Executive Summary: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

‍This executive summary provides an overview of the 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, which is organized around the Utstein Formula for Survival and provides updated recommendations aimed at improving survival rates and neurological outcomes following cardiac arrest. This executive summary outlines key changes, emphasizing the importance of high-quality chest compressions, early defibrillation, and the integration of advanced resuscitation techniques. These Guidelines also highlight critical post–cardiac arrest care strategies, including targeted temperature management and hemodynamic stabilization. Additionally, they stress the need for population-specific resuscitation approaches, particularly for pediatric patients, pregnant individuals, and individuals with cardiac arrest due to special circumstances. A strong focus is placed on continuous training and education for both medical professionals and lay rescuers to enhance the implementation and effectiveness of these lifesaving interventions. The 2025 Guidelines also highlight the importance of an integrated system of people, protocols, policies, and resources to achieve quality improvement in cardiac arrest care. An overview of ethical considerations relevant to emergency cardiovascular care, resuscitation, and approaches to decision-making surrounding cardiac arrest is also included. By following these updated recommendations, the American Heart Association seeks to optimize resuscitation efforts and improve patient outcomes in cardiac emergencies.

Introduction

The 2025 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) provide a comprehensive review of evidence-based recommendations for resuscitation and ECC. The Guidelines for CPR were first published in 1966 in response to requests from several organizations and agencies about the need for standards and guidelines regarding training and response.¹

Since then, the CPR Guidelines have been reviewed, updated, and published periodically by the AHA.^2–10 As with prior Guidelines, this document is closely aligned with evidence evaluation conducted by the 2025 International Liaison Committee on Resuscitation (ILCOR) and associated member councils. ILCOR was formed in 1992 to provide a forum for liaison between principal resuscitation organizations worldwide. At the time of this publication, ILCOR comprises representatives of 9 member organizations.¹¹ Although the AHA generally publishes its Guidelines on a 5-year cycle, since ILCOR transitioned to a continuous evidence-evaluation process in 2015, the AHA has published focused updates between formal Guidelines when there is a substantial need for updated treatment recommendations based on new scientific evidence. This allows for expedited review and incorporation of significant changes in science directly into the Guidelines if deemed appropriate, increasing the potential for more timely transitions from guidelines to bedside. Since the publication of the 2020 Guidelines, there has been a significant expansion in the number of writing groups and chapters, including the addition of new chapters on post–cardiac arrest care, special circumstances, and ethics. The AHA ECC Committee has also strengthened partnerships with other organizations, such as collaborating with the American Academy of Pediatrics (AAP) to jointly publish and cochair the writing groups for Pediatric Basic Life Support (PBLS), Pediatric Advanced Life Support (PALS), and Neonatal Resuscitation. Efforts have also been made to enhance synergy and streamline content across chapters and disciplines, ensuring consistency in overlapping topics, concepts (eg, a single Chain of Survival), terminology (eg, breaths, rescue breaths, ventilations), and algorithms. The chapter writing group members updated evidence reviews specific to the scientific questions considered of greatest clinical significance, with a focus on topics with new evidence.

Epidemiology and Outcomes

In the half century since the initial Guidelines were published, cardiac arrest remains a leading cause of mortality and morbidity in the United States and worldwide, making this work still incredibly relevant. Despite advances in treatment, incidence of cardiac arrest remains high, and survival remains low. We recognize and acknowledge the negative impact of COVID-19 on resuscitation survival outcomes and on health care and lay rescuer response to cardiac arrest. Epidemiologic trends since 2023 demonstrate a modest upward trend in out-of-hospital cardiac arrest (OHCA) survival rates.¹² Recognizing the continued threat of infectious disease transmission, these 2025 Guidelines also include recommendations to reduce the risk of transmission of high-consequence respiratory pathogens during treatment of cardiac arrest (refer to Part 10: Adult and Pediatric Special Circumstances of Resuscitation).¹³

OHCA

As reported in the 2024 Cardiac Arrest Registry to Enhance Survival (CARES) Annual Report, the incidence of emergency medical services (EMS)–treated, OHCA in people of any age in the United States was 378.7 individuals per 100 000 population, with great variation in incidence and survival between states.¹² There were an estimated 263 711 EMS-treated, nontraumatic OHCA cases in the United States in 2024. Survival to hospital discharge after EMS-treated adult OHCA was 10.5%, and favorable neurologic survival was 8.2%. Bystander-witnessed adult arrests where bystander CPR was initiated had a 13.0% survival to hospital discharge compared with the 7.6% survival to discharge for unwitnessed arrests (P<0.0001); however, only 41.7% of OHCA adult patients received bystander CPR. Survival to hospital admission after EMS-treated nontraumatic OHCA was 25.7% for all presentations. Survival to hospital discharge was higher when the cardiac arrest occurred in a public place (21.1%) than if it occurred in a residential setting (8.9%) (P<0.0001). Only 12.6% of patients who experienced cardiac arrest in public had an automated external defibrillator (AED) applied by a lay rescuer. As reported in the “2025 Heart Disease and Stroke Statistics: A Report of US and Global Data from the American Heart Association,”¹⁴ 83% of the EMS-treated OHCAs in children were in private residences while 16.7% were in public places. Survival to hospital discharge was 7.4% for 1587 children <1 year of age, 14.1% for 1225 children 1 to 12 years of age, and 18.5% for 854 children 13 to 18 years of age.

In-Hospital Cardiac Arrest

Incidence of in-hospital cardiac arrest (IHCA) in adults each year in the United States is estimated to be about 292 000 patients as extrapolated using the AHA’s Get With The Guidelines Resuscitation data.¹⁴ According to the 2023 data used in this report, survival to hospital discharge was 23.6% for adult patients with IHCA and among survivors, 79.2% had favorable neurologic outcome (Cerebral Performance Category 1 or 2) at hospital discharge.¹² Survival to hospital discharge after IHCA in pediatric patients (children and infants 0–18 years of age) increased from 18.9% to 45.2% between 2000 and 2023 in the Get With The Guidelines®-Resuscitation data.¹² The notable increase in survival is multifactorial in nature, including early recognition of deterioration and the provision of high-quality CPR.

Disparities and Differences

Despite advances in resuscitation care, inequities in survival outcomes persist. In the 2025 AHA Statistics Update, it was noted that survival and neurological recovery after cardiac arrest were worse in minoritized racial and ethnic groups, including Hispanic, Black, and Asian individuals, compared with non-Hispanic White individuals. White people had a higher chance of a favorable neurologic outcome than those from minoritized groups (34.4% versus 21.7%, respectively; P=0.015).¹⁴ Individuals from racial and ethnic groups that have been historically marginalized are also more likely to have early severe electroencephalogram (EEG) or computerized tomography anoxic changes (25.0% versus 15.8%, respectively; P=0.03).¹⁴

The causes of these disparities are complex and are closely associated with socioeconomic disadvantage and unequal access to care. Unequal provision of CPR and use of an AED by lay rescuers contribute to worse cardiac arrest outcomes and are the result of unequal access to lay rescuer CPR and AED training opportunities.¹⁵ There is also increasing evidence of differences based on population density—eg, rural versus metropolitan—with the odds of OHCA survival to hospital discharge being approximately 50% lower in rural areas compared with metropolitan areas.¹⁶ Thus, the translation of guidelines and science into educational resuscitation training products must consider the needs of all patients in their development with additional emphasis on equitable delivery and accessibility, especially in low-resource settings. This topic is discussed further in “Part 12: Resuscitation Education Science” of the 2025 Guidelines. Furthermore, despite the existence of evidence-based treatment guidelines, implementation varies widely due to unequal resource availability and access to care.¹⁷ The AHA ECC 2030 Impact Goals have an explicit focus on health equity and ensuring that cardiac arrest survival and access to care are equitable for all.¹⁵ In alignment with the ECC 2030 Impact Goals, the 2025 Guidelines highlight areas of opportunity to save more lives by prioritizing equitable delivery of lifesaving interventions throughout the Chain of Survival and including equitable outcomes as a measure of success. Additional considerations related to equity are included in “Part 3: Ethics.”

Chain of Survival and Newborn Chain of Care

Much of the variation in survival rates is thought to be due to differences across the Chain of Survival (Figure 1), the critical actions that must occur in timely succession to maximize survival from cardiac arrest.¹⁸ A sixth link in the Chain of Survival was introduced in the 2020 Guidelines, with different versions for adult, pediatric, IHCA, and OHCA.¹⁹ The 4 chains introduced in 2020 have now been consolidated to a single 6-link chain of survival for the 2025 Guidelines. Missing from this chain is the topic of prevention, which the writing group considered important but would like to better define before adding a seventh link.

Similarly, successful neonatal resuscitation depends on a continuum of integrated lifesaving steps that begins with careful assessment and preparation in advance of birth as well as resuscitation and stabilization at the time of birth and through the first 28 days after birth. The 2025 Guidelines introduce the Newborn Chain of Care (Figure 2), which addresses the broader context in which neonatal resuscitation occurs. With the recognition that the care and, therefore, the outcomes of parents and newborns are inextricably linked, the 7-link Newborn Chain of Care differs from the Chain of Survival in that it starts with how health systems provide prenatal and intrapartum care (prevention), extending to postpartum, postresuscitation, and follow-up care that can optimize outcomes for parents and their newborns.

Terminology

Standardized terminology helps improve communication and accuracy in emergency response education. The 2025 Guidelines clarify the distinction between breaths and ventilations to ensure consistency in training and guidelines. To simplify nomenclature, the term rescue breaths is no longer used. Instead, breaths should be used when a person has a pulse but is not breathing and when breaths are given in conjunction with CPR, as in CPR with breaths. Ventilations should be reserved for health care professionals when providing assisted breathing through a mechanical device, such as a bag-mask device or an advanced airway device.

Similarly, lay rescuer was selected as the preferred term over layperson or lay responder when discussing care provided by non–health care professionals. The term lay rescuer is favored over bystander as it encourages action. Bystander can imply someone who is merely present but not taking action. The term lay rescuer clarifies the role and encourages action, reinforcing the vital role that people without medical training can play in an emergency.

The 2025 Guidelines also recognize the differential use of the abbreviations ROSC (return of spontaneous circulation) versus ROC (return of circulation) in the literature. For the purposes of these Guidelines, when return of circulation after CPR is achieved by mechanical means (eg, extracorporeal membrane oxygenation), the term ROC is preferentially used. When return of spontaneous circulation is due to recovery of cardiac function without mechanical intervention, the term ROSC is used.

Utstein Formula for Survival

This executive summary provides an overview of and orientation to the 2025 Guidelines, which are organized around the Utstein Formula for Survival (Figure 3).²⁰ The Utstein Formula emphasizes that survival depends on 3 interactive factors: guideline quality (science), efficient education of patient caregivers (education), and a well-functioning Chain of Survival at a local level (local implementation). Local implementation, in turn, is largely dependent on systems of care (SOC), which incorporate the links within the Chain of Survival. Each section in this summary describes the scope of each Part of the Guidelines, along with a list of the most significant and impactful new or updated recommendations for that Part. Each section also includes a list of critical knowledge gaps that highlight important research questions and significant opportunities for enhancing the Chain of Survival. This executive summary does not contain extensive external reference citations; refer to Parts 2 through 12 for more detailed reviews of the scientific evidence and corresponding recommendations.

Figure 3. The Utstein Formula for Survival, emphasizing the 3 components essential to improving survival.²⁰

Reprinted from Søreide et al.²⁰ Copyright 2013, with permission from Elsevier.

Evidence Evaluation and Guidelines Development

The 2025 Guidelines are designed to present a comprehensive compilation of guidance for CPR and ECC.²¹ These guidelines are based on an evidence evaluation process conducted by ILCOR,²² published as systematic reviews, scoping reviews, and evidence updates published since the 2020 Guidelines as well as an independent evidence review process conducted by the 2025 Guideline Writing Groups. Together, these resulted in a description of the literature that facilitated guideline development.

Each chapter of the 2025 Guidelines is organized in knowledge chunks that are grouped into discrete modules of information on specific topics or management subjects. Each modular knowledge chunk includes a table of recommendations; a brief introduction or synopsis; recommendation-specific supportive text; hyperlinked references; and, when relevant, figures, flow diagrams or algorithms, and additional tables. Each chapter has undergone blinded peer review by subject matter experts and was also reviewed and approved for publication by the AHA Science Advisory and Coordinating Committee and the AHA Executive Committee. Chapters with pediatric content (Neonatal Resuscitation, Pediatric Basic Life Support, and Pediatric Advanced Life Support) were also cochaired by the AAP and reviewed and approved by the AAP Board of Directors. The AAP also submitted names for peer review of the 2025 Guidelines and appointed one writing group member to each of the Evidence Evaluation, Ethics, Special Circumstances, and Systems of Care Writing Groups.

Each 2025 writing group reviewed all relevant and current AHA Guidelines for CPR and ECC,^{10,19,23–27} pertinent evidence evaluations and recommendations published in the International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations since 2020, AHA Focused Updates,^28–37 and all AHA evidence evaluation worksheets to determine if current guidelines should be reaffirmed, revised, or retired or if new recommendations were needed. The writing groups then drafted, reviewed, and approved recommendations after a thorough review of the literature for each topic, assigning to each a Class of Recommendation (COR; ie, strength) and Level of Evidence (LOE; ie, quality), as first described by Levine, et al. (2019)³⁸ and outlined in Table in “Part 2: Evidence Evaluation and Guidelines Development” of this supplement.²¹ Each knowledge chunk presents an overview of insights, including knowledge gaps and research priorities identified by writing group consensus discussions. A summary of knowledge gaps identified by the writing groups is included in this Executive Summary below. AHA policy requires that official positions and guidelines of the AHA must be reviewed and approved by the Board of Directors and/or its Executive Committee. Upon completion of peer review, these guidelines were reviewed and edited for publication by the AHA Science Advisory and Coordinating Committee and the AHA Executive Committee following the standard review process for all official AHA documents with legal, communications and science staff to ensure risk mitigation and accurate alignment with AHA mission.

The 2025 Guidelines contain 760 recommendations (Table). Despite recent improvements in support for resuscitation research, 38% of these recommendations are based on limited data. This highlights the persistent knowledge gaps in resuscitation science that need to be addressed through expanded research initiatives and funding opportunities.

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