Image Source – American Heart Associations Emails
The American Heart Association (AHA) is preparing for one of the most significant updates in resuscitation training and guidelines. On October 22, 2025, the new AHA Guidelines for CPR and ECC officially released, marking an important milestone for healthcare providers, instructors, and training centers worldwide.
These changes will impact Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Heartsaver® First Aid CPR AED courses. With updated materials, new delivery formats, and revised instructor requirements, it’s essential to stay informed and prepared for the upcoming transition.
In-Hospital Cardiac Arrest (IHCA) Prevention
2025 (New): Conducting safety huddles for high-risk hospitalized patients can improve team awareness of their condition and help prevent their decline, effectively lowering the rate of cardiac arrests.
Rationale: Multi-center studies found that implementing a set of protocols, which included safety huddles for high-risk patients, successfully reduced IHCA in pediatric cardiac and general intensive care units.
Naloxone Access for the Public
2025 (New): Laws should permit laypeople to carry and administer naloxone, protecting them from legal action when acting in good faith to reverse an opioid overdose.
2025 (New): Programs that distribute naloxone to the public are beneficial for expanding its availability and reducing deaths from opioid overdose.
Rationale: Research shows that laws which increase naloxone access and provide legal protection for lay rescuers, along with community distribution programs, are linked to lower death rates.
Community Programs for Out-of-Hospital Cardiac Arrest (OHCA) Response
2025 (Updated): A combined set of community initiatives is a sensible approach to enhance how lay rescuers respond to OHCA.
2025 (New): Offering more instructor-led CPR training in communities can effectively improve the lay rescuer response.
2025 (New): Mass media campaigns are a potential tool to encourage CPR learning across all demographic groups.
2025 (New): Policies that mandate CPR certification for the general public may be a reasonable step for communities to take.
Rationale: A single solution is insufficient; evidence confirms that a multi-faceted strategy using various interventions is effective for improving lay rescuer response.
Clinical Debriefing
2025 (New): Conducting debriefings both immediately after a resuscitation and at a later time is reasonable, as each may reveal unique opportunities for system improvement.
Rationale: Studies use both immediate and delayed debriefing methods. While neither has been proven better, using both can provide complementary benefits.
OHCA Team Structure
2025 (New): Including a clinician trained in advanced life support (ALS) in the resuscitation team for a suspected OHCA can be beneficial.
2025 (New): Emergency Medical Services (EMS) systems should ensure their teams are large enough for members to have clearly defined, separate roles.
Rationale: Research shows that effective OHCA resuscitation depends on having enough team members to cover all critical tasks and the advanced training to perform them.
In-Hospital Code Team Structure
2025 (New): In-hospital cardiac arrest (code) teams should be made up of members with ALS training.
2025 (New): Having dedicated code teams with clear roles, varied expertise, and adequate simulation-based training can improve patient outcomes after an IHCA.
Rationale: Similar to OHCA teams, in-hospital teams perform better when members have advanced training, well-defined roles, and practice through simulation.
On-Scene Management of OHCA
2025 (New): EMS systems must be equipped to terminate resuscitation efforts at the scene, which requires training personnel on how to deliver death notifications.
2025 (New): For most adults and children experiencing OHCA, it is beneficial to prioritize completing resuscitation on scene to achieve a sustained return of spontaneous circulation (ROSC) before transport, unless special circumstances exist.
Rationale: Since many resuscitations will end in death on scene, training for when to stop efforts and how to notify families is essential for compassionate care and preventing rescuer burnout. Transporting a patient while performing CPR reduces the quality of compressions and poses a safety risk; it should only be done if it is believed to substantially increase the chance of survival.
Extracorporeal Cardiopulmonary Resuscitation (ECPR) Systems
2025 (New): Hospitals with ECPR programs should create and regularly update their patient selection criteria to improve survival, promote fairness, and avoid futile interventions.
2025 (New): Clinicians performing peripheral ECPR cannulation on adults should be skilled in percutaneous techniques.
2025 (New): A regionalized system for ECPR is a reasonable strategy to optimize patient outcomes and use resources efficiently.
2025 (New): For a small, carefully selected group of adult OHCA patients, rapid transport to an ECPR center while resuscitation is ongoing may be considered.
Rationale: ECPR demands significant resources and highly specialized teams, making a regionalized system practical. However, the need to transport patients during cardiac arrest and the high resource cost necessitate very careful patient selection.
Organ Donation
2025 (New): Healthcare institutions should establish care systems to facilitate and evaluate organ donation following cardiac arrest, in accordance with local laws and regulations.
Rationale: Efforts to increase organ donation differ globally, as they are deeply connected to the specific values and cultural norms of each country.
Enhancing Recovery After Cardiac Arrest
2025 (New): Survivors’ recovery and long-term functional outcomes are likely improved by integrated systems that evaluate patients before discharge, reassess their needs after going home, and provide ongoing support throughout their recovery.
Rationale: While rehabilitation improves long-term outcomes, it requires a coordinated, multidisciplinary effort involving providers both inside and outside the hospital.
Major New and Updated Recommendations
Umbilical Cord Management
2025 (Updated): For healthy term infants not needing immediate resuscitation, delaying cord clamping for at least 60 seconds is beneficial compared to clamping immediately.
Rationale: Analyses confirm that delayed cord clamping improves blood volume and iron levels in infancy, with recent studies supporting a 60-second delay.
2025 (New): For non-vigorous term and late preterm infants (≥35 weeks), milking the intact umbilical cord may be a reasonable alternative to immediate clamping.
Rationale: A large study found that cord milking in non-vigorous infants reduced the need for cardiorespiratory support, rates of moderate to severe brain injury, and the use of cooling therapy.
2025 (Updated): For preterm infants (<37 weeks) not requiring immediate resuscitation, delayed cord clamping for at least 60 seconds is recommended over immediate clamping.
Rationale: Analyses show that preterm infants receiving delayed cord clamping for 60 seconds or more have a lower mortality rate compared to those with immediate clamping.
Ventilation and Continuous Positive Airway Pressure
2025 (Updated): It is reasonable to start ventilation in newborns with an initial peak inflation pressure of 20-30 cm H₂O, adjusting as needed to achieve effective air movement.
Rationale: Studies show that pressures in this range produce adequate tidal volumes for effective newborn ventilation.
2025 (Updated): A ventilation rate of 30 to 60 breaths per minute is reasonable for newborn infants.
Rationale: Research indicates this rate range delivers appropriate tidal volumes and has been associated with effective carbon dioxide clearance.
2025 (New): Video laryngoscopy can be a useful tool for intubating newborn infants.
Rationale: A review of trials found that video laryngoscopy improves intubation success rates compared to traditional methods, which remain a valid alternative.
2025 (New): For infants ≥34 weeks gestation where face-mask ventilation fails, a laryngeal mask is a reasonable alternative to an endotracheal tube.
Rationale: Studies found no significant difference in insertion time or success rates between a laryngeal mask and intubation in this scenario, with one study showing fewer NICU admissions with the laryngeal mask.
2025 (New): Using a laryngeal mask as the primary method for ventilation, instead of a face mask, may be reasonable for infants ≥34 weeks gestation.
Rationale: A meta-analysis found that using a laryngeal mask first reduced the failure rate of the assigned device and the need for intubation, and resulted in a faster recovery of heart rate.
Oxygen
2025 (New): A pulse oximeter should be applied as early as possible to any newborn receiving respiratory support or supplemental oxygen.
Rationale: Early placement provides quicker oxygen saturation readings to guide treatment, as studies show it can take over four minutes to get a reading, and even longer in preterm infants.
2025 (Updated): For preterm infants <32 weeks needing respiratory support at birth, starting with an oxygen concentration between 30% and 100% may be reasonable.
Rationale: Evidence on the best starting oxygen level has been conflicting. While some analyses showed no difference, a recent detailed meta-analysis found that starting with high oxygen (90-100%) was associated with lower mortality compared to low oxygen (21-30%). The concentration should be adjusted downward as target saturation levels are met.
Chest Compressions
2025 (New): When performing chest compressions on newborns, it may be reasonable to compress the lower third of the sternum, ensuring the pressure is applied above the xiphoid process.
Rationale: An autopsy study found that compressions over the mid-sternum did not cause liver rupture, while compressions on the xiphoid process did. X-rays also show the heart is typically positioned under the lower sternum in infants.
2025 (New): During prolonged newborn resuscitation, it may be reasonable to switch the person performing compressions every 2 to 5 minutes, ideally during pulse checks, to maintain quality.
Rationale: Manikin studies show that the quality of compressions—including rate, depth, and recoil—can decline after 2 to 5 minutes when performed by a single rescuer.
Components of High-Quality CPR
2025 (New): During cardiac arrest in infants and children, it is critical to keep interruptions to a minimum, ensuring any pause in chest compressions lasts less than 10 seconds.
Rationale: Data from a large international registry showed that more frequent and longer pauses in CPR were linked to a significantly lower chance of successfully restoring a heartbeat.
Techniques for Chest Compressions
2025 (Updated): For infants, rescuers should perform chest compressions using either the heel of one hand or the two-thumb encircling hands method. If the rescuer’s hands are too small to effectively encircle the chest, the one-hand technique is recommended.
Rationale: Simulation studies confirm the two-thumb technique is superior to the two-finger method for achieving adequate compression depth. A clinical registry study found the one-hand technique also achieved greater depth than the two-thumb technique, with no difference in rate. The two-finger technique, rarely used and ineffective in the study, is no longer recommended.
Managing Severe Foreign-Body Airway Obstruction (FBAO)
2025 (Updated): For conscious children with a severe FBAO, rescuers should perform repeated cycles of 5 back blows followed by 5 abdominal thrusts until the object is dislodged or the child becomes unresponsive.
Rationale: While coughing or thrusts can relieve many obstructions, a recent study suggested back blows may be more effective than abdominal thrusts. To standardize training and because pediatric data shows no harm, the sequence for children now starts with back blows, followed by cycles of back blows and abdominal thrusts.
2025 (Updated): For conscious infants with a severe FBAO, rescuers should perform repeated cycles of 5 back blows followed by 5 chest thrusts until the object is dislodged or the infant becomes unresponsive.
Rationale: Abdominal thrusts are avoided in infants due to the risk of internal organ injury. Chest thrusts should be delivered using the heel of one hand. Although this technique resembles a chest compression, the focus is solely on relieving the obstruction, not on other CPR components like rate and recoil, hence the specific term “chest thrusts” is used.
Airway Management
2025 (Updated): For an adult with head and neck trauma, if a jaw thrust fails to open the airway, trained rescuers should use a head tilt–chin lift.
Rationale: Establishing an open airway for oxygenation is the top priority for trauma patients. While a jaw thrust is the preferred initial method, it should not delay achieving a patent airway.
Ventilation
2025 (Updated): When ventilating an adult in cardiac arrest, it is reasonable to provide a tidal volume sufficient to produce visible chest rise.
2025 (Updated): Rescuers should avoid both under-ventilating (too few or too small breaths) and over-ventilating (too many or too large breaths) adult patients in cardiac arrest.
Rationale: Studies show rescuers often deviate from ventilation guidelines. CPR that combines effective chest compressions with proper ventilation is linked to better patient outcomes.
Compression-to-Ventilation Ratio
2025 (Updated): It is reasonable for both lay rescuers and healthcare professionals to perform CPR in cycles of 30 compressions to 2 breaths before an advanced airway is placed.
Rationale: Most studies show no outcome difference between continuous compressions and interrupted CPR with breaths. However, since ventilation is often inadequate, the 30:2 cycle allows rescuers to pause and ensure each breath produces visible chest rise.
Defibrillation Pad Placement
2025 (New): When placing defibrillation pads on an adult woman, it may be reasonable to adjust the position of her bra instead of removing it entirely.
Rationale: Women receive public defibrillation significantly less often than men. A contributing factor may be rescuer hesitation about chest exposure. Adjusting the bra, rather than removing it, could help mitigate this barrier.
CPR for Adults with Obesity
2025 (New): Standard CPR techniques should be used for adults with obesity; no modifications are recommended.
Rationale: A 2024 review of 34 studies on cardiac arrest in patients with obesity found no evidence to support altering standard CPR procedures.
Alternative CPR Techniques
2025 (Updated): Mechanical CPR devices are not recommended for routine use in adult cardiac arrest.
2025 (New): Mechanical CPR devices may be considered in specific situations where delivering high-quality manual compressions is challenging or poses a risk to rescuers, provided that interruptions during device deployment and removal are strictly minimized.
Rationale: Multiple clinical trials have found no survival benefit with mechanical CPR over manual CPR. However, these devices may offer logistical or safety advantages in certain scenarios not typically covered in research trials.
Foreign-Body Airway Obstruction
2025 (Updated): For conscious adults with a severe FBAO, rescuers should perform repeated cycles of 5 back blows followed by 5 abdominal thrusts until the object is dislodged or the person becomes unresponsive.
Rationale:** Studies in adults showed back blows were effective and caused fewer injuries than abdominal thrusts. The alternating cycle of 5 and 5 is recommended to maintain consistency with the updated infant and pediatric guidelines.
Drug Administration During Cardiac Arrest
2025 (Updated): For infants and children in cardiac arrest with a non-shockable rhythm, the first dose of epinephrine should be given as early as possible.
Rationale: A review of seven studies found that faster epinephrine administration in both out-of-hospital and in-hospital cardiac arrest was linked to better outcomes. The highest rates of favorable outcome were associated with a first dose given in less than 3 minutes.
Monitoring During CPR
2025 (Updated): For intubated infants and children, monitoring end-tidal carbon dioxide (ETCO2) may be considered to assess the quality of CPR.
2025 (New): A specific, low ETCO2 value should not be used by itself to decide when to stop resuscitation efforts.
Rationale: ETCO2 reflects blood flow generated by CPR. A study found that maintaining an ETCO2 of 20 mm Hg or higher during CPR was associated with better survival. However, because some patients with lower ETCO2 values have survived, it should not be the sole factor for ending resuscitation.
2025 (New): For infants and children with an arterial blood pressure line during CPR, healthcare professionals may target a diastolic blood pressure of at least 25 mm Hg for infants and at least 30 mm Hg for children one year and older.
Rationale: A new study shows that achieving these diastolic blood pressure targets during CPR improves the rate of survival with a good neurological outcome.
Treatment of Supraventricular Tachycardia (With a Pulse)
2025 (Updated): For infants and children with life-threatening SVT that does not respond to initial treatments and when a specialist is unavailable, intravenous procainamide, amiodarone, or sotalol may be considered.
Rationale: Procainamide and amiodarone are moderately effective for SVT resistant to first-line treatments, though they can have side effects. Sotalol has also been shown to be effective with minimal adverse events when used under expert guidance.
Post–Cardiac Arrest Management
2025 (Updated): After cardiac arrest, systolic and mean arterial blood pressure should be maintained above the 10th percentile for the child’s age.
Rationale: Low blood pressure is common after cardiac arrest. Studies have linked systolic blood pressure below the 5th percentile in the first 12 hours to lower survival rates. One trial found that maintaining blood pressure above the 10th percentile in the first 6 hours improved survival with good neurological outcomes.
Predicting Neurological Outcomes
2025 (Updated): Healthcare professionals should use multiple methods together to predict neurological outcomes after cardiac arrest.
2025 (New): The presence or absence of a cough or gag reflex, or a response to pain, is not well-established for predicting outcomes at any time.
2025 (New): When used alongside other prognostic factors, electroencephalography (EEG) can be reasonably used within 72 hours after cardiac arrest to help predict neurological outcomes.
Rationale: Reviews found that no single test is accurate enough to predict outcomes on its own. EEG is one useful tool when combined with other data. However, evidence is lacking to use cough or gag reflexes for prognosis, reinforcing the need for a multi-faceted assessment.
Recovery and Long-Term Care for Survivors
2025 (Updated): Infant and child cardiac arrest survivors should be evaluated for physical, cognitive, and emotional needs within the first year to guide their ongoing care.
Rationale: Recovery extends long after the initial hospital stay. Survivors often need continued medical, rehabilitative, and community support. Recent guidelines emphasize the importance of structured follow-up care to help patients and families achieve the best long-term quality of life.
Advanced Defibrillation Strategies
2025 (New): The benefit of changing defibrillation pad placement (vector change) for adults with persistent shockable rhythms after 3 or more shocks has not been established.
2025 (Updated): The benefit of using two defibrillators to shock simultaneously (double sequential defibrillation) for the same situation has not been established.
Rationale: A 2023 consensus identified only a single small trial supporting these techniques for refractory ventricular fibrillation. Significant questions remain, requiring more research before they can be recommended.
Initial Vascular Access
2025 (Updated): Healthcare professionals should first attempt to establish intravenous (IV) access for drug administration in adult cardiac arrest.
2025 (Updated): Intraosseous (IO) access is a reasonable alternative if IV access is unsuccessful or not feasible.
Rationale: A 2025 systematic review, including recent large trials, found that using IO access did not significantly improve outcomes compared to IV access and was associated with lower odds of achieving a sustained return of spontaneous circulation.
Vasopressor Medications
2025 (Updated): For adults with a shockable rhythm, it is reasonable to administer epinephrine after the initial defibrillation attempts have been unsuccessful.
Rationale: The evidence supports prioritizing rapid defibrillation first, followed by epinephrine if the heart does not respond to shocks.
2025 (Updated): Using vasopressin alone or in combination with epinephrine offers no advantage over using standard-dose epinephrine.
Rationale: Multiple reviews of trials and observational studies have found no difference in survival when comparing these vasopressin strategies to epinephrine alone.
Non-Vasopressor Medications
2025 (New): For adults in cardiac arrest, the benefit of using beta-blockers, bretylium, procainamide, or sotalol for ventricular fibrillation unresponsive to defibrillation is uncertain.
Rationale: A 2025 evidence update found no new data to support the use of these alternative antiarrhythmic drugs in cardiac arrest.
Adjuncts to CPR
2025 (New): Head-up CPR is not recommended for adults with cardiac arrest outside of a clinical trial setting.
Rationale: A recent review found only a few observational studies with significant limitations, resulting in very low-certainty evidence. More research is needed to evaluate this technique.
Termination of Resuscitation
2025 (Updated): In an EMS system with both basic and advanced life support providers, it is reasonable to use the universal termination of resuscitation rule for adult out-of-hospital cardiac arrest.
Rationale: This rule (applied when the arrest was not witnessed by EMS, no shock was delivered, and there was no return of circulation) has been specifically validated for use in these tiered response systems.
Management of Wide-Complex Tachycardia
2025 (Updated): Synchronized cardioversion is recommended for the acute treatment of adults with hemodynamically unstable wide-complex tachycardia.
Rationale: It is critical to quickly restore a normal rhythm in unstable patients, and synchronized cardioversion is highly effective at terminating this arrhythmia.
2025 (Updated): Synchronized cardioversion is recommended for adults with hemodynamically stable wide-complex tachycardia when vagal maneuvers or drug therapy are ineffective or cannot be used.
Rationale: While stable patients may first be treated with other methods, cardioversion is the recommended next step if the abnormal rhythm persists.
Management of Atrial Fibrillation/Flutter
2025 (Updated): For cardioversion of atrial fibrillation (AF) using a US-approved biphasic defibrillator, a starting energy of at least 200 J is reasonable, increasing if the first shock fails.
Rationale: Recent trials and a large meta-analysis found that 200-J shocks achieved over 90% success rates across common defibrillator brands. Lower-energy monophasic shocks were more likely to cause dangerous complications.
2025 (New): The benefit of using two synchronized shocks simultaneously (double synchronized cardioversion) as an initial strategy for AF is uncertain.
Rationale: Given the high success rate of optimal single-shock cardioversion, the added benefit of a double-shock strategy appears to be modest.
2025 (Updated): For cardioversion of atrial flutter, a starting energy of 200 J may be reasonable, increasing if the first shock fails.
Rationale: Recent studies support this approach for atrial flutter as well, favoring greater efficacy and simplicity without safety concerns.
Management of Bradycardia
2025 (New): For adult patients with persistent, unstable bradycardia that does not respond to medication, temporary transvenous pacing is reasonable to increase heart rate and improve symptoms.
Rationale: When drugs are ineffective, transvenous pacing can stabilize the heart rate until the underlying cause is corrected or a permanent pacemaker can be placed.
Hemodynamic Management
2025 (Updated): In adults after return of spontaneous circulation (ROSC), hypotension should be avoided by maintaining a minimum mean arterial pressure (MAP) of at least 65 mm Hg.
Rationale: Four randomized trials comparing different blood pressure targets after out-of-hospital cardiac arrest (OHCA) did not demonstrate that aiming for a higher MAP resulted in better overall survival or neurological outcomes.
Diagnostic Imaging
2025 (New): Performing a comprehensive head-to-pelvis CT scan after ROSC may be reasonable to investigate the cause of the cardiac arrest and identify any complications from resuscitation efforts.
2025 (New): Performing an echocardiogram or point-of-care cardiac ultrasound after ROSC may be reasonable to identify heart conditions that require immediate intervention.
Rationale: These imaging modalities are used to detect clinically significant issues that may need specific treatment in the post-arrest period.
Temperature Control
2025 (Updated): For adult patients who remain unresponsive after ROSC, it is reasonable to maintain controlled body temperature (either therapeutic hypothermia or strict fever prevention) for a duration of at least 36 hours.
Rationale: Temperature control encompasses a range from hypothermia (32-34°C) to strict normothermia (36-37.5°C). Based on the evolving evidence, a total duration of 36 hours is the minimum recommended period for this intervention.
Cardiac Catheterization
2025 (Updated): Coronary angiography is recommended before hospital discharge for adult cardiac arrest survivors when a cardiac cause is suspected, especially if the initial rhythm was shockable, there is unexplained heart muscle weakness, or there is evidence of significant heart muscle damage.
Rationale: Coronary artery disease is frequently found in patients after OHCA. Identifying and treating unstable blockages has been shown to improve patient outcomes.
Mechanical Circulatory Support
2025 (New): For a highly select group of adult patients with persistent, life-threatening cardiogenic shock after ROSC, the use of temporary mechanical circulatory support (such as Impella or ECMO) may be considered.
Rationale: Cardiogenic shock is a common cause or consequence of cardiac arrest. These devices can provide vital circulatory support when the heart is too weak to function on its own.
Management of Myoclonus (Muscle Jerks)
2025 (New): In adult cardiac arrest survivors, treatment to suppress muscle jerking (myoclonus) is not recommended if the jerking is not associated with seizure activity on an electroencephalogram (EEG).
Rationale: There is no evidence that myoclonus without a corresponding EEG seizure pattern causes additional brain injury. Therefore, the potential side effects of suppressing these movements outweigh any unproven benefits.
Predicting Neurological Recovery
2025 (New): When used alongside other prognostic tests, a continuous EEG background without epileptic discharges within 72 hours after cardiac arrest may be reasonably considered to support a prediction of a favorable neurological outcome in comatose adults.
Rationale: The guidelines have been updated to include predictors of good outcomes. A 2022 systematic review informed this addition regarding EEG characteristics.
Recovery and Survivorship
2025 (Updated): Cardiac arrest survivors and their caregivers should receive a structured assessment for emotional distress and be provided with treatment or referrals before hospital discharge, following medical stabilization.
Rationale: Approximately one in four survivors and their caregivers experience significant emotional distress. Studies have shown that psychosocial interventions can lead to improvements in this distress for both survivors and their support networks.
Life-Threatening Asthma
2025 (New): For adults and children with life-threatening asthma that does not respond to standard treatments, the use of Extracorporeal Life Support (ECLS) may be reasonable.
2025 (New): Treatment with inhaled anesthetics (volatile anesthetics) may be considered for the same patient group.
Rationale: Severe asthma can cause cardiac arrest by blocking airways, leading to low oxygen, high carbon dioxide, and reduced heart function. Studies show high survival rates (83.5% to 100%) when using ECLS or volatile anesthetics as rescue therapies.
Life-Threatening High Potassium (Hyperkalemia)
2025 (Updated): The effectiveness of giving intravenous calcium during cardiac arrest caused by suspected hyperkalemia is not well established for adults or children.
Rationale: Evidence that IV calcium improves survival or neurological outcomes in this scenario is limited. The decision to administer it must be balanced against the risk of interrupting critical, time-sensitive treatments like high-quality CPR, defibrillation, and epinephrine.
Life-Threatening Low Body Temperature (Hypothermia)
2025 (New): It is reasonable to use specific prognostication scores (like the HOPE or ICE score) to help decide whether to initiate ECLS rewarming for patients in hypothermic cardiac arrest.
2025 (New): For severely hypothermic patients (core temperature <28°C / 82.4°F) who are not in cardiac arrest, using ECLS to rewarm them may be reasonable.
Rationale: Severe hypothermia can cause cardiac arrest but also lowers the body’s metabolic needs, increasing the chance of survival with good neurological function. ECLS provides better survival than conventional CPR for hypothermic arrest. Using ECLS for rewarming in non-arrest patients is faster but carries its own risks.
Life-Threatening High Body Temperature (Hyperthermia)
2025 (New): For adults and children with life-threatening hyperthermia, immersion in ice water (1-5°C / 33.8-41°F) is the recommended cooling method over other alternatives.
2025 (New): Cooling should be performed as rapidly as possible, aiming for a rate of at least 0.15°C per minute (0.27°F per minute).
Rationale: Rapid cooling can prevent cardiac arrest from extreme hyperthermia. A systematic review found ice water immersion to be the most efficient method to achieve the necessary rapid cooling rate. This applies to heatstroke and hyperthermia from drugs like cocaine.
Cardiac Arrest in Patients with a Left Ventricular Assist Device (LVAD)
2025 (New): Chest compressions should be performed on unresponsive patients with a durable LVAD who show signs of impaired perfusion.
2025 (New): It may be reasonable to start chest compressions immediately while simultaneously checking for reversible, device-related problems.
Rationale: It can be difficult to confirm cardiac arrest in LVAD patients because a pulse may be absent. Perfusion should be assessed using skin color, temperature, blood pressure, and ETCO2. While studies have biases, the potential benefit of CPR is now considered to outweigh the theoretical risk of dislodging the device. The priority is to perform CPR while a second rescuer, if available, tries to restore LVAD function.
Cardiac Arrest During Pregnancy
2025 (Updated): Preparation for emergency delivery should begin immediately upon recognizing cardiac arrest in a pregnant patient, with the goal of delivering the baby within 5 minutes.
2025 (New): It is reasonable to use ECPR for pregnant or peripartum patients in cardiac arrest who do not respond to standard resuscitation.
2025 (New): A massive transfusion protocol using a balanced ratio of blood products should be used for peripartum patients with a suspected life-threatening amniotic fluid embolism.
Rationale: Emergency delivery (now termed “resuscitative delivery”) within 5 minutes improves the mother’s chances of survival. ECPR has shown survival rates of 55-75% in this group. Amniotic fluid embolism can cause severe bleeding, and a balanced transfusion strategy reduces the risk of death.
Toxicology: Opioid Overdose
2025 (New): For lay and trained rescuers, administering an opioid antagonist (e.g., naloxone) may be reasonable during cardiac arrest if an opioid overdose is suspected, provided it does not interfere with high-quality CPR and rescue breaths.
2025 (New): Patients treated for an opioid overdose should be given a supply of an opioid antagonist and instructions on its use upon discharge from a healthcare setting.
Rationale: Naloxone can reverse respiratory arrest from overdose. While its benefit during full cardiac arrest is unproven, it is not known to be harmful if given without interrupting standard care. Survivors of overdose are at high risk for another event; providing “take-home” naloxone and training can prevent future fatalities.
Healthcare professionals and instructors who use the Atlas portal will be able to access regular monthly updates through the Science and Guidelines page. This ensures that providers and educators remain aligned with the latest research, science, and clinical practices as published by the AHA.
The AHA has announced exciting launches alongside the new guidelines, including:
Resuscitation Quality Improvement (RQI®) program
International Version English (IVE) HeartCode® programs
Updates for BLS, ACLS, and PALS training modules
IVE Heartsaver® First Aid CPR AED programs
To support global learning, HeartCode® BLS will also be released in multiple languages, including German, Italian, Japanese, Portuguese, Simplified Chinese, and Spanish.
The release will include a wide range of digital and printed training resources to help providers and instructors transition smoothly. These include:
2025 AHA Guidelines for CPR & ECC (reprint and digital formats)
Highlights of the 2025 AHA Guidelines (available in 19 languages)
2025 Science In-Service eLearning course (for healthcare professionals not serving as AHA instructors)
Instructor Updates for BLS, ACLS, PALS, PEARS, and Heartsaver (mandatory eLearning for instructors)
Interim training materials for BLS, ACLS, PALS, PEARS, ACLS EP, and Heartsaver
Product and Course Orientations for instructors (optional eLearning)
Instructor Essentials courses for BLS, ACLS, PALS, and Heartsaver (to be released in early 2026 in English, with other languages to follow)
Updates for ACLS EP and PEARS will be announced at a later stage.
Once the guidelines are released, instructors and training centers will have 90 days to complete their required updates. By March 1, 2026, all instructors must finish their mandatory eLearning updates to continue teaching under the new standards.
The update course links for instructors will be made available after the launch. Training centers are encouraged to begin planning ahead to avoid last-minute compliance issues.
One of the biggest changes involves Basic Life Support (BLS) training. Starting October 22, 2025, International Training Centers (ITCs) will begin shifting from traditional instructor-led BLS classes to the HeartCode® BLS blended learning format.
This new model will include:
eLearning portion of BLS training
Access to the BLS Provider Manual eBook within the HeartCode® course
BLS Provider eCard included with the training
Importantly, ITCs will no longer purchase separate eBooks or eCards. Instead, instructors will simply mark candidates as “Skill Test Pass” or “Remediation/Fail.”
AHA has confirmed that 2020 eBooks and streaming videos will not automatically convert to the 2025 versions. This means that instructors and training centers must purchase new digital resources to align with the updated guidelines.
Key points to note:
2020 Heartsaver, BLS, PALS, and ACLS eBooks and videos will not transition to 2025 automatically.
Redeeming a 2020 eBook code after the 2025 release will still provide access to the 2020 content, not the new edition.
Between October 22, 2025, and March 1, 2026, both the 2020 and 2025 versions of training resources will be available during the transition phase.
While this decision may seem inconvenient for some training centers, it ensures that learners are trained with the most accurate and updated clinical guidelines.
The 2025 AHA Guidelines for CPR and ECC will incorporate the latest evidence-based research to improve survival rates and outcomes in cardiac arrest and emergency care situations. These changes affect:
Healthcare professionals who provide critical life-saving care
Instructors and training centers who deliver certified courses
Students and first responders preparing for real-life emergencies
By updating course formats, eLearning modules, and global accessibility, the AHA is ensuring that training remains consistent, effective, and accessible worldwide.
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