The American Academy of Pediatrics and the American Heart Association have jointly published the “2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care,” marking the first comprehensive update since 2020. The guidelines, released online Oct. 22 in Circulation and Pediatrics, address pediatric basic and advanced life support and neonatal resuscitation, with a focus on age-specific recommendations that reflect the unique physiological needs of children and newborns.
Each year, more than 7,000 out-of-hospital cardiac arrests and approximately 20,000 in-hospital cardiac arrests occur in infants and children in the United States. The new guidelines aim to improve outcomes by emphasizing early recognition of cardiac arrest, high-quality CPR starting with chest compressions, and tailored interventions for choking and ventilation.
A key change is the creation of a single chain of survival applicable to both adult and pediatric cardiac arrests, whether in or out of hospital. This chain acknowledges that prevention and preparedness are critical before arrest occurs. For infants with severe foreign body airway obstruction (FBAO), the guidelines recommend repeated cycles of 5 back blows alternating with 5 chest thrusts, explicitly advising against abdominal thrusts. For children with severe FBAO, the recommendation shifts to alternating 5 back blows with 5 abdominal thrusts, whereas earlier guidance only called for abdominal thrusts.
Compression techniques for infants have been updated: rescuers may use either the one-hand technique or the two thumbs–encircling hands technique. If the rescuer cannot encircle the chest, compressing with the heel of one hand is recommended. The previously recommended two-finger technique along the sternum was eliminated due to ineffectiveness in achieving proper depth.
The neonatal guidelines introduce a separate newborn chain of care, starting with prenatal care and extending through recovery and follow-up. This framework highlights the need for anticipation and preparation by trained healthcare professionals. Most newborns can be evaluated and monitored during deferred cord clamping for 60 seconds or more, an increase from the previous recommendation of at least 30 seconds, while maintaining skin-to-skin contact with a parent. Effective ventilation remains the priority for newborns requiring resuscitation, with a recommended ventilation rate of 30–60 inflations per minute, expanded from the prior 40-60 inflations per minute.
Dr. Henry Lee, neonatologist and volunteer co-chair of the neonatal writing group, stressed that one out of every 10-20 newborns each year needs help transitioning from the womb, underscoring the need for properly trained professionals. Dr. Javier Lasa, co-chair of the pediatric advanced life support group, noted that “children are not little adults,” and the guidelines reflect their unique needs.
The guidelines and educational materials are available in U.S. and international English, with additional translations planned. Resources can be accessed at the Pediatric Advanced Life Support and Neonatal Resuscitation Program websites. The updates are intended for lay responders and healthcare professionals in community, prehospital, and facility-based settings.
