Changes in the 2025 AHA CPR Guidelines
The 2025 American Heart Association (AHA) CPR guidelines emphasize high-quality chest compressions, early defibrillation, and integrated post-cardiac arrest care to improve survival rates and neurological outcomes. 1
Key Changes in CPR Sequence and Technique
- The CPR sequence has changed from A-B-C (Airway, Breathing, Compressions) to C-A-B (Compressions, Airway, Breathing) for all age groups except newborns, minimizing delays in initiating chest compressions 2
- Chest compressions should be performed at a rate of 100 compressions per minute to a depth of 4-5 cm (1.5-2 inches) with full chest recoil between compressions 3
- Emphasis on minimizing interruptions in chest compressions, including implementing single shock defibrillation and eliminating pulse checks immediately after defibrillation 3
- Dispatchers are now trained to help bystanders recognize cardiac arrest and provide instructions for Hands-Only CPR 2
Special Circumstances Resuscitation Updates
Drowning Resuscitation
- For drowning victims, airway management and ventilation are particularly important due to the continuum from respiratory arrest to cardiac arrest 4
- Trained rescuers should provide rescue breaths as part of CPR in cardiac arrest following drowning and may initiate with either breathing (A-B-C) or compressions (C-A-B) 4
- In-water rescue breathing by appropriately trained rescuers may prevent progression to cardiac arrest in drowning victims 4
- AED use after initiation of high-quality CPR is recommended for drowning-related cardiac arrests 4
Opioid-Associated Emergencies
- For suspected opioid overdose, provision of CPR should be the focus of initial care 4
- Naloxone can be administered along with standard care if it does not delay components of high-quality CPR 4
- After return of spontaneous breathing following naloxone administration, patients should be observed in a healthcare setting until risk of recurrent opioid toxicity is low 4
Advanced Life Support Updates
- The 2023 focused update recommends against routine use of atropine for pulseless electrical activity and asystole 4
- For post-cardiac arrest care, a deliberate strategy for temperature control is recommended for all adults who do not follow commands after return of spontaneous circulation 4
- Temperature control should maintain a constant temperature between 32°C and 37.5°C 4
- A therapeutic trial of a nonsedating antiseizure medication may be reasonable in adult survivors with electroencephalography patterns on the ictal-interictal continuum 4
- Extracorporeal cardiopulmonary resuscitation (ECPR) is now considered reasonable for select patients with cardiac arrest refractory to standard ACLS when provided within an appropriately trained and equipped system of care 4
Systems of Care Improvements
- A fifth link has been added to the Adult Chain of Survival: "post-cardiac arrest care" 2
- Greater emphasis on team approach to resuscitation 2
- Public-access defibrillation (PAD) programs are recommended in aquatic environments and large public areas 4
- Organ donation is now recognized as an important outcome that should be considered in the development and evaluation of systems of care 4
Monitoring and Quality Improvement
- Capnography is now recommended for monitoring CPR quality 2
- Increased focus on continuous training and education for both medical professionals and lay rescuers 1
- Integration of advanced resuscitation techniques within an organized system of people, protocols, policies, and resources 1
Common Pitfalls to Avoid
- Delaying chest compressions to establish an airway or provide rescue breaths - the new guidelines prioritize immediate initiation of chest compressions 2
- Interrupting chest compressions unnecessarily - minimize pauses for rhythm checks, pulse checks, and ventilations 3
- Failing to recognize the importance of post-cardiac arrest care, which is now emphasized as a critical component of the resuscitation chain 2
- Underestimating the value of AEDs in drowning-related cardiac arrests - they should be used whenever available 4
- Overestimating the role of medications like atropine in cardiac arrest management - focus should remain on high-quality CPR 4
The 2025 AHA CPR guidelines represent a continued evolution toward evidence-based practices that prioritize interventions proven to improve survival and neurological outcomes following cardiac arrest.