Late last year, the American Heart Association (AHA) released updated guidelines for CPR and emergency cardiovascular care (ECC). The recommendations build on years of ongoing evidence analysis informed by the International Liaison Committee on Resuscitation and its member organizations. The guidance reinforces the importance of high-quality chest compressions, early defibrillation, and the integration of advanced resuscitation techniques.1
The 2025 update process began when the 2020 guidelines were completed—even then, we were already thinking about the next phase,” said Ashish Panchal, MD, PhD, Professor of Emergency Medicine at The Ohio State University Wexner Medical Center and Chairperson of the AHA-led Emergency Cardiovascular Care Committee. “Understanding where the gaps in knowledge are—and identifying the questions that need to be addressed for each chapter—guided the conceptual framework for how we approached these updates.”
A diverse developmental process
The latest guideline update focuses on equitable access to lifesaving care and clarifies consistent application in real-world settings. Rather than introducing sweeping changes, the recommendations reflect targeted interventions informed by experts working through the committee, bringing diverse clinical perspectives to the guideline development process.
“The AHA always tries to diversify its committees to include pediatricians, emergency department clinicians, critical care clinicians, and other specialists,” said Daniel Arellano, PhD, RN, APRN, ACNP-BC, an acute care nurse practitioner at MD Anderson Cancer Center in Houston and a member of the committee. “They do a really good job with incorporating that diverse thought.”
Despite advances in resuscitation science, the incidence of cardiac arrest remains high, and overall survival rates are low. Outcomes also vary widely, with lower survival rates among marginalized racial and ethnic groups and in rural areas.1
With these challenges in mind, the updated guidelines introduce several key changes for both lay rescuers and professional responders. The following sections highlight select updates on resuscitation strategies. Full details are available at cpr.heart.org.
Refining terminology
Alongside clinical updates, the 2025 AHA guidelines for CPR and ECC refine the language to help improve communication and accuracy in emergency response education. For example, “rescue breaths” is no longer used; “breaths” now refers to assisted breathing during CPR or for someone with a pulse who is not breathing. “Ventilation” is reserved for mechanical respiratory support provided by professionals.1
The guidelines also recommend the term “lay rescuer” rather than “bystander,” noting the role that nonhealth care professionals play in initiating lifesaving care. Additional terminology clarifies the distinction between return of spontaneous circulation and return of circulation, differentiating spontaneous cardiac recovery from circulation achieved through mechanical support.1
Defining the role of mechanical CPR
Mechanical CPR devices have been used to deliver consistent, automated chest compressions, particularly during prolonged resuscitation efforts or situations in which maintaining high-quality manual CPR is challenging.
However, the updated guidelines stop short of recommending routine use of mechanical CPR devices. Based on the evidence reviewed, the guidelines reaffirm manual CPR as the standard approach, with mechanical devices considered only in specific circumstances when logical factors—such as transport time, crew safety, or limited personnel—make manual compressions difficult to sustain.2
Addressing equity in defibrillator placement
Timely defibrillation remains a cornerstone of cardiac arrest care. But Dr. Arellano noted that uncertainty around pad placement and clothing— particularly in women—can delay care.
“Defibrillator pad placement is important because it touches on equity and access,” he said. “In some cases, providers hesitate to adjust or remove clothing, such as bras. The guidelines give clearer direction to avoid it being a hindrance. We don’t want women to have worse outcomes simply because of clothing like bras.”
Additionally, the guidelines clarify that defibrillation pads may be placed in either an anterolateral or anteroposterior position and recommend using pads or paddles with an electrode diameter greater than 8 cm for adults.2
A unified chain of survival
The essential actions for treating cardiac arrest are contained within the comprehensive framework known as the “Chain of Survival.” This framework is flexible and can be adapted based on the specific context of the arrest, such as the victim’s age, the cause of the event, and where it takes place.
Previously, the 2020 guidelines depicted four related but distinct chains of survival for adults and children experiencing in-hospital and out-of-hospital cardiac arrest. The 2025 guidelines place renewed emphasis on the Chain of Survival as a single, unified framework that applies across adult and pediatric patients and care settings.
With the update, the Chain of Survival is a clearer progression of events, beginning with recognition of cardiac arrest and ideally culminating in survival and recovery.3 Each link in the chain is paired with a visual representation to reinforce key priorities:
- Early recognition and emergency activation
- High-quality CPR
- Defibrillation
- Advanced resuscitation
- Postcardiac arrest care
- Recovery and survivorship
Notably, the symbol for high-quality CPR now includes lungs alongside chest compressions, highlighting the importance of breathing—especially in pediatric patients and in opioid-related arrests.3
“One of the biggest aspects highlighted for me is the continued support of our initial response: Call 911, and push hard and fast,” Dr. Panchal said. “When our experts revisited the Chain of Survival, we unified it into a clearer, single framework that reinforces the concept of immediate response.”
Be intentional and implement
Covering topics from ethics and basic life support to advanced techniques and postarrest care, the updated guidelines prioritize clarity, consistency, and practical application. Clinicians and lay responders alike are encouraged to review the full guidelines and update their training to reflect these new recommendations.
The responsibility of providers, Dr. Panchal noted, extends beyond the hospital walls.
“We’re not only advocates, we’re also ambassadors. So many people look to us for guidance about what is the right thing to do at the right time,” he said. “Take to heart the importance of your role as an ambassador to save lives because people will listen to you, and they will follow your lead in learning how to do hands-only CPR and being intentional about doing the right thing.
This article was originally published in the Spring 2026 issue of CHEST Physician.
References
1. Del Rios M, Bartos JA, Panchal AR, et al. Part 1: executive summary: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2025;152(16_suppl_2):S284-S312. doi:10.1161/CIR.0000000000001372
2. Kleinman ME, Buick JE, Huber N, et al. Part 7: adult basic life support: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2025;152(16_suppl_2):S448-S478. doi:10.1161/CIR.0000000000001369
3. Dezfulian C, Cabañas JG, Buckley JR, et al. Part 4: systems of care: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2025;152(16_suppl_2):S353-S384. doi:10.1161/CIR.0000000000001378
