New 2025 AHA CPR guidelines update choking response, opioid overdose care, and pediatric training to improve survival outcomes.
The 2025 AHA CPR guidelines include new choking recommendations for all ages and emphasize alternating back blows and thrusts.
Updated guidance provides a new algorithm for suspected opioid overdose, including when to administer naloxone.
A single chain of survival now applies to all cardiac arrests, with evidence supporting CPR and defibrillation training for children aged 12 years and older.
The American Heart Association (AHA) released updated guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC), marking the first full revision since 2020. The 2025 guidelines, published in Circulation, expand recommendations for choking management, suspected opioid overdose, and pediatric resuscitation practices.1,2
For the first time, the AHA included guidance for choking in adults and revised recommendations for children and infants. For conscious children and adults, the update advises alternating 5 back blows followed by 5 abdominal thrusts until the foreign object is expelled or the person becomes unresponsive.
For infants, rescuers should alternate 5 back blows and 5 chest thrusts using the heel of one hand until the object is expelled or the infant becomes unresponsive. Abdominal thrusts are not recommended for infants because of the potential for injury.
The 2025 guidelines include a new algorithm for treating individuals with suspected opioid overdose, a cause of 80% of drug overdose deaths worldwide. According to the World Health Organization, opioid use can suppress brain activity that regulates breathing.
The guidelines outline common signs of opioid overdose—slow or absent breathing, choking sounds, drowsiness, small pupils, and bluish skin—and provide public access instruction on when to administer naloxone, the medication that reverses opioid effects.
“The American Heart Association’s 2025 CPR guidelines represent gold standard science,” said Ashish Panchal, MD, PhD, volunteer chair of the AHA Emergency Cardiovascular Care Science Committee and professor of emergency medicine at The Ohio State University. “It reflects a rigorous examination of the most up-to-date evidence that guides how resuscitation is provided for critically ill patients.”
The systems of care writing group reverted to a single chain of survival for all forms of cardiac arrest—adult or pediatric, in- or out-of-hospital—to emphasize the universal importance of high-quality compressions and rescue breaths.
Evidence reviewed by the AHA shows that children aged 12 years and older can be taught effective CPR and defibrillation. To increase community readiness, the guidelines recommend media awareness campaigns, instructor-led training, and community programs to improve lay rescuer response.
The AHA and the American Academy of Pediatrics (AAP) co-developed the pediatric and neonatal resuscitation chapters, reflecting shared leadership between the two organizations. Among the neonatal updates, delaying umbilical cord clamping for at least 60 seconds—up from 30 seconds previously—was associated with improved blood health and iron levels in newborns.
“We’re proud that these guidelines will be jointly published in the American Heart Association journal Circulation and the American Academy of Pediatrics journal Pediatrics,” said Javier Lasa, MD, FAHA, FAAP, AHA and AAP volunteer and co-chair of the 2025 Pediatric Advanced Life Support Writing Group. “This action underscores our joint commitment to advancing pediatric and neonatal resuscitation—together.”
According to AHA data, approximately 350,000 people in the United States experience an out-of-hospital cardiac arrest each year, and 90% of cases are fatal. Only about 41% of adults receive CPR before emergency medical services arrive, though early intervention can double or triple survival chances.
“We know high-quality CPR saves lives, and we need dedicated support to ensure that everyone who needs high-quality CPR receives it,” Panchal said. “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.”
Updated CPR and ECC training materials reflecting these recommendations are being released simultaneously with the publication. The materials will be translated and adapted for use in more than 90 countries to facilitate global implementation.
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