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The American Heart Association (AHA) released its 2025 Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) on October 22, 2025. This was the first comprehensive revision of the CPR and ECC guidelines since 2020. The update includes important changes to choking care, infant chest compressions, the Chain of Survival, opioid-associated emergencies, pediatric defibrillation, and resuscitation education.
For most people, the most noticeable changes are simple: choking treatment has been standardized, the two-finger technique for infant chest compressions has been removed, and the AHA has returned to one universal Chain of Survival for adult and pediatric cardiac arrest in both in-hospital and out-of-hospital settings.
The 2025 AHA Guidelines for CPR and ECC were released on October 22, 2025. They update recommendations for lay rescuers, healthcare professionals, educators, and systems of care.
The guidelines cover adult, pediatric, and neonatal resuscitation, as well as education, ethics, systems of care, and special circumstances. The AHA and American Academy of Pediatrics jointly developed the pediatric basic and advanced life support recommendations.
The most important changes for everyday CPR training include:
One of the clearest changes in the 2025 guidelines is the treatment of severe foreign-body airway obstruction (FBAO), commonly called choking.
For a conscious adult or child with severe choking, rescuers should give 5 back blows followed by 5 abdominal thrusts, repeating the sequence until the object is expelled or the person becomes unresponsive. The sequence starts with back blows.
This creates a more consistent approach to severe choking. Earlier pediatric guidance emphasized abdominal thrusts without the same five-back-blows/five-abdominal-thrusts sequence.
For infants, the procedure is different.
For an infant with severe foreign-body airway obstruction, rescuers should alternate:
For the chest thrusts, the 2025 guidelines recommend using the heel of one hand. Abdominal thrusts are not recommended for infants because of the potential for abdominal organ injury.
If the infant becomes unresponsive, the rescuer should transition to infant CPR according to the appropriate CPR algorithm.
For more detail, see our guide to how to perform the Heimlich maneuver and our infant foreign-body airway obstruction algorithm.
The 2025 guidelines made an important change to infant CPR.
The traditional two-finger technique for infant chest compressions is no longer recommended. The AHA states that the technique may be ineffective for achieving adequate compression depth.
The recommended techniques are:
If the rescuer cannot physically encircle the infant’s chest, the heel-of-one-hand technique is recommended.
This change is specifically about chest compressions during CPR. It should not be confused with other procedures in which two fingers may still be used, such as checking an infant’s pulse.
The 2025 guidelines introduce a Universal Chain of Survival for adult and pediatric cardiac arrest in both in-hospital and out-of-hospital settings.
The Chain of Survival provides a framework for coordinating the actions that can improve outcomes after cardiac arrest. The updated approach recognizes that effective resuscitation is not limited to the moment CPR begins. It includes prevention and preparedness, recognition and response, resuscitation, post-cardiac arrest care, and recovery.
The 2025 guidelines also establish a separate Neonatal Chain of Care, reflecting the unique needs of newborns from prenatal care through postnatal follow-up.
For a closer look at how the chain works in BLS, see our guide to the BLS Chain of Survival.
The 2025 guidelines add new emphasis to suspected opioid-associated emergencies.
The AHA provides a new algorithm for suspected opioid overdose and emphasizes policies that improve public access to and use of naloxone, a medication that can reverse or reduce the effects of opioids.
Possible signs of opioid overdose include slow, shallow, or absent breathing, unusual sounds such as choking or gurgling, drowsiness or loss of consciousness, constricted pupils, and blue or gray discoloration of the skin, lips, or nail beds.
When opioid overdose is suspected, rescuers should follow the appropriate emergency response and naloxone protocol while providing CPR and ventilations as appropriate for the person’s condition.
Naloxone can be administered through several routes depending on the product available. For more information, see our guide to common naloxone administration routes in BLS.
The 2025 pediatric basic life support guidelines emphasize early AED use for infants and children in cardiac arrest.
An AED should be attached as soon as possible. When available, a pediatric attenuator and pediatric pads should be used for infants and children.
For children younger than 8 years, use of a pediatric attenuator is recommended when using an AED. If neither a manual defibrillator nor an AED equipped with a pediatric attenuator is available, an AED without a pediatric attenuator may be considered.
The key point is not to delay defibrillation while waiting for a specific device. Early defibrillation is critical when a child has a shockable rhythm.
For more information, see our guide to understanding AED use in pediatric emergencies.
The 2025 guidelines include many updates, but several important foundations of high-quality CPR remain in place.
For CPR, the target chest-compression rate remains 100 to 120 compressions per minute. The goal is to maintain an effective, consistent rate while allowing complete chest recoil between compressions.
Compression depth remains important for effective CPR. Rescuers should use age-appropriate compression depth rather than treating all patients the same.
For infants, the 2025 pediatric guidelines continue to emphasize adequate depth while changing the hand technique. The change from two fingers to the heel of one hand or two-thumb encircling-hands technique is intended in part to improve the ability to achieve adequate depth.
High-quality CPR still requires minimizing interruptions in chest compressions. The pediatric guidelines specifically state that pauses in chest compressions should be less than 10 seconds whenever possible. Complete chest recoil between compressions is also an important component of high-quality CPR.
Early defibrillation remains a critical part of treating cardiac arrest when a shockable rhythm is present. For infants and children, the AED should be attached as soon as possible, using a pediatric attenuator and pediatric pads when available.
The 2025 update therefore does not replace the basic foundation of high-quality CPR. Instead, it updates specific techniques and expands guidance where new evidence supports a change.
The 2025 guidelines are not limited to basic CPR. They also comprehensively update advanced life support recommendations for healthcare professionals.
The adult advanced life support portion of the 2025 guidelines addresses cardiac arrest, peri-arrest conditions, arrhythmias, post-cardiac arrest care, and other advanced resuscitation topics. The complete guidelines include updated evidence-based recommendations across adult advanced life support and related areas.
Healthcare professionals should therefore use the current 2025 ACLS course materials, algorithms, and institutional protocols rather than relying solely on older training materials.
The 2025 pediatric advanced life support guidelines were developed jointly by the AHA and American Academy of Pediatrics. They emphasize early recognition of deterioration, effective resuscitation, coordinated systems of care, and age-appropriate management of critically ill infants and children.
The pediatric update also reinforces the importance of high-quality CPR, early defibrillation when indicated, and appropriate ventilation and oxygenation because respiratory problems remain a major cause of pediatric cardiac arrest.
Healthcare providers should complete the appropriate 2025 AHA course update or use current 2025 provider materials when their role requires updated ACLS or PALS training.
For BLS providers, see our BLS algorithm for a practical overview of the sequence used during resuscitation.
Not simply because the AHA released its 2025 guidelines.
An AHA course completion card remains valid for its stated validity period. AHA course completion cards are generally valid for two years through the end of the month in which the card was issued.
However, people should continue to follow current guidelines and training materials, particularly when taking a new course, renewing a certification, or working in a healthcare role that requires current training.
If your card has expired, you should contact an AHA Training Center about renewal or retraining. Employers, licensing bodies, or other organizations may also have requirements that affect when training must be renewed.
The 2025 AHA CPR Guidelines introduce several important changes, but the overall goal remains the same: recognize emergencies quickly, start high-quality CPR, use an AED as soon as possible when indicated, and provide appropriate care until advanced help takes over.
For lay rescuers, the biggest practical changes are the new choking sequence, the updated infant compression technique, the universal Chain of Survival, and expanded guidance for suspected opioid emergencies and naloxone. For healthcare professionals, the 2025 update also includes broader changes across BLS, ACLS, PALS, post-cardiac arrest care, and other areas of resuscitation science.
If you are preparing for a new CPR, BLS, ACLS, PALS, or First Aid course, use the current 2025 AHA training materials so your skills and knowledge reflect the latest recommendations.
The 2025 AHA Guidelines for CPR and ECC were released on October 22, 2025. They represent the first comprehensive revision of the guidelines since 2020.
For conscious adults and children with severe choking, the 2025 guidelines recommend alternating 5 back blows and 5 abdominal thrusts, beginning with back blows. For infants, rescuers should alternate 5 back blows and 5 chest thrusts, using the heel of one hand for the chest thrusts.
No. The 2025 guidelines eliminated the two-finger technique for infant chest compressions. The recommended techniques are the heel of one hand or the two-thumb encircling-hands technique.
Yes. An AED should be attached as soon as possible during pediatric cardiac arrest. Use a pediatric attenuator and pediatric pads when available. If a pediatric attenuator or manual defibrillator is unavailable, an AED without a pediatric attenuator may be considered.
No. The recommended compression rate remains 100 to 120 compressions per minute. High-quality CPR also requires adequate depth, complete recoil, and minimized interruptions.
Not solely because the guidelines changed. AHA course completion cards remain valid for their stated validity period, generally two years through the end of the month of issue. When your card expires, you should renew according to the requirements of your employer, licensing body, or training provider.
The 2025 guidelines use a Universal Chain of Survival for adult and pediatric cardiac arrest in both in-hospital and out-of-hospital settings. A separate Neonatal Chain of Care addresses care from prenatal through postnatal settings.
The AHA removed the two-finger technique because evidence indicated that it was less effective for achieving adequate compression depth. The 2025 guidelines recommend the heel of one hand or the two-thumb encircling-hands technique instead.
