The American Heart Association’s 2025 CPR & ECC Guidelines Released
The field of emergency cardiovascular care has undergone a significant shift. As of October 22, 2025, the American Heart Association (AHA) has released the comprehensive 2025 Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). These updates are a crucial development for everyone involved in emergency response, particularly the dedicated students and providers at ACLS Academy in Quincy, MA.
The purpose of these guidelines is clear: to provide best practice recommendations based on the most current global resuscitation science. They represent a comprehensive and systematic update to the 2020 guidelines, incorporating new evidence and introducing recommendations for topics where none previously existed. This evidence-based guidance provides direction for lay rescuers and healthcare professionals in the treatment of neonates, pediatrics, and adults across various chapters, including systems of care, life support, post-cardiac arrest care, special circumstances, education and training, and ethics.
The Resuscitation Reality and Goal
Despite continuous advances in treatment and training, the incidence of cardiac arrest remains high, and survival rates remain low. The AHA provides sobering statistics that underscore the need for these updated guidelines:
The incidence of emergency medical services (EMS)–treated Out-of-Hospital Cardiac Arrest (OHCA) in the United States is approximately 378.7 individuals per 100,000 population.
Survival to hospital discharge remains low, at approximately 10.5% for OHCA.
Survival is better but still requires improvement for In-Hospital Cardiac Arrest (IHCA), with rates of approximately 23.6% for adults and 45.2% for children.
These statistics highlight that variations in care and low bystander response significantly impact outcomes. The 2025 guidelines directly address these gaps by enhancing protocols for the entire Chain of Survival.
Critical Updates in Basic Life Support (BLS) and Public Access
The foundation of the 2025 guidelines begins with a consolidated and refined approach to basic life support, focusing on consistency and addressing modern public health crises.
1. The Unified Chain of Survival
The AHA has consolidated the previously separate Chains of Survival (for adults, children, in-hospital, and out-of-hospital) into a single, unified 6-link Chain of Survival. This simplification ensures that the core sequence of actions—early recognition, activation, high-quality CPR, early defibrillation, post-cardiac arrest care, and recovery—is universally understood and applied, prioritizing the critical steps that maximize the chance of survival from any cardiac emergency.
2. High-Quality CPR: Rate and Depth Metrics
The importance of High-Quality CPR is further emphasized, with specific metrics reinforced:
Compression Rate: Maintain a rate of 100 to 120 compressions per minute for all age groups.
Compression Depth (Adults): Press to a depth of at least 2 inches (5 cm), but with a new emphasis on avoiding excessive compression depth (i.e., no greater than 2.4 inches [6 cm]). This upper limit is crucial to reducing the risk of compression-related injuries while ensuring efficacy.
3. Opioid-Associated Emergencies and Naloxone
Recognizing the continued opioid epidemic, the guidelines introduce expanded recommendations for managing suspected opioid overdose. The guidance now includes public access instructions on when to use naloxone (Narcan). This integration emphasizes the importance of administering naloxone immediately, if available, in conjunction with the provision of rescue breathing and/or chest compressions.
4. Refined Choking Protocols
The technique for managing a Foreign-Body Airway Obstruction (FBAO) in infants has been explicitly updated for clarity and efficacy:
Adults and Children: Continue to use the established cycle of five abdominal thrusts followed by five back blows.
Infants: Rescuers should alternate between five back blows and five chest thrusts (using the heel of one hand) until the object is expelled or the infant becomes unresponsive. Abdominal thrusts are still contraindicated in infants.
Advanced Cardiovascular Life Support (ACLS) Updates
For the healthcare provider, the guidelines introduce crucial changes in pharmacology and monitoring, focusing on precision during the advanced stages of resuscitation.
1. Drug Administration Updates
A key pharmacological update affects the treatment of symptomatic bradycardia:
Atropine Dosing: The recommended IV dose of Atropine for treating symptomatic bradycardia has been increased to 1.0 mg (up from the previous 0.5 mg) when indicated.
2. Physiologic Monitoring for CPR Quality
The guidelines strongly advocate for the use of real-time physiologic monitoring to assess the effectiveness of CPR:
End-Tidal CO2 (ETCO2): ETCO2m monitoring is considered the most valuable, non-invasive tool for detecting Return of Spontaneous Circulation (ROSC) and evaluating the quality of compressions.
Arterial Pressure Monitoring: Continuous arterial pressure monitoring is recommended in advanced settings to help providers optimize compression quality and guide vasopressor timing and titration.
3. Pediatric and Neonatal Life Support Changes
Delayed Cord Clamping (NRP): For healthy infants who do not require immediate resuscitation, the recommended duration for delayed umbilical cord clamping has been extended to at least 60 seconds (up from 30 seconds).
PALS/BLS: Children 12 years of age or older can now be trained and directed to perform adult CPR and defibrillation protocols.
Other Key Changes in the 2025 Guidelines
The new guidelines are a comprehensive document that addresses all aspects of the resuscitation ecosystem. Guideline updates also included:
Ethics: This new, comprehensive chapter offers a detailed discussion of the foundational ethical principles that guide resuscitation care. It focuses on addressing disparities in cardiac arrest outcomes based on race and socioeconomic status, emphasizing the principles of justice and equitable care delivery.
Systems of Care: A significant focus is placed on establishing an integrated system of protocols, policies, and resources to achieve quantifiable improvements in quality. Recommendations are strengthened for optimizing bystander CPR training, telecommunicator CPR (T-CPR), and expanding public access to defibrillation.
Post-Cardiac Arrest Care (PCAC): This section refines the care of the comatose survivor, highlighting the continued importance of temperature control for neurological outcomes. Key changes include the addition of recommendations for predicting neurologic outcomes after pediatric cardiac arrest for the first time, as well as an emphasis on prioritizing IV access over IO in adult cardiac arrest.
Resuscitation Education Science: The guidelines strongly advocate for the use of real-time feedback devices in training to ensure students achieve and maintain competence in high-quality CPR metrics. There is also an increased focus on the importance of team dynamics, debriefing, and mental health support for all rescuers following a resuscitation event.
The AHA also noted that while ACLS, EP, and PEARS course guidelines were not part of the October 22, 2025, update, guidelines for these courses will be released at a later date.
For the AHA’s official Top 10 Things to Know guide, please use this link: Top Things to Know: 2025 AHA Guidelines for CPR and ECC.
The complete 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, along with the Section Abstracts, can be found here: View the Full 2025 Guidelines Abstract in Circulation.
Practical Implications for ACLS Academy Students
The release of new guidelines always initiates a necessary transition period for training centers across the nation. ACLS Academy is dedicated to making this shift seamless, upholding our standard of training our students using only the most current, evidence-based practices from the AHA.
Transition timeline for instructors
October 22, 2025: The official 2025 AHA Guidelines for CPR and ECC are released. New, updated courses and materials for BLS, ACLS, PALS, Heartsaver, and HeartCode programs become available.
October 22, 2025, to February 28, 2026:
Instructors must complete an online "Instructor Update" course for each discipline they teach (e.g., BLS, ACLS).
Instructors can use interim materials to teach courses during this period, but they must purchase the new 2025 course materials.
Training centers must finalize or cancel all open 2020 provider classes to ensure students receive their eCards before the 2020 version is retired.
March 1, 2026: All instructors must use the new 2025 guidelines and updated course materials. Training centers are required to teach the 2025 version of all courses. Any 2020 eCards not issued to students by February 28, 2026, will automatically transition to 2025 provider eCards on March 1, 2026.