2025 AHA UPDATES TO RESUSCITATION – CPR, AED, FIRST AID
QUICK GUIDE - STEP WISE APPROACH
BEFORE GIVING CPR
Bigger emphasis on getting additional help, getting an AED, and starting CPR as early as possible
Assess breathing and pulse simultaneously (within 10 seconds)
Emphasis on using naloxone if opioid poisoning is suspected
Community and Lay Rescuer Response to OHCA
Implementing a bundle of community initiatives is a reasonable strategy to improve lay rescuer response to OHCA.
Increasing the availability of instructor-led training in communities can be effective to improve lay rescuer response to OHCA.
Mobile technologies to summon responders to nearby OHCA events is a reasonable strategy to increase timely lay rescuer CPR and AED use.
Mass media campaigns may be considered to promote learning of CPR skills in all populations.
It may be reasonable for communities to implement policies that require CPR certification in the general public.
Telecommunicator Recognition of Cardiac Arrest and T-CPR
If the patient is unresponsive with abnormal, agonal, or absent breathing, the telecommunicator should assume that the patient is in cardiac arrest.
Telecommunicators should determine the location of the event before questioning to identify OHCA, allowing for simultaneous EMS dispatch.
T-CPR instructions for adult OHCA should advise compression-only CPR consistent with adult BLS guidelines.
Telecommunicators should instruct callers to initiate CPR for individuals with suspected OHCA.
T-CPR instructions for infants and children experiencing OHCA should advise conventional CPR with breaths consistent with pediatric BLS guidelines.
Telecommunicator recognition of cardiac arrest and T-CPR instructions should be reviewed and evaluated as part of an EMS system quality management process.
Video-based dispatch systems for OHCA response may be reasonable in systems with such capabilities.
Chest Compression Timing, Ventilation, and Oxygen Use in Newborns
In newborn infants, chest compressions are recommended if the heart rate remains less than 60/min despite 30 seconds of effective ventilation with visible chest movement.
During chest compressions in newborn infants, ventilation with an endotracheal tube is recommended.
For newborn infants ≥34 weeks’ gestation when endotracheal tube placement is not possible or unsuccessful, a laryngeal mask may be a reasonable alternative.
Compression-to-Ventilation Ratio and Techniques (Newborn)
It may be reasonable to deliver 3 compressions followed by 1 ventilation breath (3:1 ratio) during newborn CPR.
It may be reasonable to use the 2-thumb encircling hands technique compared with the 2-finger technique.
It may be reasonable to compress to one-third of the anterior-posterior diameter of the chest.
It may be reasonable to compress over the lower one-third of the sternum, avoiding the xiphoid process.
Pediatric BLS – Top 10 Take-Home Messages
Respiratory conditions remain the major cause of cardiac arrest in infants and children; rapid support of ventilation and oxygenation is critical.
For pediatric OHCA, providing breaths in addition to chest compressions improves survival; lay rescuers should provide breaths if able and willing.
A respiratory rate of 20–30 breaths per minute is recommended for infants and children receiving CPR with an advanced airway or who have a pulse.
For infants with severe foreign-body airway obstruction (FBAO), cycles of 5 back blows alternating with 5 chest thrusts are recommended.
For children with severe FBAO, cycles of 5 back blows alternating with 5 abdominal thrusts are recommended.
Immediate recognition of cardiac arrest is vital; unresponsive infants or children with abnormal breathing require EMS activation and immediate CPR.
High-quality CPR includes appropriate rate and depth, minimal interruptions, full chest recoil, and avoidance of excessive ventilation.
Infant compression techniques include the 1-hand or 2-thumb encircling hands technique; the 2-finger technique has been eliminated.
AEDs should be applied as soon as possible in infants and children using pediatric pads or attenuators when available.
Prompt defibrillation for VF and pVT with minimal peri-shock pauses is critical.
Adult BLS – Top 10 Take-Home Messages
Adult resuscitation should generally occur where the patient is found if high-quality CPR can be provided safely.
A lone rescuer should activate the emergency response system and then immediately begin CPR.
Chest compressions should be performed with the patient’s torso approximately at the level of the rescuer’s knees.
Health care professionals may provide compressions and ventilations for all adult cardiac arrest patients.
Ventilations should deliver enough tidal volume to produce visible chest rise while avoiding over- or underventilation.
Routine use of mechanical CPR devices is not recommended.
For adults with a pulse but abnormal breathing, provide 1 breath every 6 seconds (10 breaths/min).
CPR for adults with obesity should use the same techniques as for average-weight adults.
For severe adult FBAO, perform cycles of 5 back blows followed by 5 abdominal thrusts until relieved or unresponsiveness occurs.
Use of appropriate personal protective equipment (PPE) during adult CPR is reasonable.
