mahgoub M, Schexnayder SM, Rodriguez AJ, Sasson C, Wright JI, Brooks SC, Atkins DL, Del Rios M. Part 2: evidence evaluation and guidelines development: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S313–S322. doi: 10.1161/CIR.0000000000001373
Citation: Elmer J, Atkins DL, Daya MR, Del Rios M, Fry JT, Henderson CM, Lewis-Newby M, Madrigal VN, Marco CA, Ornato JP, Paquette ET, Parnia S, Rodriguez AJ, Shapiro JP, Schexnayder SM, Weiss EM, Zientek DM, Idris AH. Part 3: ethics: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S323–S352. doi: 10.1161/CIR.0000000000001371
Citation: Dezfulian C, Cabanas JG, Buckley JR, Cash RE, Crowe RP, Drennan IR, Mahgoub M, Mannarino CN, May T, Salcido DD, Uzendu AI, Vogelsong MA, Worth JA, Girotra S. Part 4: systems of care: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S353–384. doi: 10.1161/CIR.0000000000001378
Citation: Lee HC, Strand ML, Finan E, Illuzzi J, Kamath-Rayne BD, Kapadia V, Mahgoub M, Niermeyer S, Schexnayder SM, Schmolzer GM, Weglarz J, Williams AL, Weiner GM, Wyckoff M, Yamada NK, Szyld E. Part 5: neonatal resuscitation: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S385–S423. doi: 10.1161/CIR.0000000000001367
Citation: Joyner BL, Dewan M, Bavare A, de Caen A, DiMaria K, Donofrio-Odmann J, Fosse G, Haskell S, Mahgoub M, Meckler G, Requist J, Schexnayder SM, Olech Smith M, Werho D, Raymond TT. Part 6: pediatric basic life support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S424–S447. doi: 10.1161/CIR.0000000000001370
Citation: Kleinman ME, Buick JE, Huber N, Idris AH, Levy M, Morgan SG, Nassal MJ, Neth MR, Norii T, Nunnally ME, Rodriguez AJ, Walsh BK, Drennan IR. Part 7: adult basic life support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S448–S478. doi: 10.1161/CIR.0000000000001369
Citation: Lasa JJ, Dhillon GS, Duff JP, Hayes J, Kamath-Rayne BD, Levy A, Mahgoub M, Morgan RW, McCormick T, Roberts JS, Ross CE, Schexnayder SM, Sweberg T, Valdes SO, Topjian AA. Part 8: pediatric advanced life support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025; 152(suppl 2):S479–S537. doi: 10.1161/CIR.0000000000001368
Citation: Wigginton JG, Agarwal S, Bartos JA, Coute RA, Drennan IR, Haamid A, Kudenchuk PJ, Link MS, Panchal AR, Pelter MM, Del Rios M, Rodriguez AJ, Perman SM, Sanko S, Kotini-Shah P, Kurz MC. Part 9: adult advanced life support: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2025;152(suppl 2):S538–S577. doi: 10.1161/CIR.0000000000001376
Citation: Cao D, Arens AM, Chow SL, Easter SR, Hoffman RS, Lagina AT III, Lavonas EJ, Patil KD, Sutherland LD, Tijssen JA, Wang GS, Zelop CM, Rodriguez AJ, Drennan IR, McBride ME. Part 10: adult and pediatric special circumstances of resuscitation: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S578–S672. doi: 10.1161/CIR.0000000000001380
Citation: Hirsch KG, Amorim E, Coppler PJ, Drennan IR, Elliott A, Gordon AJ, Jentzer JC, Johnson NJ, Maciel CB, Moskowitz A, Mumma BE, Presciutti AM, Rodriguez AJ, Yen AK, Rittenberger JC. Part 11: post–cardiac arrest care: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S673–S718. doi: 10.1161/CIR.0000000000001375
Citation: Donoghue AJ, Auerbach M, Banerjee A, Blewer AL, Cheng A, Kadlec KD, Lin Y, Diederich E, Sawyer T, Stallings DT, Toft LEB, Wright JI, Schexnayder SM, Dainty KN. Part 12: Resuscitation education science: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S719–S750. doi: 10.1161/CIR.0000000000001374