DALLAS — The American Heart Association has released its first major update to CPR and emergency cardiovascular care (ECC) guidelines since 2020, adding new recommendations for choking response, opioid-related emergencies and revisions to the Chain of Survival.
The 2025 guidelines, published on Oct. 22 in Circulation, aim to make lifesaving interventions clearer and more effective for both medical professionals and bystanders.
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New choking response recommendations
For the first time, guidance for choking in conscious adults has been added, AHA said. Rescuers are now advised to alternate five back blows and five abdominal thrusts until the object is expelled or the person becomes unresponsive.
For infants, the update clarifies that caregivers should use five back blows followed by five chest thrusts with the heel of one hand — not abdominal thrusts, which pose a risk of injury.
“The American Heart Association’s 2025 CPR guidelines represent gold standard science. It reflects a rigorous examination of the most up-to-date evidence that guides how resuscitation is provided for critically ill patients,” said Dr. Ashish Panchal, chair of the American Heart Association’s Emergency Cardiovascular Care Science Committee and professor of emergency medicine at The Ohio State University. “As the science continues to evolve, it’s important that we continue to review new research specific to the scientific questions considered of greatest clinical significance that affect how we deliver life-saving care.”
Alternative techniques for CPR
The 2025 update also revises guidance on the use of mechanical CPR devices.
The routine use of mechanical CPR devices is not recommended for adult cardiac arrest, according to AHA. However, the guidelines note that mechanical CPR may be considered in specific situations where delivering high-quality manual compressions is difficult or poses a risk to healthcare professionals — such as during transport or in hazardous environments — provided interruptions in CPR are kept to a minimum during deployment and removal.
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The AHA cited numerous randomized controlled trials that found no difference in patient survival between manual and mechanical CPR. Still, researchers acknowledged that some unique clinical or logistical circumstances not represented in current studies may justify their use.
Updated guidance for opioid overdoses
With opioid overdoses accounting for 80% of all drug overdose deaths worldwide, AHA introduced a new algorithm for responding to suspected opioid emergencies.
The guidance includes public access instructions for administering naloxone, which can reverse opioid effects, and outlines key overdose indicators — such as:
- Slow, shallow or no breathing
- Choking or gurgling sounds
- Drowsiness or loss of consciousness
- Small, constricted pupils
- Blue or grey coloring of the skin, lips or nail beds
One unified chain of survival
Another major change: AHA reverted to a single chain of survival for all cardiac arrests, regardless of age or location. Previously, there were separate chains for adults, children and infants, and for in-hospital versus out-of-hospital cardiac arrests.
The streamlined approach highlights early recognition, high-quality CPR, rapid defibrillation, advanced care and post-cardiac arrest care as critical links in improving survival.
Emphasis on community training
The guidelines stress the importance of public education and CPR awareness, noting that only about 41% of adults who suffer cardiac arrest outside the hospital receive bystander CPR before EMS arrives. Early CPR can double or triple a person’s chance of survival.
To increase lay rescuer intervention, AHA recommends media campaigns, instructor-led courses and expanded community training opportunities. Research also shows that children as young as 12 can effectively learn CPR and defibrillation.
Neonatal and pediatric updates
In partnership with the American Academy of Pediatrics, AHA updated neonatal and pediatric resuscitation guidance.
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For newborns, the delay in umbilical cord clamping has been extended from 30 seconds to at least 60 seconds, which can improve blood health and iron levels. The pediatric guidelines also reflect new approaches to airway management and resuscitation timing.
“These guidelines underscore our shared commitment to protecting the youngest and most vulnerable lives,” said Dr. Javier Lasa, co-chair of the 2025 Pediatric Advanced Life Support Writing Group and associate professor at Children’s Health in Dallas.
Training materials and implementation
The American Heart Association and American Academy of Pediatrics are releasing updated CPR and ECC training materials alongside the new guidelines to accelerate implementation. The materials will be translated into multiple languages to expand access globally.
AHA has issued CPR guidelines since 1966 and continues to lead global resuscitation education and policy efforts.
“We know high-quality CPR saves lives, and we need dedicated support to ensure that everyone who needs high-quality CPR receives it,” said Panchal. “That starts with learning it yourself. We encourage everyone to take a CPR class to learn the skills and techniques to provide life-saving care in an emergency. Everyone has a role to play in the chain of survival.”
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