American Heart Association 2025 guidelines were released on 22nd October 2025. Here are the major changes.

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Systems of Care AHA 2025 updates

Prevention of In-Hospital Cardiac Arrest (IHCA)

• 2025 (New): Implementation of safety huddles to improve situational awareness in scenarios involving high-risk hospitalized patients.

Public Access to Naloxone

• 2025 (New): Public policies allowing possession, use, and immunity for civil and criminal liability for naloxone administration.
• 2025 (New): Naloxone distribution programs increase availability and decrease opioid overdose mortality.

Community Initiatives to Improve Lay Rescuer Response to OHCA

• 2025 (Updated): Implementing bundled community initiatives is reasonable and improves lay rescuer response.
• 2025 (New): Increasing availability of instructor-led CPR training in communities is effective for building lay rescuer response.
• 2025 (New): Mass media campaigns may promote learning of CPR skills in all populations.
• 2025 (New): Implementing policies requiring CPR certification in the public may be reasonable.

Clinical Debriefing

• 2025 (New): Incorporating immediate and delayed debriefing is reasonable and may identify system improvement opportunities.

OHCA Team Composition

• 2025 (New): The presence of ALS-level clinician during resuscitation is beneficial.
• 2025 (New): Ensuring sufficient EMS team size for clear role assignment is reasonable.

In-Hospital Code Team Composition

• 2025 (New): Dedicated Code teams should include ALS-trained members with defined roles, diverse expertise, and simulation training can improve IHCA outcomes.

On-Scene OHCA Resuscitation

• 2025 (New): EMS systems should train and prepare for termination of resuscitation on-scene.
• 2025 (New): Prioritizing on-scene resuscitation (focused on sustained ROSC) before transport for most OHCA patients is beneficial.

Extracorporeal Systems of Care (ECPR)

• 2025 (New): Frequent reassessment of ECPR patient selection criteria to maximize survival, ensure equity, and limit futility is reasonable.
• 2025 (New): Percutaneous technique experience for clinicians performing adult ECPR cannulation is reasonable.
• 2025 (New): Regionalized approach to ECPR may optimize outcomes and resource use.
• 2025 (New): Rapid intra-arrest transport for ECPR may be considered for selected OHCA adults.

Organ Donation

• 2025 (New): Institutions should develop systems of care facilitating organ donation after cardiac arrest.

Improving Cardiac Arrest Recovery

• 2025 (New): Integrated assessment systems for survivor recovery before, after, and ongoing post-discharge are beneficial.

NALS AHA 2025 Updates

Neonatal Advanced Life support 2025

Umbilical Cord Management

• 2025 (New): Intact cord milking is reasonable for nonvigorous term and late preterm infants (≥35 weeks).
• 2025 (Updated): Deferred cord clamping ≥60 seconds for both term and preterm newborns (<37 weeks) who do not need immediate resuscitation is recommended.

Ventilation and Airway Management

• 2025 (Updated): Initial inflation pressures (20–30 cm H₂O) should be adjusted to provide effective ventilation.
• 2025 (Updated): Ventilation rate of 30–60/min is reasonable in newborns.
• 2025 (New): Video laryngoscopy can be useful for newborn intubation.
• 2025 (New): Laryngeal mask may substitute intubation if face-mask ventilation fails (≥34 weeks).
• 2025 (New): Laryngeal mask as primary ventilation interface (≥34 weeks) may be reasonable.

Oxygenation

• 2025 (New): Pulse oximeter should be placed early for newborns needing respiratory support or oxygen.
• 2025 (Updated): Preterm newborns (<32 weeks) receiving support at birth may start with 30–100% oxygen.

Chest Compressions

• 2025 (New): Compress over lower third of sternum (above xiphoid) for newborns.
• 2025 (New): Switch compressors every 2–5 minutes during neonatal CPR.

Pediatric Basic Life Support 2025 Updates

Components of High-Quality CPR

• 2025 (New): Interruptions in CPR for infants/children should be minimized; pauses <10 seconds.

Sequence of Resuscitation

• 2025 (Updated): For infants, use heel of 1 hand or 2 thumb–encircling hands technique for compressions, not 2-finger technique.

Foreign-Body Airway Obstruction (FBAO)

• 2025 (Updated): For children, repeated cycles of 5 back blows alternated with 5 abdominal thrusts for severe FBAO.
• 2025 (Updated): For infants, repeated cycles of 5 back blows alternating with 5 chest thrusts for severe FBAO.

Pediatric Advanced Life Support 2025 Updates

Drug Administration During Cardiac Arrest

• 2025 (Updated): Early epinephrine for infants/children in cardiac arrest with nonshockable rhythm is reasonable.

Measuring Physiology During CPR

• 2025 (Updated): ETCO₂ monitoring may be considered for infants/children with invasive airway during CPR.
• 2025 (New): Do not use ETCO₂ cutoff alone to end resuscitative efforts for infants/children.
• 2025 (New): Target diastolic BP ≥25 mm Hg (infants) and ≥30 mm Hg (children ≥1 y) during CPR.

Treatment of Supraventricular Tachycardia With a Pulse

• 2025 (Updated): In SVT unresponsive to first-line treatments, IV procainamide, amiodarone, or sotalol may be reasonable.

Post–Cardiac Arrest Management

• 2025 (Updated): Maintain systolic/mean arterial BP >10th percentile for age post–cardiac arrest.
• 2025 (Updated): Use multimodal approach for neurological prognostication.
• 2025 (New): Cough/gag reflexes or pain response not established for neurological prognosis after pediatric arrest.
• 2025 (New): Using EEG up to 72 hours post-arrest may help assess prognosis.

Post–Cardiac Arrest Recovery and Survivorship

• 2025 (Updated): Evaluate physical, cognitive, and emotional needs for pediatric cardiac arrest survivors within first year.

Adult Basic Life Support

Airway Management

• 2025 (Updated): Jaw thrust preferred in head/neck trauma, but if airway can’t open, use head tilt–chin lift.

Ventilation

• 2025 (Updated): Give enough tidal volume for visible chest rise (Avoid hypo/hyperventilation) when ventilating adults in arrest.

Compression-to-Ventilation Ratio

• 2025 (Updated): Cycles of 30:2 are reasonable before advanced airway.

Defibrillation Pads

• 2025 (New): Adjusting bra position rather than removing it for adult defibrillation pads might be reasonable.

CPR for Adults With Obesity

• 2025 (New): Use standard techniques for CPR in cardiac arrest for adults with obesity.

Alternative Techniques for CPR

• 2025 (Updated): Routine use of mechanical CPR devices is not recommended for adult arrest.
• 2025 (New): They may be considered in settings where manual compressions are challenging.

Foreign-Body Airway Obstruction

• 2025 (Updated): For severe FBAO, adults should get repeated cycles of 5 back blows and 5 abdominal thrusts.

Adult Advanced Life Support

Vector Change and Double Sequential Defibrillation

• 2025 (New): Usefulness of vector change (Anterolateral to Anteroposterior pad position) defibrillation for refractory VF/pVT is unestablished.
• 2025 (Updated): Usefulness of double sequential defibrillation for refractory VF/pVT is unestablished.

Initial Vascular Access

• 2025 (Updated): Attempt IV access first for drug administration; IO access if IV is not feasible.

Vasopressor Medications

• 2025 (Updated): Give epinephrine after initial failed defibrillation for patients in arrest with shockable rhythm.
• 2025 (Updated): Vasopressin (alone or with epinephrine) offers no advantage over epinephrine alone.

Nonvasopressor Medications

• 2025 (New): Use of β-blockers, bretylium, procainamide, or sotalol for refractory VF/pVT is of uncertain benefit.

Adjuncts to CPR

• 2025 (New): Head-up CPR not recommended for adults except in clinical trials.

Termination of Resuscitation Measures

• 2025 (Updated): In tiered EMS systems, the universal termination of resuscitation rule is reasonable for OHCA.

Wide-Complex Tachycardia

• 2025 (Updated): Synchronized cardioversion recommended for unstable/wide-complex tachycardia. If stable, try after first-line treatment.

Atrial Fibrillation or Flutter With Rapid Ventricular Response

• 2025 (Updated): Initial energy setting of ≥200 J for AF cardioversion is reasonable.
• 2025 (New): Usefulness of double synchronized cardioversion for AF is uncertain.
• 2025 (Updated): Initial setting of 200 J for atrial flutter is reasonable.

Initial Management of Bradycardia

• 2025 (New): Temporary transvenous pacing for refractory, unstable bradycardia is reasonable.

Post–Cardiac Arrest Care

Blood Pressure in Adults After Cardiac Arrest

• 2025 (Updated): Maintain MAP ≥65 mm Hg; avoid hypotension after ROSC.

Diagnostic Studies for Adults After Cardiac Arrest

• 2025 (New): Head-to-pelvis CT may be reasonable to assess etiology/complications.
• 2025 (New): Echocardiography/cardiac ultrasound may help identify conditions needing intervention.

Temperature Control for Adults After Cardiac Arrest

• 2025 (Updated): Maintain temperature control ≥36 hours for patients unresponsive after ROSC.

Percutaneous Coronary Intervention

• 2025 (Updated): Coronary angiography before discharge is recommended when etiology suspected in cardiac arrest survivors.

Temporary Mechanical Circulatory Support

• 2025 (New): Temporary mechanical circulatory support may be considered in highly selected refractory cardiogenic shock cases after arrest.

Diagnosis and Management of Myoclonus

• 2025 (New): Do not treat myoclonus without EEG correlate in arrest survivors.

Neuroprognostication

• 2025 (New): Continuous EEG without discharges within 72 hours post-arrest may support favorable prognosis.

Recovery and Survivorship After Cardiac Arrest

• 2025 (Updated): Survivors and caregivers should get structured assessment and help for emotional distress before hospital discharge.

Special Circumstances of Cardiac Arrest

Life-Threatening Asthma Exacerbation

• 2025 (New): ECLS may help in refractory asthma failure.
• 2025 (New): Volatile anesthetics may help in refractory life-threatening asthma.

Life-Threatening Hyperkalemia

• 2025 (Updated): Effectiveness of IV calcium in cardiac arrest from suspected hyperkalemia is not established.

Life-Threatening Hypothermia

• 2025 (New): Use prognostication scores to guide ECLS rewarming for hypothermic arrest.
• 2025 (New): ECLS rewarming for severe hypothermia without arrest may be reasonable.

Life-Threatening Hyperthermia

• 2025 (New): Ice-water immersion (1–5 °C) and rapid cooling (≥0.15 °C/min) are recommended for hyperthermia.

Left Ventricular Assist Devices (LVAD)

• 2025 (New): If impaired perfusion and unresponsiveness, chest compressions should be performed in LVAD patients.
• 2025 (New): Start immediate chest compressions in LVAD patients while assessing device status.

Cardiac Arrest During Pregnancy

• 2025 (Updated): Begin resuscitative delivery as soon as arrest is recognized, aim to finish by 5 minutes.
• 2025 (New): ECPR may be reasonable in peripartum/pregnant patients not responding to standard resuscitation.
• 2025 (New): Massive transfusion protocol for life-threatening amniotic fluid embolism in peripartum is recommended.

Opioid Overdose

• 2025 (New): Naloxone administration may be reasonable in suspected opioid-overdose arrest, provided CPR is not delayed.
• 2025 (New): Provide take-home naloxone and instruction to adults/children treated for opioid overdose at hospital discharge.

Resuscitation Education and Implementation Science

Use of Feedback Devices During CPR Training

• 2025 (Updated): Feedback devices recommended for CPR training (For both health care professionals and lay rescuers).

Rapid-Cycle Deliberate Practice

• 2025 (New): Rapid-cycle deliberate practice in BLS/ALS training may be reasonable.

Teamwork and Leadership Training

• 2025 (Updated): Training should include specific teamwork competencies.

Gamified Learning

• 2025 (New): May be useful for CPR training in both health professionals and lay rescuers.

Virtual Reality and Augmented Reality

• 2025 (New): VR can support knowledge acquisition in BLS/ALS training for lay rescuers and professionals but not recommended for CPR skill practice.
• 2025 (New): Augmented reality can provide real-time CPR feedback in BLS training.

Opioid Overdose Training for Lay Rescuers

• 2025 (Updated): Lay rescuers should receive education on opioid overdose recognition and initial treatment.

Disparities in Education

• 2025 (Updated): Focus CPR training/awareness on specific racial/ethnic populations, low socioeconomic status populations and high-density areas.
• 2025 (Updated): Address barriers to CPR in women via training and awareness.
• 2025 (Updated): Increase access to CPR training materials in diverse languages.
• 2025 (Updated): Promote cost-effective, safe CPR training for low-resource settings.

CPR Training in School Children

• 2025 (New): Start CPR training in children <12 years to increase willingness and confidence.

Alternative Objects for Chest Compression Training

• 2025 (New): Usefulness of alternative objects to train lay rescuers in chest compressions (vs. manikins) is not well established.

Scripted Debriefing

• 2025 (New): Instructor-scripted debriefing may be reasonable during resuscitation education.

Use of Cognitive Aids

• 2025 (New): Cognitive aids may be reasonable for healthcare professionals during resuscitation but are not for lay rescuers.

Full pdf of changes from AHA

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Additional languages expected for HeartCode BLS: German, Italian, Japanese, Portuguese, Simplified Chinese, and Spanish.
Instructor Essentials courses of BLS, ACLS, PALS, and Heartsaver are expected to be released in early 2026 in English. Additional languages will be released after.

• ACLS EP and PEARS updates will be released at a future date.

2025 Orientation for Instructors

You need to undergo mandatory orientation courses to get familiarized with the updated course delivery (Must finish before 1st Mar 2025)

• BLS instructor update
• ACLS instructor update
• PALS instructor update
• Heartsaver instructor update
• PEARS instructor update

AHA also says you need your own copy of Instructor materials like teaching videos.

BLS update in AHA 2025

Starting 22 October 2025, International Training Centers will begin to transition to the HeartCode® BLS blended learning format. Let us explain the process of online + offline BLS.

• Step1 – Purchase online access for eLearning from AHA via various training centers available near you (List can be found on https://medcourse.in). Medcourse partners will offer a combo pack of offline + skill test.
• Step 2 – Finish learning and clear testing on theory online.
• Step 3 – Find a training center (https://medcourse.in can help you locate one near you as per your convenience) to finish Skill test.
• Step 4 – Once you finish skill test, the ITC will mark the candidate as Skill test pass or remediation/fail. If you do not clear the testing, you will be asked to attempt again on same day or at a later date.
• Step 5 – Receive your certificate on your dashboard immediately.

Update on eBooks and Videos

AHA has a disappointing news about eBooks. eBooks of 2020 version will not be converted to 2025 automatically. Same is the case with AHA streaming videos. The instructors need to purchase new videos.

2020 streaming videos and 2020 eBooks in the Heartsaver, BLS, PALS, and ACLS product lines will not transition to 2025 streaming videos and eBooks.

If you purchase an eBook code and redeem after release of 2025 guidelines, even then that code will provide access to 2020 material only. This is a harsh move in our opinion.

Between 22 October 2025 and 1 March 2026, both 2020 and 2025 versions will be made available. So, make sure you enquire properly before enrolling. Insist for 2025 certification only.

Releasing 22 October 2025

• HeartCode® programs and healthcare products in the core disciplines of BLS, ACLS, PALS.
• Heartsaver® First Aid CPR AED product line
• Resuscitation Quality Improvement® (RQI®) Programs
• 2025 AHA Guidelines for CPR & ECC Reprint & Digital Reprint
• Highlights of the 2025 AHA Guidelines (in 19 languages)
• 2025 AHA Guidelines Science In-Service (this is an eLearning course for healthcare
  professionals who are not AHA instructors)
• Instructor Updates (required eLearning for Instructors) for BLS, ACLS, PALS, PEARS®, and Heartsaver
• Interim training materials for BLS, ACLS, PALS, PEARS, ACLS for Experienced Provider
  (ACLS EP), and Heartsaver
• Product and Course Orientations for BLS, ACLS, PALS, and Heartsaver (optional
  eLearning for Instructors)