2025 CPR Guidelines Key Points
The 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation emphasize high-quality chest compressions, early defibrillation, and integrated post-cardiac arrest care to optimize survival and neurological outcomes. 1
High-Quality CPR Fundamentals
- Perform chest compressions to a depth of 5-6 cm (2-2.4 inches) for adults while avoiding excessive compression depths 2, 3
- Maintain a compression rate of 100-120 compressions per minute 4, 3
- Allow complete chest recoil between compressions to enable proper cardiac filling 4, 3
- Minimize interruptions in chest compressions to maximize perfusion 4, 2
- Change compressors every 2 minutes or sooner if fatigued to maintain compression quality 4
- Push hard and fast while avoiding excessive ventilation 4
CPR Sequence and Technique
- Follow the C-A-B sequence (Compressions, Airway, Breathing) rather than A-B-C to minimize delays in initiating chest compressions 5
- For standard CPR, perform cycles of 30 compressions and 2 breaths 4
- Use an AED as soon as it is available 4
- CPR should be started first and continued until an AED is obtained and ready for use 4
- Compression-only CPR may be appropriate for lay rescuers who are untrained or unwilling to provide ventilations 4, 3
Defibrillation Guidelines
- For shockable rhythms (VF/pVT), deliver one shock followed by immediate resumption of CPR for 2 minutes 4
- Use manufacturer-recommended energy settings for biphasic defibrillators (typically 120-200 Joules initially) 4
- For monophasic defibrillators, use 360 Joules 4
- Double sequential defibrillation for refractory shockable rhythms has not been established as effective (Class 2b, LOE C-LD) 4
Medication Administration
- Establish IV access first when possible for drug administration in cardiac arrest (Class 2a, LOE B-NR) 4
- Consider IO access if IV attempts are unsuccessful or not feasible (Class 2b, LOE B-NR) 4
- For non-shockable rhythms, administer epinephrine as soon as feasible (Class 2a, C-LD) 4
- For shockable rhythms, consider epinephrine after initial defibrillation attempts have failed (Class 2b, C-LD) 4
- Epinephrine dosing: 1 mg IV/IO every 3-5 minutes 4
- Amiodarone dosing for refractory VF/pVT: First dose 300 mg bolus, second dose 150 mg 4
- Lidocaine alternative dosing: First dose 1-1.5 mg/kg, second dose 0.5-0.75 mg/kg 4
Advanced Airway Management
- Once an advanced airway is placed, provide 1 breath every 6 seconds (10 breaths per minute) with continuous chest compressions 4
- Use waveform capnography or capnometry to confirm and monitor endotracheal tube placement 4
Special Circumstances
Drowning Resuscitation
- For drowning victims, ventilation is particularly important due to the hypoxic nature of the arrest 2
- In-water resuscitation (ventilations only) may be delivered by trained rescuers when feasible and safe 4
- On-boat CPR may be delivered if rescuers determine it is feasible and safe 4
- Use the highest possible inspired oxygen concentration when available 4
Opioid-Associated Emergencies
- Focus on high-quality CPR for suspected opioid overdose 2
- Administer naloxone along with standard care if it doesn't delay high-quality CPR 2
- Observe patients after return of spontaneous breathing until risk of recurrent toxicity is low 2
Post-Resuscitation Care
- Implement targeted temperature management between 32°C and 37.5°C for adults who don't follow commands after ROSC 2
- Avoid both hypoxemia and hyperoxemia, targeting oxygen saturation of 94-98% once reliably measured 2
- Avoid hypocapnia during post-ROSC care 2
Systems of Care Improvements
- Implement public-access defibrillation programs in aquatic environments and large public areas 2
- Use real-time CPR feedback devices to improve CPR quality metrics 2
- Consider extracorporeal CPR (ECPR) for select patients with cardiac arrest refractory to standard ACLS when provided within an appropriately trained system 2
- Recognize organ donation as an important outcome in systems of care development 2