Updated CPR Guidelines Introduce New Choking Response, Opioid Overdose Protocol and Unified Chain of Survival

The 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care published in Circulation represent the first comprehensive revision since 2020, introducing critical updates that address choking emergencies, opioid overdoses, and resuscitation protocols that could significantly impact survival rates. With approximately 350,000 people in the U.S. experiencing out-of-hospital cardiac arrest annually resulting in death 90% of the time according to Association statistics, these evidence-based guidelines translate the latest science into clear, lifesaving recommendations that empower people to act when seconds matter.

New choking guidance represents a substantial shift in emergency response protocols. For conscious children and adults, rescuers should now alternate five back blows followed by five abdominal thrusts until the object is expelled or the person becomes unresponsive. This marks a significant departure from previous guidelines that didn't include adult choking guidance and recommended only abdominal thrusts for children. Infant choking response has been updated to alternate between five back blows and five chest thrusts using the heel of one hand, with abdominal thrusts specifically not recommended due to injury risks. These changes address the reality that 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.

The guidelines provide groundbreaking public access instruction for treating suspected opioid overdose, which causes 80% of all drug overdose deaths worldwide according to the World Health Organization. For the first time, the guidelines include specific guidance on naloxone use, a medication that reverses opioid effects. The World Health Organization notes that opioid use can lead to death because opioids affect the part of the brain that regulates breathing, with overdose signs including slow or no breathing, choking sounds, loss of consciousness, constricted pupils, and blue or grey skin coloring.

A major structural change involves reverting to a single chain of survival for all forms of cardiac arrest, whether adult or pediatric, in-hospital or out-of-hospital. This consolidation highlights the importance of performing both compressions and breaths, particularly for children and infants. The guidelines also confirm that children 12 years old or older can be taught effective CPR and defibrillation, expanding the potential pool of trained rescuers. To improve lay-rescuer response to out-of-hospital cardiac arrests where only approximately 41% of adults receive CPR before emergency medical services arrive, the guidelines recommend support for media campaigns, instructor-led training, and community training initiatives.

Developed in collaboration with the American Academy of Pediatrics, the pediatric and neonatal guidelines include additional updates such as delaying umbilical cord clamping for at least 60 seconds for most term and preterm infants not needing immediate resuscitation, up from the previously recommended 30 seconds, which has been shown to improve newborn blood health and iron levels. The American Heart Association plays a unique dual role in resuscitation, leading global efforts in public awareness and education while serving as the scientific authority that develops official CPR and emergency cardiovascular care guidelines used by training providers in the U.S. and over 90 countries worldwide.