The American Heart Association has released the “2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC),” marking the first full revision since 2020. Published in the journal Circulation, the guidelines introduce significant updates to choking response, opioid-related emergencies, and a revised chain of survival, reflecting the latest scientific evidence to empower bystanders and healthcare providers.
One of the key changes is the new guidance for choking in conscious children and adults, which now recommends alternating five back blows followed by five abdominal thrusts until the object is expelled or the person becomes unresponsive. For infants, rescuers should alternate between five back blows and five chest thrusts using the heel of one hand. Abdominal thrusts are not recommended for infants due to the risk of injury. This update addresses gaps in previous guidelines, where adult choking guidance was absent and pediatric guidance only included abdominal thrusts.
The guidelines also provide a new algorithm for treating individuals with suspected opioid overdose, which accounts for 80% of all drug overdose deaths worldwide, according to the World Health Organization. Signs of an opioid overdose include slow or no breathing, choking sounds, drowsiness, constricted pupils, and blue or grey skin. For the first time, public access guidance on naloxone use is included, a medication that can reverse opioid effects.
Another major update is the consolidation of the chain of survival into a single chain for all forms of cardiac arrest, whether adult or pediatric, in- or out-of-hospital. This unified chain emphasizes the importance of chest compressions and rescue breaths, especially in children and infants. Evidence now shows that children 12 years or older can be taught effective CPR and defibrillation, expanding the potential pool of rescuers.
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 CPR before emergency medical services arrive, yet early CPR can double or triple survival chances. The Association encourages everyone to take a CPR class to learn life-saving skills.
The pediatric and neonatal guidelines were co-developed with the American Academy of Pediatrics, resulting in unified recommendations. For newborns, delaying umbilical cord clamping for at least 60 seconds, up from 30 seconds, has been shown to improve blood health and iron levels. The guidelines are accompanied by new training materials to accelerate adoption of the latest science.
“The American Heart Association’s 2025 CPR guidelines represent gold standard science,” said Ashish Panchal, M.D., Ph.D., volunteer chair of the Emergency Cardiovascular Care Science Committee. “As the science evolves, it’s important to review new research to deliver life-saving care.” The updates are based on rigorous evidence evaluation and aim to address the most clinically significant questions in resuscitation.
For more details, the full guidelines are available in Circulation at https://doi.org/10.1161/cir.0000000000001303. The American Heart Association continues to lead global resuscitation efforts, training millions annually.
