The American Heart Association released comprehensive updates to its cardiopulmonary resuscitation guidelines, marking the first full revision since 2020 with significant changes to choking response protocols and opioid overdose treatment. Published in the Association's flagship journal Circulation, the 2025 guidelines address critical gaps in emergency response that could impact survival rates for thousands of Americans experiencing cardiac emergencies each year.
Among the most notable changes are updated choking response recommendations that now include guidance for adults, which was absent from previous guidelines. For conscious children and adults, rescuers should alternate five back blows followed by five abdominal thrusts until the object is expelled or the person becomes unresponsive. This represents a shift from earlier guidance for children that called for performing abdominal thrusts only. For infants, the guidelines recommend alternating between five back blows and five chest thrusts using the heel of one hand, while specifically advising against abdominal thrusts due to injury risks.
The guidelines also introduce new protocols for suspected opioid overdoses, which account for 80% of all drug overdose deaths worldwide according to the World Health Organization. For the first time, the guidelines provide public access instruction on naloxone use, a medication that can reverse opioid effects. The World Health Organization notes that opioid use can lead to death by affecting the brain's breathing regulation, with overdose signs including slow or no breathing, choking sounds, loss of consciousness, constricted pupils, and blue or grey skin coloring.
Another significant change involves reverting to a single chain of survival for all forms of cardiac arrest, whether adult or pediatric, in-hospital or out-of-hospital. This consolidation emphasizes the importance of performing both compressions and breaths, particularly for children and infants. The update reflects new evidence showing that children 12 years old or older can be taught effective CPR and defibrillation.
The guidelines come at a critical time, as approximately 350,000 people in the U.S. experience out-of-hospital cardiac arrest annually, with 90% resulting in death according to Association statistics. Only about 41% of adults experiencing cardiac arrest outside hospitals receive CPR before emergency medical services arrive, despite evidence that early CPR could double or triple survival chances. The 2024 CARES Annual Report documents these concerning statistics.
To improve lay-rescuer response, the guidelines recommend support for media campaigns, instructor-led training, and community training programs. The Association and American Academy of Pediatrics are simultaneously releasing updated training materials reflecting the new recommendations, accelerating adoption of the latest science. The organizations developed pediatric and neonatal guidelines collaboratively, with writing groups evenly balanced between both organizations.
Neonatal guidelines include extended recommendations for delaying umbilical cord clamping for at least 60 seconds for most term and preterm infants not needing immediate resuscitation, up from the previously recommended 30 seconds, which has been shown to improve newborn blood health and iron levels. The unified approach across all age groups and emergency types represents a significant step toward standardizing life-saving techniques that could impact survival rates nationwide.
