Updated CPR guidelines provide expanded recommendations for managing choking and opioid overdose

The "2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC)," published today in the Association's flagship journal, Circulation, marks the first full revision of lifesaving resuscitation guidance since 2020. Among the updates are expanded recommendations for managing choking and suspected opioid overdose, in addition to other lifesaving interventions.

Each year, approximately 350,000 people in the U.S. experience an out-of-hospital cardiac arrest - when the heart suddenly stops beating - which results in death 90% of the time, according to the Association's statistics. The 2025 CPR guidelines provide an extensive review of the latest science, translating it into clear, lifesaving recommendations that empower people to act when every second counts.

Out-of-hospital cardiac arrests caused by respiratory emergencies or asphyxia occur in more than 9% of adults and 39% of children in the U.S. New guidance on choking recommends alternating five back blows followed by five abdominal thrusts for conscious children and adults, until the foreign object is expelled or the person becomes unresponsive. Choking guidance for adults was not included in the previous guidelines, and earlier guidance for children called for performing abdominal thrusts only. For infants, rescuers should alternate between five back blows and five chest thrusts using the heel of one hand, until the foreign object is expelled or the infant becomes unresponsive. Abdominal thrusts are not recommended for infants, due to the risk of injury.

The guidelines also provide updated recommendations for treating people experiencing a suspected opioid overdose, which is the cause of 80% of all drug overdose deaths worldwide. According to the World Health Organization (WHO), opioid use can lead to death because opioids affect the part of the brain that regulates breathing. Signs of an opioid overdose include:

• Slow, shallow or no breathing
• Choking or gurgling sounds
• Drowsiness or loss of consciousness
• Small, constricted pupils
• Blue or grey coloring of the skin, lips or nail beds

For the first time, the guidelines provide public access instruction on when to use naloxone, a medication used to reverse or reduce the effects of opioids.

The American Heart Association's 2025 CPR guidelines represent gold standard science. It reflects a rigorous examination of the most up-to-date evidence that guides how resuscitation is provided for critically ill patients. As the science continues to evolve, it's important that we continue to review new research specific to the scientific questions considered of greatest clinical significance that affect how we deliver life-saving care."

Ashish Panchal, M.D., Ph.D., volunteer chair of the American Heart Association Emergency Cardiovascular Care Science Committee, physician and professor of emergency medicine, The Ohio State University

Ashish Panchal, M.D., Ph.D., volunteer chair of the American Heart Association Emergency Cardiovascular Care Science Committee, physician and professor of emergency medicine at The Ohio State University

Together with the American Academy of Pediatrics, the Association co-developed the pediatric and neonatal guidelines that help protect the youngest and most vulnerable lives. These chapters were co-led by volunteer experts from both organizations, with writing groups evenly balanced between their members, resulting in a unified set of recommendations that reflect the shared expertise, dedication and vision of both organizations.

Alongside major changes to choking recommendations for infants, the neonatal guidelines provide further direction for treating newborns. For most term and preterm infants not needing immediate resuscitation, delaying umbilical cord clamping for at least 60 seconds - up from the previously recommended 30 seconds - has been shown to improve a newborn's blood health and iron levels.

"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. This action underscores our joint commitment to advancing pediatric and neonatal resuscitation — together," said Javier Lasa, MD, FAHA, FAAP, American Heart Association and American Academy of Pediatrics volunteer and co-chair of the 2025 Pediatric Advanced Life Support Writing Group and associate professor in critical care and cardiology at Children's Health in Dallas.

Further updates offer suggestions for increasing lay rescuer intervention in a cardiac emergency, noting that only approximately 41% of adults experiencing cardiac arrest outside of the hospital receive CPR before emergency medical services arrive. Early CPR could double or triple a person's chance of survival. New recommendations include:

• Consolidating the chain of survival into one chain, which highlights the importance of doing compressions and breaths, especially in children and infants. Previously, there were separate chains of survival for adults, infants and children experiencing a cardiac emergency, and for cases of in-hospital and out-of-hospital cardiac arrest.
• Aligning with new scientific evidence that suggests children 12 years old or older can be taught effective CPR and defibrillation.
• Further improving lay rescuer response to out-of-hospital cardiac arrests, by recommending the use of media awareness and education campaigns, increased instructor-led training and expanded community training.

The American Heart Association updates and publishes CPR guidelines periodically, as it has since issuing the first CPR guideline in 1966. The Association also plays a unique dual role in resuscitation—leading global efforts in public awareness, education and policy change, while also serving as the scientific authority that develops the official CPR and emergency cardiovascular care guidelines used by other CPR and first aid training providers in the U.S. and in over 90 countries worldwide. For more than five decades, the Association has trained millions of people each year in CPR, first aid and advanced cardiovascular care through its programs and awareness campaigns. As a founding member of the international committee that shapes lifesaving resuscitation guidelines, the Association ensures the CPR recommendations reflect the most advanced research from global experts around the world.

"We know high-quality CPR saves lives, and we need dedicated support to ensure that everyone who needs high-quality CPR receives it," said Panchal. "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. Everyone has a role to play in the chain of survival."

The American Heart Association and American Academy of Pediatrics are releasing new CPR and ECC training materials that reflect the latest guidelines' recommendations simultaneously with publication, accelerating adoption of the newest science so learners can begin using the most current, science-backed resources immediately. The updated guidelines and CPR training materials will be translated and trans created into many additional languages.