The American Heart Association has released its 2025 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, the first full revision since 2020. Published today in the journal Circulation, the updated recommendations address choking, opioid overdoses, and a streamlined chain of survival, reflecting the latest scientific evidence to improve outcomes for cardiac arrest victims.
Each year, approximately 350,000 people in the U.S. experience an out-of-hospital cardiac arrest, which proves fatal 90% of the time, according to the Association’s statistics. Out-of-hospital cardiac arrests caused by respiratory emergencies or asphyxia occur in more than 9% of adults and 39% of children. The new guidelines aim to empower bystanders with clear, actionable steps.
For choking in conscious children and adults, the guidelines now recommend alternating five back blows followed by five abdominal thrusts until the object is expelled or the person becomes unresponsive. This marks a change from previous guidance, which did not include back blows for adults and recommended only abdominal thrusts for children. For infants, rescuers should alternate five back blows and five chest thrusts using the heel of one hand; abdominal thrusts are not recommended due to injury risk.
Opioid overdoses, which cause 80% of drug overdose deaths worldwide, receive new attention. The guidelines provide a public access algorithm for when to use naloxone, a medication that reverses opioid effects. Signs of overdose include slow or no breathing, choking sounds, drowsiness, constricted pupils, and blue or gray skin. This is the first time the Association has offered public access instruction on naloxone use.
The systems of care writing group elected to revert to a single chain of survival for all forms of cardiac arrest, whether adult or pediatric, in- or out-of-hospital. This consolidated chain emphasizes the importance of chest compressions and rescue breaths, especially for children and infants, who often experience respiratory-related cardiac arrest.
Evidence now shows that children 12 years old or older can be taught effective CPR and defibrillation. To improve lay-rescuer response, the guidelines recommend support for media campaigns, instructor-led training, and community training. Only about 41% of adults experiencing out-of-hospital cardiac arrest receive bystander CPR before emergency services arrive, yet early CPR can double or triple survival chances.
The neonatal guidelines, developed jointly with the American Academy of Pediatrics, now recommend delaying umbilical cord clamping for at least 60 seconds for most term and preterm infants not needing immediate resuscitation, up from the previous 30 seconds, to improve blood health and iron levels.
“We know high-quality CPR saves lives, and we need dedicated support to ensure that everyone who needs high-quality CPR receives it,” said Ashish Panchal, M.D., Ph.D., volunteer chair of the AHA Emergency Cardiovascular Care Science Committee. The Association updates and publishes CPR guidelines periodically, having issued the first in 1966. The full guidelines and new training materials are available at heart.org.
