Circulation

October 21, 2025 Circulation. 2025;152(suppl 2):S284–S312. DOI: 10.1161/CIR.0000000000001372

Circulation is available at www.ahajournals.org/journal/circ

© 2025 American Heart Association, Inc.

Part 1: Executive Summary: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Marina Del Rios, MD, MS, Chair; Jason A. Bartos, MD, PhD; Ashish R. Panchal, MD, PhD; Dianne L. Atkins, MD; José G. Cabañas, MD, MPH; Dazhe Cao, MD; Katie N. Dainty, PhD; Cameron Dezfulian, MD; Aaron J. Donoghue, MD, MSCE; Ian R. Drennan, ACP, PhD; Jonathan Elmer, MD, MS; Karen G. Hirsch, MD; Ahamed H. Idris, MD; Benny L. Joyner, MD, MPH; Beena D. Kamath-Rayne, MD, MPH; Monica E. Kleinman, MD; Michael C. Kurz, MD; Javier J. Lasa, MD; Henry C. Lee, MD; Mary E. McBride, MD, MEd; Tia T. Raymond, MD, MBA; Jon C. Rittenberger, MD, MS; Stephen M. Schexnayder, MD; Edgardo Szyld, MD, MSc; Alexis Topjian, MD, MSCE; Jane G. Wigginton, MD, MSCS; Jeanette K. Previdi, MPH, BSN, RN, Vice Chair

ABSTRACT: 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.

Key Words: AHA Scientific Statements ◼ arrhythmias, cardiac ◼ cardiopulmonary resuscitation ◼ critical care ◼ delivery of health care

◼ ethics ◼ heart arrest ◼ life support care

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

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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 EMStreated 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

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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 bagmask 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

Figure 1. Cardiac arrest Chain of Survival. CPR indicates cardiopulmonary resuscitation.

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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. 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

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.

Figure 2. Newborn Chain of Care.

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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.

ETHICS

“Part 3: Ethics” provides an overview of ethical considerations that are particularly relevant to ECC and resuscitation.39 This discussion is divided into 4 main sections. First, the chapter provides an overview of key frameworks in medical ethics that provide a structure through which health care professionals can analyze difficult decisions. In addition to principlism, which is organized around the principles of autonomy, justice, beneficence, and nonmaleficence and is currently the dominant medical ethical framework, the discussion highlights the importance of dignity and equity in ECC. Second, the authors summarize common approaches to ethical decision-making in ECC, including advanced directives, protocols, and shared decision-making. The chapter then discusses the specific decision to withhold or terminate CPR in adults and special populations, such as geriatric patients, children, and newborn infants. Additional consideration is given to the ethical complexity of prognostication and uncertainty, decisions to withhold or withdraw potentially ineffective therapies, and cultural and religious considerations. Finally, authors considered other selected ethical topics of importance in ECC. These include the process of research and knowledge generation (including guidelines development); the impact on health care professionals, patients, and families of those providing, receiving, or witnessing

Table.  Recommendations in the 2025 Guidelines Classification SOC Neonatal PBLS BLS PALS ALS Spec Circ PCAC Education Total % Class (Strength) of Recommendation 1 (strong) 13 21 19 25 36 19 66 23 11 233 31 2a (moderate) 19 24 11 21 25 18 84 6 9 217 29 2b (weak) 6 18 6 15 45 29 58 41 16 234 31 3: No benefit (moderate) 0 1 0 3 12 8 21 9 1 55 7 3: Harm (strong) 0 3 1 3 2 5 6 0 1 21 3 Totals 38 67 37 67 120 79 235 79 38 760 100 Level (Quality) of Evidence A 1 3 0 0 1 2 2 0 2 11 1 B-R 4 8 0 6 3 22 9 21 9 82 11 B-NR 21 13 4 7 32 20 32 41 6 176 23 C-LD 9 30 20 40 61 29 67 12 20 288 38 C-EO 3 13 13 14 23 6 125 5 1 203 27 Totals 38 67 37 67 120 79 235 79 38 760 100 ALS indicates advanced life support; BLS, basic life support; PALS, pediatric advanced life support; PBLS, pediatric basic life support; PCAC, post–cardiac arrest care; SOC, systems of care; and Spec Circ, special circumstances.

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resuscitation; crisis standards of care; advanced therapies, such as mechanical circulatory support; and organ and tissue donation. Ethics is most relevant to complex situations where there is not a single correct course of action and the process of knowledge generation differs from other medical domains. Thus, the chapter is presented in narrative format, rather than as modular chunks, and refrains from making evidence-based treatment recommendations.

SYSTEMS OF CARE

Survival after cardiac arrest requires an integrated system of people, protocols, policies, and resources along with ongoing data acquisition and review to achieve quality improvement. Such SOC, which are highly influenced by the environment in which they operate, produce efficiency and effectiveness in responding to cardiac arrest. Within the Utstein Formula for Survival (refer to Figure 3), SOC represents the operational means by which local implementation occurs. The objective of a cardiac arrest SOC is to quickly, efficiently, and effectively perform each step within the Chain of Survival. Part 4 of the 2025 Guidelines, “Systems of Care,” focuses on elements that are relevant to a broad range of resuscitation situations.40 Previous SOC guidelines have identified a Chain of Survival (refer to Figure 1), beginning with prevention and preparedness to resuscitate and proceeding through resuscitation to post–cardiac arrest care, survivorship and recovery. The SOC guidelines include recommendations on training of specific personnel, implementation of protocols that have been demonstrated to be effective, and incorporation of nonhuman resources to optimize cardiac arrest care with ongoing debriefing and quality-improvement strategies. Germane to OHCA, this Part contains recommendations about EMS team composition and transport, community initiatives to promote lay rescuer response, public access to defibrillation and naloxone, and the role of emergency telecommunicators. Germane to IHCA are recommendations about cardiac arrest prevention and code team composition. Finally, this Part includes recommendations about extracorporeal membrane oxygenation CPR, cardiac arrest centers, organ donation, survivorship systems, and performance measurement across the continuum of resuscitation.

Significant New and Updated Recommendations Prevention of IHCA We have combined the recommendations for adult and pediatric early warning systems and rapid response teams and recommend both as a means for preventing IHCA (early warning systems: COR 2a, LOE B-R; rapid response teams: COR 2a, LOE B-NR). The use of safety huddles is now recommended for patients identified as high risk to prevent IHCA (COR 2a, LOE B-NR).41–43 Public Access to Naloxone Two new recommendations advise the implementation of public policies that permit the use of naloxone in cases of suspected opioid overdose without fear of prosecution (COR 1, LOE B-NR)44–46 and that support public distribution of naloxone through various means (COR 2a, LOE B-NR).47,48

Community Initiatives to Promote Lay Rescuer Response to OHCA Prior recommendations on mobile technologies were combined into this knowledge chunk aimed at using various means to encourage lay rescuer CPR and use of AEDs. Recommendations are now provided on community education (COR 2a, LOE B-NR),49–52 mass media campaigns (COR 2b, LOE C-LD),53 policies supporting mandatory CPR certification (COR 2b, LOE C-LD),54,55 the use of mobile technologies (COR 2a, LOE B-NR),56–58 and bundled approaches (COR 2a, LOE B-NR) to achieve higher rates of lay rescuer response.59–62 Telecommunicator Recognition and Instructions Recommendations regarding telecommunicator recognition of OHCA were strengthened (COR 1, LOE C-LD),63 and the LOE for providing compression-only instructions in adult OHCA was raised (COR 1, LOE A) in recognition of a meta-analysis of randomized trials that supports this recommendation.64 Team Composition for OHCA and IHCA New recommendations are provided on the resuscitation team composition within the in- and out-of-hospital settings. These support the inclusion of at least one team member with advanced cardiac life support training (OHCA: COR 2a, LOE B-NR; IHCA: COR 1, LOE B-NR) and the delineation of roles with sufficient team size to achieve these roles (OHCA: COR 2a, LOE B-NR; IHCA: COR 2a, LOE B-NR). On-Scene OHCA Resuscitation New recommendations are made supporting ongoing resuscitation at the scene of OHCA in most cases, as opposed to early transport to a hospital (COR 2a, LOE B-NR).65–67 This strategy will necessitate termination of resuscitation on scene in many cases, and, therefore, it is recommended that EMS be trained in death notification to family and friends, which is a challenging task (COR 1, LOE B-NR).68–70

Cardiac Arrest Centers In light of a recent randomized controlled trial (RCT) that did not support transport of post–cardiac arrest patients to regionalized centers of excellence,71 and acknowledging the lack of certainty about criteria that define a cardiac arrest center, the class of this recommendation was reduced from 2a to 2b and the LOE was increased to B-R (COR 2b, LOE B-R).

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Extracorporeal Membrane Oxygenation CPR SOC A new knowledge chunk pertaining to the components of an SOC intended to support extracorporeal CPR (ECPR) has been added. Four new recommendations provide guidance on the components of an SOC that are needed to support ECPR. These include recommendations regarding patient selection (COR 2a, LOE C-LD), cannulation strategies (COR 2a, LOE C-LD), regionalization of ECPR (COR 2a, LOE C-LD), and intra-arrest transport to regionalized ECPR centers (COR 2b, LOE B-R). Organ Donation Included is a new Class 1 recommendation (COR 1, LOE C-EO) that institutions develop SOC intended to evaluate patients who have had a cardiac arrest and who are unlikely to have a favorable outcome for the possibility of organ donation. Survivorship and Rehabilitation Systems We now recommend (COR 2a, LOE B-R) that institutions create SOC that span inpatient and outpatient domains to evaluate cardiac arrest survivors for disabilities and to provide them ongoing support to optimize recovery.72–77

Clinical Debriefing We reiterated prior recommendations on clinical debriefing and added a new recommendation to consider incorporating immediate (hot) and delayed (cold) debriefing as a means to achieve system improvement (COR 2a; LOE C-EO).

Knowledge Gaps Resuscitation science continues to evolve, with a growing understanding as new literature emerges of how integrated SOC impact clinical outcomes. Although many areas still require further study, the writing group felt that the following questions represent the most important knowledge gaps in SOC and, therefore, deserve the highest priority for future research:

•	 How can mobile technologies best be used to increase witness status in OHCA and resuscitation by lay rescuers to maximize opportunities for early intervention? •	 What are the most cost-effective and feasible community interventions (including use of novel mobile technologies and drones) to optimize lay rescuer response to OHCA? •	 Does telecommunicator-assisted conventional CPR (with breaths) offer improved outcomes compared with telecommunicator-assisted compression-only CPR in pediatric OHCA? •	 Do specific etiologies of OHCA (eg, opioid-­ associated OHCA) warrant telecommunicators encouraging lay rescuers to perform conventional CPR (with breaths) over compression-only CPR? •	 What are the patient characteristics wherein rapid response team and medical emergency team programs provide the greatest outcome benefits? Which interventions are most effective? Should automated early warning scores be linked to rapid response team or medical emergency team programs? •	 What are the optimal timing, methods, and specific components of feedback or debriefing after attempted cardiac arrest resuscitation? •	 How should behavior and leadership skill training be applied to code teams and EMS systems to optimize resuscitation? •	 How can out-of-hospital and in-hospital datasets best be integrated as part of quality-improvement programs and research within SOC? •	 Which patients warrant transport to a hospital with ongoing CPR, and what are the safest means of doing so while maintaining high-quality CPR? •	 What constitutes a regionalized cardiac arrest center justifying longer transport times based on improved outcomes?

NEONATAL RESUSCITATION

Part 5 of the 2025 Guidelines, “Neonatal Resuscitation,” includes recommendations on following the resuscitation algorithm through steps of anticipation and preparation, umbilical cord management at delivery, initial actions, temperature maintenance, heart rate monitoring, respiratory support, chest compressions, intravascular access and therapies, withholding and discontinuation of resuscitation, and postresuscitation care.78 These recommendations were developed by a multidisciplinary team of experts led by volunteer experts from the AHA and AAP. Consistent with the Utstein Formula for Survival (refer to Figure 3), the 2025 Guidelines provide a comprehensive review of recommendations for neonatal resuscitation, including new and updated recommendations that are based on the latest evidence from studies published in the medical literature and reviews completed by ILCOR.79 These recommendations are also inclusive of and have updated upon the 2023 update to the neonatal resuscitation guidelines.80

Significant New and Updated Recommendations Umbilical Cord Management Deferring umbilical cord clamping in most instances for at least 60 seconds after birth can be beneficial in both term (COR 2a, LOE B-R) and preterm (COR 1, LOE A) newborn infants who do not require immediate resuscitation.37 For nonvigorous term newborn infants (and late preterm infants ≥35 weeks’ gestation), intact cord

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milking may be reasonable when compared with immediate cord clamping (COR 2b, LOE B-R) because it may reduce the need for cardiorespiratory support.81 Cord milking is not recommended for newborn infants <28 weeks’ gestation because it is associated with intraventricular hemorrhage (COR 3: Harm, LOE B-R).82 Oxygen Oxygen concentration should be adjusted using pulse oximetry to target goals (COR 1, LOE C-EO). The initial oxygen concentration when providing ventilation is 21% for term and late preterm newborn infants ≥35 weeks’ gestation (COR 2b, LOE C-LD).83 For preterm newborn infants 32 to 35 weeks’ gestation, it may be reasonable to begin with 21% to 30% oxygen, with higher initial oxygen concentration for preterm infants <32 weeks’ gestation (COR 2b, LOE C-LD), as a recent meta-analysis reported that high initial oxygen concentration may be associated with lower mortality.84,85 Providing Assisted Ventilation For term newborn infants, initial peak inflation pressures of up to 30 cm H2O are reasonable, with adjustment of peak inflation pressures as needed (COR 2a, LOE C-LD).86 For preterm newborns, initial peak inflation pressures of 20 to 25 cm H2O are reasonable, with adjustment of peak inflation pressures as needed (COR 2a, LOE C-LD).87 Ventilation Corrective Maneuvers Ventilation corrective maneuvers can be useful when initial positive pressure inflations are not effective in newborn infants who require ventilation (COR 2a, LOE C-LD).88 Video laryngoscopy compared with traditional laryngoscopy can be useful for newborn infants who require endotracheal intubation (COR 2a, LOE B-R).79 Devices and Interfaces A laryngeal mask, also referred to as a supraglottic airway, can be used as the primary interface to provide ventilation for newborn infants ≥34 weeks’ gestation (COR 2b, LOE C-LD).89 It can also be an alternative airway used in the process of corrective ventilation steps when facemask ventilation is not effective (COR 2a, LOE C-LD).90 A T-piece resuscitator can be beneficial to administer ventilation to newborn infants, particularly for preterm infants, because it may reduce the duration of ventilation and decrease the risk of bronchopulmonary dysplasia (COR 2a, LOE B-R).91 Newborn Chain of Care The Newborn Chain of Care addresses the broader context in which neonatal resuscitation occurs and how systems, starting from prenatal care and extending to postresuscitation and follow-up care, can optimize neonatal outcomes. Knowledge Gaps

Some of the most pertinent gaps in neonatal resuscitation research include the following:

•	 What is the optimal initial oxygen concentration and oxygen titration strategy for preterm newborn infants requiring resuscitation? •	 What is the optimal interval between birth and clamping the umbilical cord, and what interventions should be provided during this interval? •	 Which term infants are best supported with continuous positive airway pressure versus supplemental oxygen or close observation without intervention? •	 What are optimal adjustment strategies after starting assisted ventilation for positive end-expiratory pressure and peak inflation pressure? •	 Can algorithms using large data sources predict which babies will require resuscitation or predict the likelihood of death or very poor neurodevelopmental outcome, and can corresponding tools impact clinical outcomes?

PEDIATRIC BASIC LIFE SUPPORT

Part 6 of the 2025 Guidelines, “Pediatric Basic Life Support,” includes recommendations for the treatment of pediatric OHCA and IHCA for patients outside of the newborn period.92 In contrast to the 2020 Guidelines, which combines PBLS and PALS in the same chapter (“Part 4: Pediatric Basic and Advanced Life Support”),25 this 2025 summary focuses solely on PBLS. These recommendations were developed by a multidisciplinary team of experts led by volunteer experts from the AHA and AAP. The causes, treatment, and outcomes of cardiac arrest in children differ from those of cardiac arrest in adults. For example, pediatric cardiac arrests are more often due to respiratory causes that progress to cardiac arrest rather than a primary cardiac event. These Guidelines contain recommendations for PBLS that are based on the best available resuscitation science. These apply to infants and children up to signs of puberty in the prearrest and intra-arrest phases of care in multiple settings, including the community, prehospital, and hospital environments. Topics reviewed include cardiac arrest in special circumstances, such as severe foreign body airway obstruction (FBAO). This summary highlights the new and updated recommendations in PBLS since 2020 that will have a significant impact on processand ­patient-related outcomes from cardiac arrest. ­Additional recommendations related to pediatric resuscitation can be found in “Part 4: Systems of Care” and “Part 10: Adult and Pediatric Special Circumstances of Resuscitation.”

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Significant New and Updated Recommendations Emphasis of Breaths With Chest Compressions Despite increasing frequency of compression-only CPR in adults and children and mixed results when comparing conventional CPR (chest compressions and breaths) and compression-only CPR, large observational studies in children with OHCA show the best outcomes with conventional CPR.93–104 A small observational study of school-aged children found similar outcomes between conventional and compressiononly CPR (COR 1, LOE B-NR).104 Large observational studies of children with OHCA do, however, show that compression-only CPR is superior to no lay rescuer CPR (COR 2a, LOE B-NR). Elimination of 2-Finger Compression In infants, systematic reviews and meta-analyses from simulation studies suggest that the 2 thumb–encircling hands technique is a superior technique when compared with 2-finger compressions, particularly for depth.105–109 In a multicenter, prospective observational registry study, the 1-hand technique resulted in greater compression depth than the 2-thumbs technique in infants, with no difference in chest compression rate between hand positions.110 The 2-finger technique was utilized rarely in this study but, when used, no chest compression segments were compliant with AHA pediatric guidelines (COR 1, LOE B-NR).110 Minimizing Perishock Pauses Prolonged pauses in chest compressions before and after shock delivery decrease blood flow and oxygen delivery to vital organs, such as the brain and heart, and are associated with decreased survival (COR 1, LOE C-EO).111,112 Foreign Body Airway Obstruction A recent observational study of adult FBAO suggests improved clearance of a foreign body with the use of back blows over abdominal thrusts.113 To create consistency for instructional purposes, and in the absence of inferiority from pediatric data, management of severe FBAO in children now starts with cycles that ­alternate 5 back blows, followed by a series of 5 abdominal thrusts, repeating as necessary (COR 1, LOE C-LD).

Knowledge Gaps Some of the most pertinent gaps in pediatric resuscitation research include the following:

•	 What are the optimal chest compression metrics for pediatric resuscitation regarding compression depth, rate, and fraction (to include details about the timing and duration of pauses)? Do the optimal performance metrics change according to age or etiology? •	 With what frequency should the rhythm and pulse be checked during CPR? •	 What is the optimal ventilation rate during CPR in patients with or without an advanced airway? Is it age dependent? •	 What is the optimal position for performing chest compressions (eg, on a step stool, kneeling on the bed, standing)? •	 What is the effect of leaning on the chest and providing incomplete expansion of the chest in between chest compressions? •	 What is the ideal concentration of oxygen to deliver when performing CPR? •	 What is the ideal compression-to-ventilation ratio? •	 What are the optimal timing and dosing of defibrillation for ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) and its interface with CPR? •	 What clinical tools can be used to help in the decision to terminate pediatric IHCA or OHCA resuscitation? •	 What is the effectiveness of a single shock compared with sequential (stacked) shocks in pediatrics? •	 What is the adverse impact of shocking nonshockable rhythms with a manual defibrillator in IHCA? •	 Is the time to shock with self-adhesive pads significantly different than with paddles? •	 Is there an optimal pad position for defibrillation in pediatrics? If so, is it anteroposterior or anterolateral? •	 Are there comparative pediatric population-based data for FBAO interventions (chest compressions versus abdominal thrusts)? •	 What are the safety and efficacy of commercial devices to treat FBAO?

ADULT BASIC LIFE SUPPORT

Part 7 of the 2025 Guidelines, “Adult Basic Life Support,” provides recommendations for adults experiencing cardiac arrest, respiratory arrest, and FBAO.114 Early provision of high-quality CPR and prompt defibrillation are the key interventions to improve outcomes from adult cardiac arrest. The chapter addresses the recognition of cardiac arrest, the initial steps of CPR, and specific aspects of performance, such as rate and depth of chest compressions. Algorithms are provided to illustrate the sequence of resuscitation for adult cardiac arrest and interventions for FBAO. One notable change to the adult basic life support (BLS) algorithm is the inclusion of naloxone use by lay rescuers during respiratory and cardiac arrest. For purposes of these Guidelines, persons with signs of puberty are treated using the recommendations for adult BLS, while prepubertal children are treated using the recommendations in “Part 6: Pediatric Basic Life Support.”

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Significant New and Updated Recommendations Foreign Body Airway Obstruction Based on additional evidence of effectiveness and safety, the use of back blows is now recommended as the initial step for conscious adults with FBAO, followed by abdominal thrusts (COR 1, LOE B-NR).113 As in 2020, once the person becomes unresponsive, the recommendation is to initiate CPR (COR 1, LOE C-LD), with inspection of the mouth for presence of a foreign body prior to delivery of breaths (COR 1, LOE C-EO). A new algorithm for treatment of FBAO for adults is included. Fundamentals of Ventilation The use of breaths with chest compressions is recommended for both health care professionals (COR 2a, LOE C-LD) and lay rescuers (COR 2a, LOE B-R) when they are willing and capable. For lay rescuers who are willing to perform breaths, the use of a pocket mask, a face shield, or mouth-to-mouth breaths is acceptable. Providing breaths by using a pocket mask has been shown to deliver more effective breaths than using a face shield, so a pocket mask should be used if available. Observational studies suggest that breaths provided during CPR are often inadequate, so rescuers and health care professionals are advised to deliver each breath until there is visible chest rise (COR 2a, LOE C-LD).115 Positioning and Location for CPR The effectiveness of chest compression delivery can be improved through optimizing rescuer hand position, rescuer body position, and patient position. Whenever possible, CPR should be performed on a firm surface. A rescuer should position themselves so that their knee is aligned with the patient’s torso, either by kneeling next to the patient or using a step stool for improved chest compression quality (COR 1, LOE B-NR). During the COVID-19 pandemic, the use of prone positioning for patients with hypoxic respiratory failure led to increased experience with the use of prone CPR. While the supine position is preferred, rescuers can consider providing CPR in the prone position if the supine position is not possible or would lead to significant delays in initiation of compressions (COR 2b, LOE C-LD).116 Feedback Devices and Mechanical CPR Based on additional studies, the use of real-time feedback devices during CPR is recommended to improve manual CPR performance (COR 2a, LOE B-R).117 Studies comparing mechanical to manual CPR have shown that mechanical CPR is no better than manual CPR in improving patient survival. At present, the routine use of mechanical CPR devices is not recommended (COR 3-No Benefit, LOE B-R) but may be considered in specific circumstances in which high-quality CPR cannot be maintained or for health care professional safety, such as during transport to a hospital (COR 2b, LOE C-LD).

Knowledge Gaps Questions that address some of the most pertinent gaps in adult resuscitation research include the following:

•	 What is the optimal sequence of interventions for adults with severe FBAO? •	 What are the most reliable indicators to quickly and accurately identify cardiac arrest in adults? •	 Should health care professionals check for a pulse prior to initiation of CPR? •	 What is the optimal pad configuration (eg, anteriorlateral versus anterior-posterior) to improve defibrillation success? •	 What is the optimal time interval for duration of chest compressions after shock delivery and prior to reassessing rhythm? Are there methods to assess presence of a perfusing rhythm prior to the current 2-minute interval? •	 Are asynchronous breaths or ventilations effective during continuous chest compressions without an advanced airway? •	 What is the optimal chest compression depth, rate, and duty cycle for adult cardiac arrest? •	 What is the optimal chest compression fraction during CPR by trained lay rescuers and health care professionals? •	 Are there noninvasive techniques for measuring blood flow during CPR that could guide performance of chest compressions? •	 What are the appropriate targets for ventilation volumes and rates during BLS care of an adult patient who is in cardiac arrest? •	 Can respiratory volume monitoring provide accurate measurements during CPR? What is the optimal ventilation rate and volume for an adult with absent or abnormal breathing but with presence of a pulse?

PEDIATRIC ADVANCED LIFE SUPPORT

Part 8 of the 2025 Guidelines, “Pediatric Advanced Life Support,” includes recommendations for the treatment of pediatric OHCA and IHCA, including postarrest care and survivorship.118 These Guidelines contain recommendations for PALS and are based on the best available resuscitation science. These recommendations were developed by a multidisciplinary team of experts led by volunteer experts from the AHA and AAP. For the purposes of the PALS guidelines, pediatric patients are infants and children up to 18 years of age, excluding newborn infants. In contrast, PBLS guidelines apply to infants and children without signs of puberty.119

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Additions to PALS recommendations include post– cardiac arrest care, neuroprognostication, and recovery. This 2025 summary focuses solely on PALS and highlights new and updated recommendations that will have important impacts on process and patient-related outcomes from cardiac arrest. Additional pediatric-specific guidance and recommendations are provided for PBLS in “Part 6: Pediatric Basic Life Support,”92 recommendations about the training of resuscitation professionals in “Part 12: Resuscitation Education Science,”120 recommendations about SOC in “Part 4: Systems of Care,”40 recommendations for special circumstances in “Part 10: Adult and Pediatric Special Circumstances of Resuscitation,”13 and considerations around ethics in “Part 3: Ethics.”39

Significant New and Updated Recommendations Early Epinephrine The goal of epinephrine administration during CPR is to optimize coronary perfusion pressure and maintain ­cerebral perfusion pressure. Earlier administration of epinephrine during CPR is associated with favorable outcomes for infants and children. For infants and children in cardiac arrest with initial nonshockable rhythm, it is reasonable to administer the initial dose of epinephrine as early as possible (COR 2a, LOE C-LD).121–126 Similarly, for infants and children in cardiac arrest with initial shockable rhythm, it may be reasonable to administer epinephrine after 2 attempts at defibrillation or sooner if rapid defibrillation is not possible (COR 2b, C-LD).127,128 Diastolic Blood Pressure to Guide CPR For patients with continuous invasive arterial blood pressure monitoring in place at the time of cardiac arrest, it is reasonable for health care professionals to use diastolic blood pressure to assess the child’s response to resuscitation efforts (COR 2a, LOE B-NR).129–131 Ideal blood pressure targets during CPR are now provided for infants and children with continuous invasive arterial blood pressure monitoring in place during CPR. In these cases, it may be reasonable for health care professionals to target a diastolic blood pressure ≥25 mm Hg in infants and ≥30 mm Hg in children ≥1 year of age (COR 2b, LOE C-LD).129–131 Post–Cardiac Arrest Blood Pressure Monitoring and Targets Hypotension is common following resuscitation from cardiac arrest in infants and children and can exacerbate brain and myocardial ischemic injury. Post–cardiac arrest hypotension has been associated with lower rates of survival to hospital discharge. After cardiac arrest in infants and children, continuous arterial pressure monitoring is recommended to identify and treat hypotension when appropriate resources are available (COR 1, LOE C-EO).132–138 In ­addition, after cardiac arrest in infants and children, it is recommended to maintain systolic and mean arterial blood pressure ≥10th percentile for age (COR 1, LOE B-NR).132–138

Neuroprognostication Early and reliable neurological prognostication after resuscitation from pediatric cardiac arrest is essential to guide treatment, enable accurate counseling, and provide family support. In addition, accurate neurological prognostication is critical to avoid inappropriate withdrawal of life-sustaining therapy in patients who may have a meaningful recovery, while also avoiding life-sustaining treatments in cases of futility. Health care professionals are instructed to avoid using single data elements (exam findings such as pupillary light reflex or Glasgow Coma Scale, biomarker, EEG, or magnetic resonance imaging finding) at any given time point to predict good or poor neurologic outcome. Multiple data points are needed to accurately access prognosis for pediatric cardiac arrest survivors (COR 1, LOE B-NR).133,139–151

Knowledge Gaps Some of the most pertinent gaps in PALS research include the following:

•	 What is the appropriate age and setting to transition from (1) neonatal resuscitation protocols to pediatric resuscitation protocols and (2) from pediatric resuscitation protocols to adult resuscitation protocols? •	 What is the optimal method to transition from weight-based dosing to fixed-dose medication administration during cardiac arrest in adolescents or children with high body mass index? •	 With what frequency should doses of epinephrine be administered after the initial dose? •	 Should epinephrine dosing strategies be individualized to patients based on hemodynamic response or blood pressure targets? •	 Are there specific situations in which advanced airway placement is either beneficial or harmful in OHCA or IHCA? Do they differ based on the etiology of cardiac arrest? •	 Can echocardiography or cerebral monitoring improve CPR quality or outcomes from cardiac arrest? •	 What is the role of ECPR for infants and children with OHCA and IHCA due to noncardiac causes? •	 What is the optimal timing and dosing of initial defibrillation for VF or pulseless VT or subsequent defibrillation for refractory VF or pulseless VT? •	 What clinical tools can be used to help in the decision to terminate pediatric IHCA and OHCA resuscitation?

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•	 How can postarrest prognostication be improved with current modalities or new modalities? •	 What rehabilitation therapies and follow-up should be provided to improve outcomes after cardiac arrest? •	 What are the most effective and safe medications for adenosine-refractory supraventricular tachycardia? •	 Are there specific modifications to the cardiac arrest algorithm that should be used when treating a patient with specific conditions, such as myocarditis, cardiomyopathies, single-ventricle congenital heart disease, or pulmonary hypertension?

ADULT ADVANCED LIFE SUPPORT

Part 9 of the 2025 Guidelines, “Adult Advanced Life Support,” includes recommendations for the treatment of adult cardiac emergencies, including immediate arrhythmia management in stable and unstable patients.152 These recommendations are also inclusive of, and have updated upon, the 2023 AHA Focused Update on Adult Advanced Life Support.153 When those arrhythmias result in OHCA or IHCA, these Guidelines also review and recommend the appropriate electrical, medical, and airway management and when and how to consider terminating resuscitation if ROSC is not achieved. This chapter does not encompass recommendations for BLS, the training of responding health care professionals, special circumstances regarding the provision of advanced life support (ALS) care, post–cardiac arrest care, or the incorporation of ALS techniques or personnel into a resuscitation system of care.24,154 These topics are each addressed in their own chapters to provide the appropriate attention to those recommendations and the volume of literature analyzed (“Part 2: Evidence Evaluation and Guidelines Development,”21 “Part 4: Systems of Care,”40 “Part 5: Neonatal Resuscitation,”78 “Part 6: Pediatric Basic Life Support,”92 “Part 7: Adult Basic Life Support,”114 “Part 8: Pediatric Advanced Life Support,”118 “Part 10: Adult and Pediatric Special Circumstances of Resuscitation,”13 “Part 11: Post–Cardiac Arrest Care,”155 “Part 12: Resuscitation Education Science”).120 Additionally, considerations around ethics of resuscitation are provided in “Part 3: Ethics.”39

Significant New and Updated Recommendations Cardioversion of Atrial Fibrillation or Flutter Uncontrolled tachycardia resulting from atrial fibrillation or flutter increases myocardial oxygen demand while simultaneously impairing compensatory measures (ie, ventricular filling, cardiac output, coronary perfusion) to meet that demand. Patients who are unstable and those with rate-related ischemia caused by atrial fibrillation or flutter should undergo urgent electrical cardioversion (COR 1, LOE C-LD). Previous editions of these Guidelines advocated for an incremental approach (using a low initial energy setting and escalating until success); however, it is now recommended to begin at 200 J because new evidence demonstrates greater initial shock success, reduced likelihood of inducing VF, shorter duration of anesthesia (if appropriate), and a smaller cumulative electrical burden with this approach (COR 2b, LOE C-LD).156

Double Sequential Defibrillation Combined with CPR, successful biphasic defibrillation, creating current across the thorax from electrode pad to pad, is ≈75% effective in terminating VF and VT.157 Double sequential defibrillation has emerged as a potential treatment for those patients with shock-refractory VF.158 Technology to reliably identify shock-refractory VF, in contrast to recurrent VF following defibrillation, and precisely deliver double sequential external defibrillation in the optimal therapeutic window, defined in milliseconds, requires further investigation before being recommended for routine practice (COR 2b, LOE B-R). Head-Up CPR Head-up CPR seeks to augment conventional supine CPR to increase cerebral perfusion pressure with the goal of improving favorable neurological outcome.159 Head-up CPR is a bundle of care studied as a combination of mechanical chest compressions, an impedance threshold device, and application of an automated device to control sequential elevation of the head and thorax during compressions.160 Current evidence regarding head-up CPR is limited, and in the absence of RCTs or evaluations with contemporary comparisons, its use is not recommended outside of well-designed clinical trials with the appropriate community consent (COR 3 No Benefit, LOE C-LD). Polymorphic Ventricular Tachycardia Sustained polymorphic VT results in reduced ventricular filling and eventual cessation of cardiac output and coronary perfusion, inevitably rendering the patient clinically unstable. While previous editions of these Guidelines have suggested multiple treatment modalities on the basis of clinical stability, it is now recommended that all adult patients with sustained polymorphic VT receive immediate defibrillation (COR 1, LOE B-NR). While other medical treatments may be useful in preventing polymorphic VT or its recurrence on the basis of the underlying pathology (ie, prolonged QT interval; COR 2b, LOE C-LD), these modalities should not delay defibrillation to terminate polymorphic VT.

Knowledge Gaps Some of the most pertinent gaps in adult ALS research include the following:

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•	 How can technologies developed to diagnose the underlying cardiac rhythm during CPR be used to guide patient management with ALS techniques (ie, timing or vector of defibrillation, administration of epinephrine)? •	 How can echocardiography, independent of method (transthoracic or transesophageal), augment the performance of CPR and outcomes from cardiac arrest? •	 What is the optimal application of termination of resuscitation guidelines on the basis of the makeup of the responding EMS agency? •	 What is the optimal dosing, timing, and route of delivery for epinephrine to maximize neurologically intact survival? •	 How should ALS techniques, or the order of their performance, change in the setting of OHCA or IHCA in an adult with congenital heart disease? •	 What are the most effective and safe methods for termination of adenosine-refractory supraventricular tachycardia? •	 What is the best method to incorporate measures of acute physiology (end-tidal carbon dioxide, arterial blood pressure, etc) into resuscitation decisionmaking, including the consideration of terminating efforts? •	 How do alternative positions for CPR (head-up CPR, etc) affect or improve its performance and the subsequent outcomes (ROSC, neurologically intact survival)? •	 Are there specific situations or health care professional characteristics in which the choice of advanced airway placement is either beneficial or harmful in OHCA or IHCA? Do they differ based on the etiology of cardiac arrest? •	 What is the role of noninvasive methods of aortic occlusion in successful resuscitation from cardiac arrest?

ADULT AND PEDIATRIC SPECIAL CIRCUMSTANCES OF RESUSCITATION

Part 10 of the 2025 Guidelines, “Adult and Pediatric Special Circumstances of Resuscitation,” includes modifications to basic and advanced life support for adults and children in special situations.13 Depending on the data available, recommendations are made for the management of patients in cardiac arrest or for patients with life-threatening conditions inclusive of cardiac arrest. In the 2020 Guidelines, special circumstances of resuscitation were included within the recommendations for adult basic and advanced life support.24 For the 2025 Guidelines, we emphasized the review of evidence for both the adult and pediatric populations and provided recommendations for the population where applicable. Adult and pediatric recommendations were provided concurrently when the COR and LOE aligned, and, otherwise, pediatric recommendations were separately provided.

These recommendations are also inclusive of, and have updated upon, the 2023 AHA toxicology focused update161 and the 2024 AHA drowning focused update.162 Additionally, new recommendations were provided for the following topics: interposed abdominal compression, electrocution, gas embolism, high-­consequence respiratory pathogens, hyperthermia, durable left ventricular assist device (LVAD), amniotic fluid embolism in peripartum patients, and poisoning following volatile hydrocarbon exposure. In all, the updated special circumstances of resuscitation modified 44 recommendations and added 140 new recommendations (many of which were pediatric specific).

Significant New and Updated Recommendations Extracorporeal Life Support While not available in every setting or generalizable to undifferentiated cardiac arrest, adults and children in cardiac arrest or a periarrest state with a potentially reversible etiology are being supported with extracorporeal life support devices, such as venoarterial extracorporeal membrane oxygenation in disease processes such as anaphylaxis (adults and children: COR 2a, LOE C-EO), asthma (adults and children: COR 2a, LOE C-LD), cardiac surgery (adults: COR 2a, LOE C-EO; children: COR 2a, LOE C-LD), cardiac interventional laboratory (adults: COR 2a, LOE C-LD), hypothermia (adults: COR 2a, LOE B-NR; children: COR 2a, LOE C-LD), pregnancy (COR 2a, LOE B-NR), and pulmonary embolism (adults: COR 2a, LOE B-NR; children: COR 2a, LOE C-LD) and in poisonings by agents such as β-blockers, calcium channel blockers, cocaine, local anesthetics, sodium channel blockers, and sympathomimetics. Refer to the guideline for individual COR and LOE for extracorporeal life support use in each of the poisoning agents in adults and children.

High-Consequence Respiratory Pathogen Chest compressions, bag-mask ventilation, defibrillation, suctioning, and endotracheal intubation should be considered aerosol-generating procedures that pose a risk of infection to resuscitation team members (COR 1, LOE C-LD).163–169 However, a real-world study found that rates of SARS-CoV-2 transmission to resuscitation team members with personal protective equipment were low.170

Hyperkalemia Clinical evidence supporting IV calcium (adults and children: COR 2b, LOE C-LD) or IV sodium bicarbonate (adults and children: COR 2b, LOE C-EO) administration are limited in humans and uncertain to improve survival

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or favorable neurological outcomes.171,172 The utility of other therapies such as insulin and glucose (adults and children: COR 2b, LOE C-EO) and inhaled β-agonist (adults and children: COR 3 No Benefit, LOE C-EO), intended to lower potassium concentrations in the setting of cardiac arrest, is unclear when weighing the possible benefits against the risk of harm if potentially interrupting well-established interventions like CPR.171,172

Hyperthermia Adults and children with life-threatening hyperthermia from environmental causes (adults and children: COR 1, LOE C-EO), cocaine poisoning (adults: COR 1, LOE C-LD; children: COR 1, LOE C-EO), or sympathomimetic poisoning (adults: COR 1, LOE C-LD; children: COR 1, LOE C-EO) should be rapidly cooled, ideally at a rate of at least 0.15 °C/min (adults: COR 2a, LOE C-LD; children: COR 2a, LOE C-EO).173 This is best achieved with immersion in ice water (adults: COR 2a, LOE B-R; children: COR 2a, LOE C-EO).174

Left Ventricular Assist Device The absence of a palpable pulse can make confirming cardiac arrest in adults and children with an LVAD difficult, so assess perfusion by surrogate markers such as cool skin temperature, central cyanosis, poor capillary refill, and a low mean arterial pressure.175 Treatment includes prioritization of CPR (adults and children: COR 1, LOE C-LD) while simultaneously assessing and attempting to restart LVAD function if a second rescuer is available (adults and children: COR 2b, LOE C-LD).

Pregnancy Management of cardiac arrest during pregnancy is a complex clinical scenario that requires resuscitation strategies that accommodate the physiological changes of pregnancy.176–178 Manual left lateral uterine displacement during chest compression should be provided for a pregnant cardiac arrest patient when the fundal height is at or above the umbilicus to allow for optimal cardiac output by relieving the compression on the inferior vena cava and aorta (COR 1, LOE C-LD).179 Anatomic and physiologic changes of pregnancy add difficulty to airway management given the lack of tolerance for hypoxia and risk of aspiration. Airway management should be prioritized during the resuscitation of a pregnant patient in cardiac arrest (COR 1, LOE C-LD).177 Resuscitative delivery relieves aortocaval compression and returns sequestered uterine blood back to the systemic circulation in efforts to resuscitate the pregnant patient. Team preparation should begin at the recognition of cardiac arrest, and delivery of the fetus should be complete by 5 minutes (COR 1, LOE B-NR).177 Opioids

For trained rescuers assisting an adult or child with suspected opioid overdose who has respiratory depression or respiratory arrest and has a definite pulse, breaths or bag-mask ventilation should be provided (COR 1, LOE B-NR). For lay rescuers assisting an adult or child with suspected opioid overdose who is unresponsive and not breathing normally, CPR with breaths should be provided (COR 1, LOE B-NR). An opioid antagonist (eg, naloxone) should be given to people with respiratory arrest from suspected opioid overdose (COR 1, LOE B-NR). Trained rescuers, lay rescuers, and members of the general public can all administer naloxone.

Knowledge Gaps Some of the most pertinent knowledge gaps in adult and pediatric special circumstances include the following:

•	 Does a higher dose of epinephrine, such as 5 mg administered intramuscularly in adults, confer benefit in cardiac arrest from anaphylaxis? •	 Is there survival benefit to the use of intracoronary epinephrine to treat adult cardiac arrest in the cardiac intervention laboratory? •	 Is there a benefit to 3 stacked shocks in VF in adults after cardiac surgery compared with standard measures for ALS? •	 How does resuscitation using airway-­breathingcompressions versus compressions-airway-­ breathing affect outcomes in cardiac arrest following drowning? •	 Is drying the chest before using an AED on a drowned child or adult necessary for safe defibrillation, and does it improve rates of success? •	 How can teams mitigate the effects of personal protective equipment on resuscitation team performance and health care professional fatigue? •	 What is the benefit or harm of calcium in the treatment of hyperkalemia and cardiac arrest? •	 In adults and children with cardiac arrest due to environmental hypothermia, what is the optimal temperature to rewarm to prior to defibrillation and administration of epinephrine? •	 What is the best method to confirm cardiac arrest in an adult or child with an LVAD? •	 What is the optimal airway management device and timing in cardiac arrest in pregnancy? •	 What is the optimal amount of time chest compressions should be continued after patients in cardiac arrest from pulmonary embolism receive systemic fibrinolytics? •	 Does high-dose insulin therapy for adults and children with life-threatening β-blocker or calcium channel blocker poisoning, administered in addition to or instead of standard vasopressors, reduce mortality or ischemic complications?

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•	 What is the benefit of naloxone when given to adults and children in cardiac arrest with suspected opioid overdose?

POST–CARDIAC ARREST CARE

Overview Part 11 of the 2025 Guidelines, “Post–Cardiac Arrest Care,” includes recommendations for the care of adult patients after ROSC.155 These recommendations are also inclusive of, and have updated upon, the 2023 AHA adult life support focused update.153 This encompasses management in the prehospital, emergency department, and in-hospital settings. The management of patients in the post-ROSC period is critically important and spans the Chain of Survival from the acute resuscitation period through survivorship. These Guidelines contain recommendations for post–cardiac arrest care that are based on the best available resuscitation science. This summary highlights new and updated recommendations that may improve outcomes from cardiac arrest.

Significant New and Updated Recommendations Post-ROSC Diagnostics Twelve-lead electrocardiogram, echocardiography, pointof-care cardiac ultrasound, and computed tomographic imaging are used in postarrest patients to identify clinically significant diagnoses requiring intervention, including evaluating for the underlying cause of cardiac arrest as well as identification and treatment of complications from cardiac arrest and CPR. A 12-lead electrocardiogram should be performed (COR 1, LOE B-NR), and it may be reasonable to perform computed tomography (COR 2b, LOE B-NR), echocardiography (COR 2b, LOE C-LD), or point-of-care cardiac ultrasound (COR 2b, LOE C-LD) for adult patients after ROSC. The use of these diagnostic modalities is reviewed, and the recommendations regarding ultrasound and computed tomographic imaging are new additions. Duration of Temperature Control Temperature control refers to the entire period of active temperature management, either to a hypothermic or normothermic target. Maintaining a temperature between 32 °C and 37.5 °C in patients unresponsive to verbal commands after ROSC is recommended for adults (COR 1, LOE B-R). In settings where a hypothermic ­target is used initially, a period of fever prevention or temperature control to a normothermic target may follow. Trials are heterogeneous in their durations of temperature control, for both hypothermic and normothermic targets. One RCT found no difference in outcomes comparing hypothermic temperature control for 24 hours versus 48 hours.180 Another RCT found no difference in outcomes comparing a period of device-based fever prevention of 12 hours versus 48 hours after an initial 24-hour period of temperature control to 36 °C (36 hours versus 72 total hours of temperature control).181 Other RCTs protocolized all patients to 72 hours of total temperature control.182,183 Recognizing evolution of evidence and definitions with respect to temperature control, 36 hours of total temperature control is the shortest recommended duration (COR 2a, LOE B-R).

Management of Post-ROSC Shock Hypotension requiring vasopressors is common in post– cardiac arrest patients.184,185 There are no large-scale RCTs comparing clinical outcomes between different vasopressors. Data from patients in cardiogenic shock, many of whom experienced cardiac arrest, suggest epinephrine and dopamine have been associated with a less favorable safety profile; however, this was not found in a recent meta-analysis of the literature focused on cardiac arrest patients.186–188 Thus there is insufficient evidence to recommend a specific vasopressor to treat low blood pressure in adult patients after cardiac arrest (COR 2b, LOE B-NR). Additionally, temporary mechanical circulatory support devices have been used to increase blood pressure and cardiac output in patients with cardiogenic shock, often as an adjunct to vasopressor therapy. In highly selected adult patients with refractory cardiogenic shock after cardiac arrest and ROSC, temporary mechanical circulatory support may be considered (COR 2b, LOE B-NR). Invasive Neuromonitoring Hypoxic-ischemic brain injury leads to disruptions in the physiological processes involved in cerebral homeostasis, leading to risks of secondary brain injury.189 Neurologic injury is the primary cause of death in patients who initially survive to ROSC; thus, there is interest in improving neurologic care in the postarrest period. While several studies have examined different approaches to ­invasive neurologic monitoring for hypoxic-ischemic brain injury, methodological limitations exist that limit the ability to make a recommendation about any invasive neuromonitoring technique. A discussion on the usefulness of monitoring intracranial pressure, cerebral blood flow, and brain tissue oxygenation was included in the Guidelines, acknowledging the growing body of literature on this topic and the movement toward personalized neurologic care in the post–cardiac arrest period. The usefulness of these different invasive neuromonitoring modalities has not been established (COR 2b, LOE C-LD). Management of Seizures and Myoclonus Seizures and status epilepticus are common acute neurologic complications in the post–cardiac arrest period, occurring in 10% to 35% of patients who do not follow commands after ROSC.190–195 Myoclonus is a clinical

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exam finding that may be a manifestation of a seizure if it occurs time locked with an EEG correlate, or myoclonus may occur without an EEG correlate. Thus, after ROSC, promptly performing and interpreting an EEG is recommended for the diagnosis of seizures in adult patients with myoclonus (COR 1, LOE C-LD). Recommendations addressing diagnosis and management of myoclonus and management of EEG findings on the ictal-interictal continuum are important additions. Neuroprognostication for Favorable Outcome Accurate neuroprognostication is important to avoid inappropriate withdrawal of life support in patients who may otherwise achieve a favorable outcome and to avoid ineffective treatment when an unacceptable or unfavorable outcome is inevitable.196 Neuroprognostication has historically focused on identifying prognostic tests that predict unfavorable outcome with high specificity. There is increasing focus on developing prognostic tests that predict favorable outcome. Recommendations focused on prognosis for favorable outcome are new additions to these Guidelines. Health Care Professional Burnout An important addition to the Guidelines is acknowledging the stressors placed on health care professionals who care for patients with cardiac arrest. Burnout among health care workers is common197 and negatively impacts health care professionals’ productivity (eg, absenteeism, turnover)198 and patient care (eg, reduced patient satisfaction, increased errors by health care professionals).199 Randomized controlled trials targeting burnout in health care workers have led to some improvement in at least one dimension of burnout or mental health outcome.200–206 Variability in intervention methods and outcome measures, considerable attrition, and high risk of bias inherent in behavioral trials limit the degree to which any one well-being intervention method can be recommended. Nonetheless, interventions to address health care professional burnout may be beneficial (COR 2b, LOE B-NR).

Knowledge Gaps Questions that address some of the most pertinent knowledge gaps in post–cardiac arrest care include the following:

•	 How does one select target temperature? •	 What is the optimal timing for initiation and duration of temperature control? •	 Should the approach to temperature control vary based on patient characteristics? •	 Is there a preferred method of cooling and rewarming? •	 How does one select physiologic targets (blood pressure, oxygenation, ventilation, etc) for individual patients in the postarrest period? •	 How does one achieve optimal physiologic targets in the postarrest period (eg, vasopressor selection, role of mechanical circulatory support, role of intracranial monitoring)? •	 Do subgroups of patients (eg, chronic lung disease, immunocompromised status) benefit from early antibiotic administration after ROSC? •	 What is the optimal combination of prognostic tests (eg, clinical examination in combination with neuroimaging or EEG to predict outcome)? •	 What is the optimal timing for obtaining prognostic tests? •	 What are threshold cutoffs that predict unfavorable outcome? •	 How can prediction of favorable outcome be improved? •	 How can future neuroprognostication research mitigate biases introduced from withdrawal of life-­ sustaining treatment? •	 When is the optimal time to assess survivors and caregivers for emotional distress? •	 What are optimal components of psychosocial interventions to address survivor and caregiver emotional distress? •	 What are optimal interventions to address burnout in health care professionals?

RESUSCITATION EDUCATION SCIENCE

Part 12 of the 2025 Guidelines, “Resuscitation Education Science,” includes recommendations about various instructional design features in resuscitation training, including CPR feedback devices, rapid-cycle deliberate practice, scripted debriefing, gamified learning, spaced learning and booster training, teamwork and leadership training, manikin fidelity, virtual and augmented reality, and the use of cognitive aids.120 Recommendations for these instructional design elements have been split into those for health care professionals and those for lay rescuers. The second section of Part 12 describes how specific health care professional considerations may influence the impact of educational interventions, including disparities according to sex, gender, race, socioeconomic status, and language as well as factors that act as barriers or facilitators to lay rescuer willingness to perform CPR.

Significant, New, and Updated Recommendations Feedback Devices During CPR Training It is recommended that feedback devices be used during training for health care professionals (COR 1, LOE A) and lay rescuers (COR 1, LOE A). Feedback devices for CPR provide objective, real-time data to learners during

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training. This is an advantage over visual observation of CPR by an instructor, which has been shown to be unreliable.207–209 A meta-analysis of 17 RCTs among health care professionals found that CPR feedback devices had a moderate to large positive effect on CPR quality metrics. A separate meta-analysis of 3 randomized trials in lay rescuers found that depth and rate compliance were improved.

Disparities in CPR Education It is recommended to focus and tailor lay rescuer CPR training to specific racial and ethnic populations and neighborhoods and incorporate awareness efforts in the United States (COR 1, LOE B-NR). Cohort studies have shown that residents of Black and Hispanic neighborhoods are less likely to be trained in or to receive CPR.210–215 Additional studies have shown that neighborhood mapping to identify areas for targeted training is feasible.216,217 It is recommended to prioritize low socioeconomic status populations and neighborhoods for lay rescuer CPR training and awareness efforts (COR 1, LOE B-NR). Cohort studies have shown that low socioeconomic status is associated with less CPR training and lower likelihood of receiving lay rescuer CPR.212,218–232 It is recommended to address barriers to lay rescuers performing CPR on females, through educational training and public awareness efforts (COR 1, LOE B-NR). Women are less likely to receive lay rescuer CPR in public places.233,234 Studies of potential lay rescuers have shown prevalent misconceptions about causing injury and concern about being accused of inappropriate contact with people experiencing cardiac arrest.235,236 It is reasonable to address barriers to linguistically isolated communities by increasing availability and access to CPR training materials in diverse languages (COR 2a, LOE C-LD). Language barriers in communities have been associated with lower rates of lay rescuer CPR.237–242 It is reasonable to consider cost-effective methods for CPR training and promoting safe access to CPR training for low socioeconomic status populations and settings (COR 2a, LOE C-LD). Cost, safety concerns, and insufficient information availability are barriers to CPR training in low socioeconomic status neighborhoods.239,241–244

CPR Training in Schoolchildren It is recommended that children aged 12 through 18 years be trained to perform high-quality CPR (COR 1, LOE C-LD). Multiple studies have shown that children ≥12 years can learn and perform effective chest compressions.245–249 It is recommended to start CPR training children <12 years in order to increase willingness and selfconfidence in later years (COR 1, C-LD). Schoolchildren from the age of 4 to 7 years of age can adequately make an emergency call250–255 or follow the instructions of an AED.251–254 Moreover, a playful approach to CPR at early ages promotes motivation and interest in schoolchildren <12 years and annual repetition can increase the willingness and self-confidence related to the initialization of resuscitation measures in later years.255

Virtual and Augmented Reality It may be reasonable to use virtual reality (VR) to support knowledge acquisition in basic and advanced life support training for lay rescuers and health care professionals (COR 2b, LOE B-R). Virtual reality refers to training with simulated patients via interactive scenarios within 3-dimensional replications of actual care environments. Four studies of VR use in BLS education found better knowledge acquisition than with other forms of training.256–259 Virtual reality should not be used to teach CPR skills in laypeople and health care professionals (COR 3: Harm, LOE B-R). Multiple studies of CPR quality performance comparing VR-based training to standard training found that VR resulted in poorer compliance with guidelines for chest compression depth, rate, and recoil.260–264 The use of augmented reality to provide real-time CPR feedback may be considered for BLS training of laypeople and health care professionals (COR 2b, LOE CL-D). Augmented reality refers to the use of holographic images overlaid onto a real clinical environment. Four RCTs using augmented reality for CPR feedback during training yielded mixed results, with one study showing better overall CPR performance265 and other studies showing no difference.266–268 Gamified Learning It may be reasonable to use gamified learning elements as a component of resuscitation training for health care professionals (COR 2b, LOE C-LD). Gamified learning involves the use of game-like elements during resuscitation training. These elements can include competition, point systems, scaffolded levels of difficulty, and leaderboards. Gamification has been shown to increase learner engagement and enhance recall of content.269 Scripted Debriefing It may be reasonable for an instructor to use a debriefing script during resuscitation education (COR 2b, LOE C-LD). Scripted debriefing involves the creation of a written plan for debriefing learners during and following life support training. These scripts aim to standardize debriefing during resuscitation training, supporting facilitators with a clear plan and guiding discussion. Standardized debriefing helps to maintain consistency in the delivery of debriefings across training centers and resuscitation programs. Randomized controlled trials in resuscitation

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training settings showed that scripted debriefing was associated with improved CPR quality,270 improved team leadership and knowledge acquisition,271 and improved debriefing quality among novice instructors.272 Rapid-Cycle Deliberate Practice It may be reasonable to incorporate rapid-cycle deliberate practice as part of basic or advanced life support training for health care personnel (COR 2b, LOE C-LD). Rapid-cycle deliberate practice is defined by rapid cycling between deliberate practice and directed feedback until skill mastery is achieved.273 Multiple studies have demonstrated that this training is associated with faster initiation of chest compressions, defibrillation, ventilation, and epinephrine administration, as well as improved compression fraction and shorter pauses before defibrillation.273–277 Alternative Objects for Chest Compression Training Lay Rescuers The usefulness of alternative objects (as an alternative to a manikin) to train laypeople in chest compressions is not well established (COR 2b, LOE C-LD). Barriers to CPR training in low-resource settings include cost, access to training centers, and time constraints. Studies of low-cost, easy-access objects as an alternative to manikins (eg, pillow, foam blocks, toilet paper, rolls, plastic bottles), which allow lay rescuers in low-resource settings to train in chest compressions, have yielded mixed results.278–284

Knowledge Gaps Some of the most pertinent gaps in resuscitation education research include the following:

•	 What are the optimal methods for identifying and targeting areas with lower prevalence of CPR training and lower lay rescuer CPR rates? What methods best overcome barriers to training for people living in those areas? •	 Which educational interventions most impact real-world performance and clinical outcomes, as opposed to educational outcomes or performance in training? •	 How can instructional design features be combined or blended to optimize outcomes? Future studies should evaluate the synergistic effects of instructional design features when used in a blended manner. •	 What are the most effective ways to train and develop resuscitation instructors? Future research should evaluate the impact of various faculty development strategies on instructor skills and learner outcomes. •	 What is the impact of varying levels of cost, resource and personnel availability, and training center infrastructure on the ability to implement ­technology-dependent instructional design features (eg, high-fidelity manikins, VR)?

SUMMARY

Cardiac arrest remains a serious condition with high morbidity and mortality, impacting individuals of all ages, sexes, genders, races, geographic regions, and socioeconomic backgrounds. While survival rates have seen some improvements since 2020, substantial efforts are still needed to reduce the significant burden of this disease. This executive summary outlines updated and new recommendations from the 2025 Guidelines, developed through rigorous evidence evaluation, and new horizons of ethical challenges that result from advancing resuscitation science. Continued progress over the next decade will require strengthening the Chain of Survival and enhancing coordinated SOC. The knowledge gaps identified in the 2025 Guidelines highlight critical research questions that should be addressed, presenting key opportunities for future funding in resuscitation science. While developing Guidelines is a crucial first step, their implementation and ongoing research will be essential in driving meaningful improvements in patient outcomes. Funding for such research is a critical priority in reducing death and disability from cardiac arrest.

ARTICLE INFORMATION The American Heart Association requests that this document be cited as follows: Del Rios M, Bartos JA, Panchal AR, Atkins DL, Cabañas JG, Cao D, Dainty KN, Dezfulian C, Donoghue AJ, Drennan IR, Elmer J, Hirsch KG, Idris AH, Joyner BL, Kamath-Rayne BD, Kleinman ME, Kurz MC, Lasa JJ, Lee HC, McBride ME, Raymond TT, Rittenberger, JC, Schexnayder SM, Szyld E, Topjian A, Wigginton JG, Previdi JK. Part 1: executive summary: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl):S284–S312. doi: 10.1161/CIR.0000000000001372 Acknowledgments The writing group acknowledges the members of the Evidence Evaluation and Guidelines Development, Ethics, Systems of Care, Neonatal Resuscitation, Pediatric Basic Life Support, Basic Life Support, Pediatric Advanced Life Support, Advanced Life Support, Special Circumstances, Post–Cardiac Arrest Care, and Resuscitation Education Science Writing Groups. We especially would like to thank the following individuals for their contributions: Laura Haygood, MLIS; Chalan King, MS; Melissa Mahgoub, PhD; Peace Ossom, MLS, MS; Abdul Pullattayil, MISt, AHIP; Amber J. Rodriguez, PhD; Comilla Sasson, MD, PhD; Julie Sell, MSN, RN; and Jaylen Wright, PhD.

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Disclosures Writing Group Disclosures

Writing group member Employment Research grant Other research support Speakers’ bureau/ honoraria Expert witness Ownership interest Consultant/ advisory board Other Marina Del Rios The University of Chicago Medicine National Institutes of Health† None None None None None None Jeanette K. Previdi NA None None None None None American Heart Association† None Dianne Atkins University of Iowa None None None None None None None Jason A. Bartos University of Minnesota None None None None None None None José G. Cabañas Wake County EMS None None None None None None None Dazhe Cao University of Texas Southwestern Medical Center Medical Toxicology Foundation* None None None None None None Katie N. Dainty North York General Hospital AMS Healthcare*; Canadian Institutes of Health Research* None None None None Philips Healthcare* None Cameron Dezfulian Baylor College of Medicine None None None None None None None Aaron J. Donoghue The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine None None None None None None None Ian R. Drennan University of Toronto (Canada) ZOLL Medical† None ZOLL Medical† None None None None Jonathan Elmer University of Pittsburgh None None None None None None None Karen G. Hirsch Stanford University NIH* None None None None None None Ahamed H. Idris University of Texas Southwestern Medical Center at Dallas None None None None None None None Benny L. Joyner State University of New York, University at Buffalo None None None None None None None Beena D. Kamath- Rayne American Academy of Pediatrics None None None None None None None Monica E. Kleinman Boston Children’s Hospital Children’s Hospital of Philadelphia* PRG S&T† None None None None None Michael C. Kurz University of Chicago None None None None None None None Javier J. Lasa Children’s Health Systems of Texas, UT Southwestern Medical Center None None None None None None None Henry C. Lee University of California San Diego None None None None None None None Mary E. McBride Lurie Children’s Heart Center None None None None None American Heart Association† None Ashish R. Panchal The Ohio State University Wexner Medical Center None None None None None None None Tia T. Raymond Medical City Children’s Hospital None None None None None None None Jon C. Rittenberger Guthrie Medical Center None None None Cipriani and Werner, PC* None None None Stephen M. Schexnayder Univ. of Arkansas/ Arkansas Children’s Hospital None None None None Love & Kirschenbaum LLLC† American Heart Association† Edgardo Szyld Indiana University None None None None None None None Alexis Topjian Children’s Hospital of Philadelphia & University of Pennsylvania School of Medicine NIH† None None None None Elsevier† None Jane G. Wigginton UT Dallas None None None None None None None This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $5000 or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $5000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition.

*Modest. †Significant.

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REFERENCES

1 Cardiopulmonary resuscitation: Statement by the Ad Hoc Committee on

Cardiopulmonary Resuscitation of the Division of Medical Sciences, National Academy of Sciences—National Research Council. JAMA. 1966;198:372– 379. doi: 10.1001/jama.1966.03110170084023 2.	 Standards for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). 3. Advanced life support. JAMA. 1974;227(Suppl):852–860. doi: 10.1001/jama.227.7.833 3.	 Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). JAMA. 1980;244:453–509. doi: 10.1001/jama.1980.03310050017015 4.	 Standards and guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC). National Academy of Sciences - National Research Council. JAMA. 1986;255:2905–2989. doi: 10.1001/jama.1986.03370210073024 5.	 Guidelines for cardiopulmonary resuscitation and emergency cardiac care. Emergency Cardiac Care Committee and Subcommittees, American Heart Association. Part I. Introduction. JAMA. 1992;268:2171–2183. doi: 10.1001/jama.1992.03490160041023 6.	 Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Car-

diovascular Care. Part 6: Advanced cardiovascular life support: section 7: algorithm approach to ACLS emergencies: section 7A: principles and practice of ACLS. The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. Circulation. 2000;102(8 Suppl):I86–I89. doi: 10.1161/01.cir.102.suppl_1.i-86 7 ECC Committee, Subcommittees and Task Forces of the American Heart

Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2005;112:IV1–IV203. doi: 10.1161/CIRCULATIONAHA.105.166550 8.	 Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, Samson RA, Kattwinkel J, Berg RA, Bhanji F, et al. Part 1: Executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S640–S656. doi: 10.1161/CIRCULATIONAHA.110.970889 9.	 Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, Brooks SC, de Caen AR, Donnino MW, Ferrer JM, et al. Part 1: Executive summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S315–S367. doi: 10.1161/CIR.0000000000000252 10.	 Merchant RM, Topjian AA, Panchal AR, Cheng A, Aziz K, Berg KM, Lavonas EJ, Magid DJ; Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Life Support, Resuscitation Education Science, and Systems of Care Writing Groups. Part 1: Executive summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_ suppl_2):S337–S357. doi: 10.1161/CIR.0000000000000918 11.	 International Liaison Committee on Resuscitation 2025; Accessed May 26, 2025. https://ilcor.org/ 12.	 Cardiac Arrest Registry to Enhance Survival. CARES 2024 Annual Re-

port; Accessed May 26, 2025. https://mycares.net/sitepages/uploads/2025/2024_flipbook/index.html?page=1

Reviewer Disclosures

Reviewer Employment Research grant Other research support Speakers’ bureau/ honoraria Expert witness Ownership interest Consultant/ advisory board Other Blair L. Bigham McMaster University (Canada) None None None None None None None Brahmajee K. Nallamothu University of Michigan None None American Heart Association† None AngioInsight† None None Jerry P. Nolan Warwick Medical School, University of Warwick (United Kingdom) NIHR (Grant for Airways-3 study)* None None None None None Elsevier (Editor-in- Chief, Resuscitation)† Gavin D. Perkins Warwick Medical School and University Hospitals NHS Foundation Trust (United Kingdom) Funding from National Institute for Health Research (paid to institution)†; Resuscitation Council UK (paid to institution)†; British Heart Foundation (paid to institution)†; Lateral Foundation (Paid to ILCOR)† None None None None None European Resuscitation Council (Director)*; Resuscitation Council UK (President)*; ILCOR (immediate past co-chair)*; Elsevier (Editor, Resuscitation and Resuscitation Plus)* Thomas Rea University of Washington Philips (Grant to evaluate community response strategies. We are not evaluating proprietary technology but rather general response strategies. The grant is to my employer the University of Washington)*; Federal government (Grant to study components of CPR and outcome of cardiac arrest)* None None None None None None This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $5000 or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $5000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition.

*Modest. †Significant.

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13 Cao D, Arens AM, Chow SL, et al. Part 10: Adult and pediatric spe-

cial circumstances of resuscitation: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S578–S672. doi: 10.1161/CIR.0000000000001380 14.	 Martin SS, Aday AW, Allen NB, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Bansal N, Beaton AZ, et al; on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Committee. 2025 Heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2025;151:e41–e660. doi: 10.1161/CIR.0000000000001303 15.	 Merchant RM, Becker LB, Brooks SC, Chan PS, Del Rios M, McBride ME, Neumar RW, Previdi JK, Uzendu A, Sasson C; on behalf of the American Heart Association. The American Heart Association emergency cardiovascular care 2030 impact goals and call to action to improve cardiac arrest outcomes: a scientific statement from the American Heart Association. Circulation. 2024;149:e914–e933. doi: 10.1161/CIR.0000000000001196 16.	 Smith A, Masters S, Ball S, Finn J. The incidence and outcomes of outof-hospital cardiac arrest in metropolitan versus rural locations: A systematic review and meta-analysis. Resuscitation. 2023;185:109655. doi: 10.1016/j.resuscitation.2022.11.021 17.	 Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389:1453–1463. doi: 10.1016/S0140-6736(17)30569-X 18.	 Cummins RO, Ornato JP, Thies WH, Pepe PE. Improving survival from sudden cardiac arrest: the “chain of survival” concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation. 1991;83:1832–1847. doi: 10.1161/01.cir.83.5.1832 19.	 Berg KM, Cheng A, Panchal AR, Topjian AA, Aziz K, Bhanji F, Bigham BL, Hirsch KG, Hoover AV, Kurz MC, et al; on behalf of the Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Life Support, and Resuscitation Education Science Writing Groups. Part 7: Systems of care: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S580–S604. doi: 10.1161/CIR.0000000000000899 20.	 Søreide E, Morrison L, Hillman K, Monsieurs K, Sunde K, Zideman D, Eisenberg M, Sterz F, Nadkarni VM, Soar J, et al; on behalf of the Utstein Formula for Survival Collaborators. The formula for survival in resuscitation. Resuscitation. 2013;84:1487–1493. doi: 10.1016/j.resuscitation.2013.07.020 21.	 Panchal AR, Bartos JA, Wyckoff MH, Drennan IR, Mahgoub M, Schexnayder SM, Rodriguez AJ, Sasson C, Wright JI, Brooks SC, et al. Part 2: Evidence evaluation and guidelines development: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl_2):S313–S322. doi: 10.1161/CIR.0000000000001373 22.	 International Liaison Committee on Resuscitation (ILCoR). Science Advisory Committee Guidance and Templates. 2025; Accessed May 26, 2025. https://www.ilcor.org/documents/continuous-evidence-evaluation-guidance-and-templates 23.	 Magid DJ, Aziz K, Cheng A, Hazinski MF, Hoover AV, Mahgoub M, Panchal AR, Sasson C, Topjian AA, Rodriguez AJ, et al. Part 2: Evidence evaluation and guidelines development: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S358–S365. doi: 10.1161/CIR.0000000000000898 24.	 Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, et al; on behalf of the Adult Basic and Advanced Life Support Writing Group. Part 3: Adult basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S366–S468. doi: 10.1161/CIR.0000000000000916 25.	 Topjian AA, Raymond TT, Atkins D, Chan M, Duff JP, Joyner BL Jr, Lasa JJ, Lavonas EJ, Levy A, Mahgoub M, et al; Pediatric Basic and Advanced Life Support Collaborators. Part 4: Pediatric basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S469–S523. doi: 10.1161/CIR.0000000000000901 26.	 Aziz K, Lee HC, Escobedo MB, Hoover AV, Kamath-Rayne BD, Kapadia

VS, Magid DJ, Niermeyer S, Schmölzer GM, Szyld E, et al. Part 5: Neonatal resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S524–S550. doi: 10.1161/CIR.0000000000000902 27 Cheng A, Magid DJ, Auerbach M, Bhanji F, Bigham BL, Blewer AL, Dainty

KN, Diederich E, Lin Y, Leary M, et al. Part 6: Resuscitation education science: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S551–S579. doi: 10.1161/CIR.0000000000000903 28.	 Nolan JP, Maconochie I, Soar J, Olasveengen TM, Greif R, Wyckoff MH, Singletary EM, Aickin R, Berg KM, Mancini ME, et al. Executive summary: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(suppl 1):S2–S27. doi: 10.1161/CIR.0000000000000890 29.	 Morley PT, Atkins DL, Finn JC, Maconochie I, Nolan JP, Rabi Y, Singletary EM, Wang TL, Welsford M, Olasveengen TM, et al. Evidence evaluation process and management of potential conflicts of interest: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(suppl 1):S28–S40. doi: 10.1161/CIR.0000000000000891 30.	 Olasveengen TM, Mancini ME, Perkins GD, Avis S, Brooks S, Castrén M, Chung SP, Considine J, Couper K, Escalante R, et al; on behalf of the Adult Basic Life Support Collaborators. Adult basic life support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(suppl 1):S41–S91. doi: 10.1161/CIR.0000000000000892 31.	 Berg KM, Soar J, Andersen LW, Böttiger BW, Cacciola S, Callaway CW, Couper K, Cronberg T, D’Arrigo S, Deakin CD, et al; on behalf of the Adult Advanced Life Support Collaborators. Adult advanced life support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(suppl 1):S92–S139. doi: 10.1161/CIR.0000000000000893 32.	 Maconochie IK, Aickin R, Hazinski MF, Atkins DL, Bingham R, Couto TB, Guerguerian AM, Nadkarni VM, Ng KC, Nuthall GA, et al; on behalf of the Pediatric Life Support Collaborators. Pediatric life support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(suppl 1):S140–S184. doi: 10.1161/CIR.0000000000000894 33.	 Wyckoff MH, Wyllie J, Aziz K, de Almeida MF, Fabres J, Fawke J, Guinsburg R, Hosono S, Isayama T, Kapadia VS, et al; on behalf of the Neonatal Life Support Collaborators. Neonatal life support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(suppl 1):S185–S221. doi: 10.1161/CIR.0000000000000895 34.	 Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, et al; on behalf of the Education, Implementation, and Teams Collaborators. Education, implementation, and teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142(suppl 1):S222–S283. doi: 10.1161/CIR.0000000000000896 35.	 Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, Zideman D, Bhanji F, Andersen LW, Avis SR, et al; on behalf of the Collaborators. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: summary from the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group. Circulation. 2022;145:e645– e721. doi: 10.1161/CIR.0000000000001017 36.	 Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, et al; on behalf of the Collaborators. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: summary from the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation. 2023;148:e187–e280. doi: 10.1161/CIR.0000000000001179 37.	 Greif R, Bray JE, Djärv T, Drennan IR, Liley HG, Ng KC, Cheng A, Douma MJ, Scholefield BR, Smyth M, et al. 2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation. 2024;150:e580–e687. doi: 10.1161/CIR.0000000000001288 38.	 Levine GN, O’Gara PT, Beckman JA, Al-Khatib SM, Birtcher KK, Cigarroa JE,

de las Fuentes L, Deswal A, Fleisher LA, Gentile F, et al. Recent innovations, modifications, and evolution of ACC/AHA clinical practice guidelines: an update for our constituencies: a report of the American College of Cardiology/ American Heart Association task force on clinical practice guidelines. Circulation. 2019;139:e879–e886. doi: 10.1161/CIR.0000000000000651

Downloaded from http://ahajournals.org by on October 7, 2026

Circulation. 2025;152(suppl 2):S284–S312. DOI: 10.1161/CIR.0000000000001372 October 21, 2025 S305

Del Rios et al Executive Summary: 2025 AHA Guidelines for CPR and ECC

39.	 Elmer J, Atkins DL, Daya MR, Del Rios M, Fry JT, Henderson CM, Lewis-Newby M, Madrigal VN, Marco CA, Ornato JP, et al. Part 3: Ethics: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S323–S352. doi: 10.1161/CIR.0000000000001371 40.	 Dezfulian C, Cabañas JG, Buckley JR, Cash RE, Crowe RP, Drennan IR, Mahgoub M, Mannarino CN, May T, Salcido DD, et al. Part 4: Systems of care. Circulation. 2025;152(suppl 2):S353–384. doi: 10.1161/CIR.0000000000001378 41.	 Alten J, Cooper DS, Klugman D, Raymond TT, Wooton S, Garza J, Clarke-Myers K, Anderson J, Pasquali SK, Absi M, et al; on behalf of the PC4 CAP Collaborators. Preventing cardiac arrest in the pediatric cardiac intensive care unit through multicenter collaboration. JAMA Pediatrics. 2022;176:1027–1036. doi: 10.1001/jamapediatrics.2022.2238 42.	 Dewan M, Soberano B, Sosa T, Zackoff M, Hagedorn P, Brady PW, Chima RS, Stalets EL, Moore L, Britto M, et al. Assessment of a situation awareness quality improvement intervention to reduce cardiac arrests in the PICU. Pediatr Crit Care Med. 2022;23:4–12. doi: 10.1097/PCC.0000000000002816 43.	 Moskowitz A, Berg KM, Cocchi MN, Grossestreuer AV, Issa M, Balaji L, Chase M, Yang JX, Sarge J, O’Donoghue S, et al. A trigger and response system for preventing cardiac arrest in the ICU. Crit Care Explor. 2021;3:e0557. doi: 10.1097/CCE.0000000000000557 44.	 McClellan C, Lambdin BH, Ali MM, Mutter R, Davis CS, Wheeler E, Pemberton M, Kral AH. Opioid-overdose laws association with opioid use and overdose mortality. Addict Behav. 2018;86:90–95. doi: 10.1016/j.addbeh.2018.03.014 45.	 Tabatabai M, Cooper RL, Wilus DM, Edgerton RD, Ramesh A, MacMaster SA, Patel PN, Singh KP. The effect of naloxone access laws on fatal synthetic opioid overdose fatality rates. J Prim Care Commun Health. 2023;14:21501319221147246. doi: 10.1177/21501319221147246 46.	 You HS, Ha J, Kang CY, Kim L, Kim J, Shen JJ, Park SM, Chun SY, Hwang J, Yamashita T, et al. Regional variation in states’ naloxone accessibility laws in association with opioid overdose death rates-Observational study (STROBE compliant). Medicine (Baltimore). 2020;99:e20033. doi: 10.1097/MD.0000000000020033 47.	 Freiermuth CE, Ancona RM, Brown JL, Punches BE, Ryan SA, Ingram T, Lyons MS. Evaluation of a large-scale health department naloxone distribution program: Per capita naloxone distribution and overdose morality. PLoS One. 2023;18:e0289959. doi: 10.1371/journal.pone.0289959 48.	 Hakansson A, Alanko Blome M, Isendahl P, Landgren M, Malmqvist U, Troberg K. Distribution of intranasal naloxone to potential opioid overdose bystanders in Sweden: effects on overdose mortality in a full region-wide study. BMJ open. 2024;14:e074152. doi: 10.1136/bmjopen-2023-074152 49.	 Boland LL, Formanek MB, Harkins KK, Frazee CL, Kamrud JW, Stevens AC, Lick CJ, Yannopoulos D. Minnesota Heart Safe Communities: are ­community-based initiatives increasing pre-ambulance CPR and AED use? Resuscitation. 2017;119:33–36. doi: 10.1016/j.resuscitation.2017.07.031 50.	 Fordyce CB, Hansen CM, Kragholm K, Dupre ME, Jollis JG, Roettig ML, Becker LB, Hansen SM, Hinohara TT, Corbett CC, et al. Association of public health initiatives with outcomes for out-of-hospital cardiac arrest at home and in public locations. JAMA Cardiol. 2017;2:1226–1235. doi: 10.1001/jamacardio.2017.3471 51.	 Tay PJM, Pek PP, Fan Q, Ng YY, Leong BS, Gan HN, Mao DR, Chia MYC, Cheah SO, Doctor N, et al. Effectiveness of a community based out-of-­hospital cardiac arrest (OHCA) interventional bundle: Results of a pilot study. Resuscitation. 2020;146:220–228. doi: 10.1016/j.resuscitation.2019.10.015 52.	 Uber A, Sadler RC, Chassee T, Reynolds JC. Does non-targeted community CPR training increase bystander CPR frequency? Prehosp Emerg Care. 2018;22:753–761. doi: 10.1080/10903127.2018.1459978 53.	 Becker L, Vath J, Eisenberg M, Meischke H. The impact of television public service announcements on the rate of bystander CPR. Prehosp Emerg Care. 1999;3:353–356. doi: 10.1080/10903129908958968 54.	 Li S, Qin C, Zhang H, Maimaitiming M, Shi J, Feng Y, Huang K, Bi Y, Wang M, Zhou Q, et al. Survival after out-of-hospital cardiac arrest before and after legislation for bystander CPR. JAMA Netw Open. 2024;7:e247909. doi: 10.1001/jamanetworkopen.2024.7909 55.	 Vetter VL, Griffis H, Dalldorf KF, Naim MY, Rossano J, Vellano K, McNally B, Glatz AC; CARES Surveillance Group. Impact of state laws: CPR education in high schools. J Am Coll Cardiol. 2022;79:2140–2143. doi: 10.1016/j.jacc.2022.03.359 56.	 Berglund E, Hollenberg J, Jonsson M, Svensson L, Claesson A, Nord A,

Nordberg P, Forsberg S, Rosenqvist M, Lundgren P, et al. Effect of smartphone dispatch of volunteer responders on automated external defibrillators and out-of-hospital cardiac arrests: the SAMBA randomized clinical trial. JAMA Cardiol. 2023;8:81–88. doi: 10.1001/jamacardio.2022.4362 57 Derkenne C, Jost D, Roquet F, Dardel P, Kedzierewicz R, Mignon A, Travers

S, Frattini B, Prieux L, Rozenberg E, et al. Mobile smartphone technology is associated with out-of-hospital cardiac arrest survival improvement: the first year “Greater Paris Fire Brigade” experience. Acad Emerg Med. 2020;27:951–962. doi: 10.1111/acem.13987 58.	 Andelius L, Malta Hansen C, Lippert FK, Karlsson L, Torp-Pedersen C, Kjær Ersbøll A, Køber L, Collatz Christensen H, Blomberg SN, Gislason GH, et al. Smartphone activation of citizen responders to facilitate defibrillation in out-of-hospital cardiac arrest. J Am Coll Cardiol. 2020;76:43–53. doi: 10.1016/j.jacc.2020.04.073 59.	 Bergamo C, Bui QM, Gonzales L, Hinchey P, Sasson C, Cabanas JG. TAKE10: A community approach to teaching compression-­only CPR to high-risk zip codes. Resuscitation. 2016;102:75–79. doi: 10.1016/j.resuscitation.2016.02.019 60.	 Hwang WS, Park JS, Kim SJ, Hong YS, Moon SW, Lee SW. A systemwide approach from the community to the hospital for improving neurologic outcomes in out-of-hospital cardiac arrest patients. Eur J Emerg Med. 2017;24:87–95. doi: 10.1097/MEJ.0000000000000313 61.	 Moller Nielsen A, Lou Isbye D, Knudsen Lippert F, Rasmussen LS. Engaging a whole community in resuscitation. Resuscitation. 2012;83:1067–1071. doi: 10.1016/j.resuscitation.2012.04.012 62.	 Nielsen AM, Isbye DL, Lippert FK, Rasmussen LS. Persisting effect of community approaches to resuscitation. Resuscitation. 2014;85:1450–1454. doi: 10.1016/j.resuscitation.2014.08.019 63.	 Nguyen DD, Spertus JA, Kennedy KF, Gupta K, Uzendu AI, McNally BF, Chan PS. Association between delays in time to bystander CPR and survival for witnessed cardiac arrest in the United States. Circ Cardiovasc Qual Outcomes. 2024;17:e010116. doi: 10.1161/CIRCOUTCOMES.123.010116 64.	 Hupfl M, Selig HF, Nagele P. Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis. Lancet. 2010;376:1552– 1557. doi: 10.1016/S0140-6736(10)61454-7 65.	 Grunau B, Kawano T, Rea TD, Okubo M, Scheuermeyer FX, Reynolds JC, Heidet M, Drennan IR, Cheskes S, Fordyce CB, et al. Emergency medical services employing intra-arrest transport less frequently for out-of-hospital cardiac arrest have higher survival and favorable neurological outcomes. Resuscitation. 2021;168:27–34. doi: 10.1016/j.resuscitation.2021.09.004 66.	 Grunau B, Kime N, Leroux B, Rea T, Van Belle G, Menegazzi JJ, Kudenchuk PJ, Vaillancourt C, Morrison LJ, Elmer J, et al. Association of intra-arrest transport vs continued on-scene resuscitation with survival to hospital discharge among patients with out-of-hospital cardiac arrest. JAMA. 2020;324:1058–1067. doi: 10.1001/jama.2020.14185 67.	 Okubo M, Komukai S, Izawa J, Chung S, Drennan IR, Grunau BE, Lupton JR, Ramgopal S, Rea TD, Callaway CW. Survival after intra-arrest transport vs on-scene cardiopulmonary resuscitation in children. JAMA Netw Open. 2024;7:e2411641. doi: 10.1001/jamanetworkopen.2024.11641 68.	 Morrison LJ, Verbeek PR, Vermeulen MJ, Kiss A, Allan KS, Nesbitt L, Stiell I. Derivation and evaluation of a termination of resuscitation clinical prediction rule for advanced life support providers. Resuscitation. 2007;74:266–275. doi: 10.1016/j.resuscitation.2007.01.009 69.	 Harris MI, Crowe RP, Anders J, D’Acunto S, Adelgais KM, Fishe J. Applying a set of termination of resuscitation criteria to paediatric outof-hospital cardiac arrest. Resuscitation. 2021;169:175–181. doi: 10.1016/j.resuscitation.2021.09.015 70.	 Campos A, Ernest EV, Cash RE, Rivard MK, Panchal AR, Clemency BM, Swor RA, Crowe RP. The association of death notification and related training with burnout among emergency medical services professionals. Prehosp Emerg Care. 2021;25:539–548. doi: 10.1080/10903127.2020.1785599 71.	 Patterson T, Perkins GD, Perkins A, Clayton T, Evans R, Dodd M, Robertson S, Wilson K, Mellett-Smith A, Fothergill RT, et al; on behalf of the ARREST trial collaborators. Expedited transfer to a cardiac arrest centre for non-STelevation out-of-hospital cardiac arrest (ARREST): a UK prospective, multicentre, parallel, randomised clinical trial. Lancet. 2023;402:1329–1337. doi: 10.1016/S0140-6736(23)01351-X 72.	 Moulaert VR, van Heugten CM, Winkens B, Bakx WG, de Krom MC, Gorgels TP, Wade DT, Verbunt JA. Early neurologically-focused follow-up after cardiac arrest improves quality of life at one year: a randomised controlled trial. Int J Cardiol. 2015;193:8–16. doi: 10.1016/j.ijcard.2015.04.229 73.	 Moulaert VR, Goossens M, Heijnders IL, Verbunt JA, Heugten CM. Early neurologically focused follow-up after cardiac arrest is cost-effective: A trial-based economic evaluation. Resuscitation. 2016;106:30–36. doi: 10.1016/j.resuscitation.2016.06.015 74.	 Joshi VL, Christensen J, Lejsgaard E, Taylor RS, Zwisler AD, Tang LH. Ef-

fectiveness of rehabilitation interventions on the secondary consequences of surviving a cardiac arrest: a systematic review and meta-analysis. BMJ Open. 2021;11:e047251. doi: 10.1136/bmjopen-2020-047251

Downloaded from http://ahajournals.org by on October 7, 2026

October 21, 2025 Circulation. 2025;152(suppl 2):S284–S312. DOI: 10.1161/CIR.0000000000001372 S306

Del Rios et al Executive Summary: 2025 AHA Guidelines for CPR and ECC

75.	 Wagner MK, Christensen J, Christensen KA, Dichman C, Gottlieb R, Kolster I, Hansen CM, Hoff H, Hassager C, Folke F, et al. A multidisciplinary ­guideline-based approach to improving the sudden cardiac arrest care pathway: The Copenhagen framework. Resusc Plus. 2024;17:100546. doi: 10.1016/j.resplu.2023.100546 76.	 Mion M, Al-Janabi F, Islam S, Magee N, Balasubramanian R, Watson N, Potter M, Karamasis GV, Harding J, Seligman H, et al. Care after resuscitation: implementation of the United Kingdom’s first dedicated multidisciplinary follow-up program for survivors of out-of-hospital cardiac arrest. Ther Hypother Temperature Manag. 2020;10:53–59. doi: 10.1089/ther.2018.0048 77.	 Mion M, Simpson R, Johnson T, Oriolo V, Gudde E, Rees P, Quinn T, Vopelius-Feldt VJ, Gallagher S, Mozid A, et al. British Cardiovascular Intervention Society consensus position statement on out-of-hospital cardiac arrest 2: post-discharge rehabilitation. Interv Cardiol (London, England). 2022;17:e19. doi: 10.15420/icr.2022.08 78.	 Lee HC, Strand ML, Finan E, Illuzzi J, Kamath-Rayne BD, Kapadia V, Mahgoub M, Niermeyer S, Schexnayder S, Schmölzer GM, et al. Part 5: Neonatal resuscitation: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S385– S423. doi: 10.1161/CIR.0000000000001367 79.	 Liley HG, Weiner GM, Wyckoff MH, et al. Neonatal life support: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations. Circulation. 2025;152(suppl 1):s•••–s•••. doi: 10.1161/CIR.0000000000001363 80.	 Yamada NK, Szyld E, Strand ML, Finan E, Illuzzi JL, Kamath-Rayne BD, Kapadia VS, Niermeyer S, Schmölzer GM, Williams A, et al; on behalf of the American Heart Association and American Academy of Pediatrics. 2023 American Heart Association and American Academy of Pediatrics focused update on neonatal resuscitation: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2024;149:e157–e166. doi: 10.1161/CIR.0000000000001181 81.	 Katheria AC, Clark E, Yoder B, Schmölzer GM, Yan Law BH, El-Naggar W, Rittenberg D, Sheth S, Mohamed MA, Martin C, et al; on behalf of the Milking In Nonvigorous Infants group. Umbilical cord milking in nonvigorous infants: a cluster-randomized crossover trial. Am J Obstet Gynecol. 2023;228:217 e211–217 e214. doi: 10.1016/j.ajog.2022.08.015 82.	 Katheria A, Reister F, Essers J, Mendler M, Hummler H, Subramaniam A, Carlo W, Tita A, Truong G, Davis-Nelson S, et al. Association of umbilical cord milking vs delayed umbilical cord clamping with death or severe intraventricular hemorrhage among preterm infants. JAMA. 2019;322:1877– 1886. doi: 10.1001/jama.2019.16004 83.	 Welsford M, Nishiyama C, Shortt C, Isayama T, Dawson JA, Weiner G, Roehr CC, Wyckoff MH, Rabi Y; International Liaison Committee on Resuscitation Neonatal Life Support Task Force. Room air for initiating term newborn resuscitation: a systematic review with meta-analysis. Pediatrics. 2019;143:e20181825. doi: 10.1542/peds.2018-1825 84.	 Welsford M, Nishiyama C, Shortt C, Weiner G, Roehr CC, Isayama T, Dawson JA, Wyckoff MH, Rabi Y; on behalf of the International Liaison Committee on Resuscitation Neonatal Life Support Task Force. Initial oxygen use for preterm newborn resuscitation: a systematic review with meta-analysis. Pediatrics. 2019;143:e20181828. doi: 10.1542/peds.2018-1828 85.	 Sotiropoulos JX, Oei JL, Schmölzer GM, Libesman S, Hunter KE, Williams JG, Webster AC, Vento M, Kapadia V, Rabi Y, et al. Initial oxygen concentration for the resuscitation of infants born at less than 32 weeks’ gestation: a systematic review and individual participant data network meta-analysis. JAMA Pediatr. 2024;178:774–783. doi: 10.1001/jamapediatrics.2024.1848 86.	 Bjorland PA, Ersdal HL, Haynes J, Ushakova A, Oymar K, Rettedal SI. Tidal volumes and pressures delivered by the NeoPuff T-piece resuscitator during resuscitation of term newborns. Resuscitation. 2022;170:222–229. doi: 10.1016/j.resuscitation.2021.12.006 87.	 O’Currain E, O’Shea JE, McGrory L, Owen LS, Kamlin O, Dawson JA, Davis PG, Thio M. Smaller facemasks for positive pressure ventilation in preterm infants: A randomised trial. Resuscitation. 2019;134:91–98. doi: 10.1016/j.resuscitation.2018.12.005 88.	 Mileder LP, Derler T, Baik-Schneditz N, Schwaberger B, Urlesberger B, Pichler G. Optimizing noninvasive respiratory support during postnatal stabilization: video-based analysis of airway maneuvers and their effects. J Matern Fetal Neonatal Med. 2022;35:3991–3997. doi: 10.1080/14767058.2020.1846176 89.	 Yamada NK, McKinlay CJ, Quek BH, Schmölzer GM, Wyckoff MH,

Liley HG, Rabi Y, Weiner GM. Supraglottic airways compared with face masks for neonatal resuscitation: a systematic review. Pediatrics. 2022;150:e2022056568. doi: 10.1542/peds.2022-056568 90 Diggikar S, Krishnegowda R, Nagesh KN, Lakshminrusimha S, Trevisanuto

D. Laryngeal mask airway versus face mask ventilation or intubation for neonatal resuscitation in low-and-middle-income countries: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2023;108:156– 163. doi: 10.1136/archdischild-2022-324472 91.	 Trevisanuto D, Roehr CC, Davis PG, Schmölzer GM, Wyckoff MH, Liley HG, Rabi Y, Weiner GM; International Liaison Committee on Resuscitation Neonatal Life Support Task Force. Devices for administering ventilation at birth: a systematic review. Pediatrics. 2021;148:e2021050174. doi: 10.1542/peds.2021-050174 92.	 Joyner BL, Dewan M, Bavare A, de Caen A, DiMaria K, Donofrio-Odmann J, Fosse G, Haskell S, Mahgoub M, Meckler G, et al. Part 6: Pediatric basic life support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S424–S447. doi: 10.1161/CIR.0000000000001370 93.	 Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Nadkarni VM, Berg RA, Hiraide A; on behalf of the implementation working group for All-Japan Utstein Registry of the Fire and Disaster Management Agency. Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. Lancet. 2010;375:1347–1354. doi: 10.1016/S0140-6736(10)60064-5 94.	 Goto Y, Maeda T, Goto Y. Impact of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological outcomes in children with out-of-hospital cardiac arrests: a prospective, nationwide, ­population-based cohort study. J Am Heart Assoc. 2014;3:e000499. doi: 10.1161/JAHA.113.000499 95.	 Naim MY, Burke RV, McNally BF, Song L, Griffis HM, Berg RA, Vellano K, Markenson D, Bradley RN, Rossano JW. Association of bystander cardiopulmonary resuscitation with overall and neurologically favorable survival after pediatric out-of-hospital cardiac arrest in the United States: a report from the Cardiac Arrest Registry to Enhance Survival Surveillance Registry. JAMA Pediatr. 2017;171:133–141. doi: 10.1001/jamapediatrics.2016.3643 96.	 Fukuda T, Ohashi-Fukuda N, Kobayashi H, Gunshin M, Sera T, Kondo Y, Yahagi N. Conventional versus compression-only versus no-bystander cardiopulmonary resuscitation for pediatric out-of-hospital cardiac arrest. Circulation. 2016;134:2060–2070. doi: 10.1161/CIRCULATIONAHA.116.023831 97.	 Ashoor HM, Lillie E, Zarin W, Pham B, Khan PA, Nincic V, Yazdi F, Ghassemi M, Ivory J, Cardoso R, et al; on behalf of the ILCOR Basic Life Support Task Force. Effectiveness of different compression-to-ventilation methods for cardiopulmonary resuscitation: a systematic review. Resuscitation. 2017;118:112–125. doi: 10.1016/j.resuscitation.2017.05.032 98.	 Gräsner JT, Wnent J, Herlitz J, Perkins GD, Lefering R, Tjelmeland I, Koster RW, Masterson S, Rossell-Ortiz F, Maurer H, et al. Survival after out-of-hospital cardiac arrest in Europe - results of the EuReCa TWO study. Resuscitation. 2020;148:218–226. doi: 10.1016/j.resuscitation.2019.12.042 99.	 Naim MY, Griffis HM, Berg RA, Bradley RN, Burke RV, Markenson D, McNally BF, Nadkarni VM, Song L, Vellano K, et al. Compression-only versus rescue-breathing cardiopulmonary resuscitation after pediatric outof-hospital cardiac arrest. J Am Coll Cardiol. 2021;78:1042–1052. doi: 10.1016/j.jacc.2021.06.042 100.	 Yoshimoto H, Fukui K, Nishimoto Y, Kuboyama K, Oishi Y, Sekine K, Hiraide A. Annual improvement trends in resuscitation outcome of patients defibrillated by laypersons after out-of-hospital cardiac arrests and compressiononly resuscitation of laypersons. Resuscitation. 2023;183:109672. doi: 10.1016/j.resuscitation.2022.12.010 101.	 Goto Y, Funada A, Maeda T, Goto Y. Temporal trends in neurologically intact survival after paediatric bystander-witnessed out-of-hospital cardiac arrest: A nationwide population-based observational study. Resusc Plus. 2021;6:100104. doi: 10.1016/j.resplu.2021.100104 102.	 Goto Y, Funada A, Maeda T, Goto Y. Dispatcher-assisted conventional cardiopulmonary resuscitation and outcomes for paediatric outof-hospital cardiac arrests. Resuscitation. 2022;172:106–114. doi: 10.1016/j.resuscitation.2021.10.003 103.	 Murasaka K, Yamashita A, Owada H, Wato Y, Inaba H. Association between the types of bystander cardiopulmonary resuscitation and the survival with good neurologic outcome of preschool pediatric out-of-hospital cardiac arrest cases in Japan: A propensity score matching analysis using an extended nationwide database. Front Pediatr. 2022;10:1075983. doi: 10.3389/fped.2022.1075983 104.	 Kiyohara K, Kitamura Y, Ayusawa M, Nitta M, Iwami T, Nakata K, Sobue

T, Kitamura T. Dissemination of chest compression-only cardiopulmonary resuscitation by bystanders for out-of-hospital cardiac arrest in students:

Downloaded from http://ahajournals.org by on October 7, 2026

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Del Rios et al Executive Summary: 2025 AHA Guidelines for CPR and ECC

a nationwide investigation in Japan. J Clin Med. 2022;11:928. doi: 10.3390/jcm11040928 105.	 Douvanas A, Koulouglioti C, Kalafati M. A comparison between the two methods of chest compression in infant and neonatal resuscitation. A review according to 2010 CPR guidelines. J Maternal Fetal Neonatal Med. 2018;31:805–816. doi: 10.1080/14767058.2017.1295953 106.	 Lee JE, Lee J, Oh J, Park CH, Kang H, Lim TH, Yoo KH. Comparison of two-thumb encircling and two-finger technique during infant cardiopulmonary resuscitation with single rescuer in simulation studies: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98:e17853. doi: 10.1097/MD.0000000000017853 107.	 Chang CY, Hou YT, Chien YJ, Chen YL, Lin PC, Chen CS, Wu MY. Twothumb or two-finger technique in infant cardiopulmonary resuscitation by a single rescuer? A meta-analysis with GOSH analysis. Int J Environ Res Public Health. 2020;17:5214. doi: 10.3390/ijerph17145214 108.	 Chang CY, Lin PC, Chien YJ, Chen CS, Wu MY. Analysis of chest-­compression depth and full recoil in two infant chest-compression techniques performed by a single rescuer: systematic review and meta-analysis. Int J Environ Res Public Health. 2020;17:4018. doi: 10.3390/ijerph17114018 109.	 Millin MG, Bogumil D, Fishe JN, Burke RV. Comparing the two-finger versus two-thumb technique for single person infant CPR: A systematic review and meta-analysis. Resuscitation. 2020;148:161–172. doi: 10.1016/j.resuscitation.2019.12.039 110.	 O’Connell KJ, Sandler A, Dutta A, Ahmed R, Neubrand T, Myers S, Kerrey B, Donoghue A. The effect of hand position on chest compression quality during CPR in young children: findings from the Videography in Pediatric Resuscitation (VIPER) collaborative. Resuscitation. 2023;185:109741. doi: 10.1016/j.resuscitation.2023.109741 111.	 Kang JY, Kim YJ, Shin YJ, Huh JW, Hong SB, Kim WY. Association between time to defibrillation and neurologic outcome in patients with in-hospital cardiac arrest. Am J Med Sci. 2019;358:143–148. doi: 10.1016/j.amjms.2019.05.003 112.	 Lauridsen KG, Morgan RW, Berg RA, Niles DE, Kleinman ME, Zhang X, Griffis H, Del Castillo J, Skellett S, Lasa JJ, et al; on behalf of the ­pediRES-Q Investigators. Association between chest compression pause duration and survival after pediatric in-hospital cardiac arrest. Circulation. 2024;149:1493–1500. doi: 10.1161/CIRCULATIONAHA.123.066882 113.	 Dunne CL, Cirone J, Blanchard IE, Holroyd-Leduc J, Wilson TA, Sauro K, McRae AD. Evaluation of basic life support interventions for foreign body airway obstructions: a population-based cohort study. Resuscitation. 2024;201:110258. doi: 10.1016/j.resuscitation.2024.110258 114.	 Kleinman M, Buick J, Huber N, Idris A, Levy M, Morgan S, Nassal M, Neth M, Norii T, Nunnally M, et al. Part 7: Adult basic life support: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2025;152:S448–S478. doi: 10.1161/CIR.0000000000001369 115.	 Idris AH, Aramendi Ecenarro E, Leroux B, Jaureguibeitia X, Yang BY, Shaver S, Chang MP, Rea T, Kudenchuk P, Christenson J, et al. Bagvalve-mask ventilation and survival from out-of-hospital cardiac arrest: a multicenter study. Circulation. 2023;148:1847–1856. doi: 10.1161/CIRCULATIONAHA.123.065561 116.	 Hsu CH, Considine J, Pawar RD, Cellini J, Schexnayder SM, Soar J, Olasveengen TM, Berg KM; Advanced Life Support, Basic Life Support, Paediatric Life Support Task Forces at the International Liaison Committee on Resuscitation ILCOR. Cardiopulmonary resuscitation and defibrillation for cardiac arrest when patients are in the prone position: A systematic review. Resusc Plus. 2021;8:100186. doi: 10.1016/j.resplu.2021.100186 117.	 Gambolò L, Di Fronzo P, Ristagno G, Biserni S, Milazzo M, Socaci DM, Sarli L, Artioli G, Bonacaro A, Stirparo G. The role of different feedback devices in the survival of patients in cardiac arrest: systematic review with metaanalysis. J Clin Med. 2024;13:5989. doi: 10.3390/jcm13195989 118.	 Lasa J, Dhillon GS, Duff JP, et al. Part 8: pediatric advanced life support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S479–S537. doi: 10.1161/CIR.0000000000001368 119.	 Topjian AA, Raymond TT, Atkins D, Chan M, Duff JP, Joyner BL Jr, Lasa JJ, Lavonas EJ, Levy A, Mahgoub M, et al; on behalf of the Pediatric Basic and Advanced Life Support Collaborators. Part 4: Pediatric basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S469–S523. doi: 10.1161/CIR.0000000000000901 120.	 Donoghue A, Auerbach M, Banerjee A, Blewer A, Cheng A, Kadlec K, Lin

Y, Diederich E, Sawyer T, Stallings D, et al. Part 12: Resuscitation education science: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2025;152(suppl 2):S719–S750. doi: 10.1161/CIR.0000000000001374 121.	 Ohshimo S, Wang CH, Couto TB, Bingham R, Mok YH, Kleinman M, Aickin

R, Ziegler C, DeCaen A, Atkins DL, et al; on behalf of the International Liaison Committee on Resuscitation (ILCOR) Pediatric Task Force. Pediatric timing of epinephrine doses: a systematic review. Resuscitation. 2021;160:106–117. doi: 10.1016/j.resuscitation.2021.01.015 122.	 Andersen LW, Berg KM, Saindon BZ, Massaro JM, Raymond TT, Berg RA, Nadkarni VM, Donnino MW; on behalf of the American Heart Association Get With the Guidelines–Resuscitation Investigators. Time to epinephrine and survival after pediatric in-hospital cardiac arrest. JAMA. 2015;314:802–810. doi: 10.1001/jama.2015.9678 123.	 Lin YR, Li CJ, Huang CC, Lee TH, Chen TY, Yang MC, Chou CC, Chang CF, Huang HW, Hsu HY, et al. Early epinephrine improves the stabilization of initial post-resuscitation hemodynamics in children with nonshockable out-of-hospital cardiac arrest. Front Pediatr. 2019;7:220. doi: 10.3389/fped.2019.00220 124.	 Lin YR, Wu MH, Chen TY, Syue YJ, Yang MC, Lee TH, Lin CM, Chou CC, Chang CF, Li CJ. Time to epinephrine treatment is associated with the risk of mortality in children who achieve sustained ROSC after traumatic out-of-hospital cardiac arrest. Crit Care. 2019;23:101. doi: 10.1186/s13054-019-2391-z 125.	 Fukuda T, Kondo Y, Hayashida K, Sekiguchi H, Kukita I. Time to epinephrine and survival after paediatric out-of-hospital cardiac arrest. Eur Heart J Cardiovasc Pharmacother. 2018;4:144–151. doi: 10.1093/ehjcvp/pvx023 126.	 Hansen M, Schmicker RH, Newgard CD, Grunau B, Scheuermeyer F, Cheskes S, Vithalani V, Alnaji F, Rea T, Idris AH, et al; on behalf of the Resuscitation Outcomes Consortium Investigators. Time to epinephrine administration and survival from nonshockable out-of-hospital cardiac arrest among children and adults. Circulation. 2018;137:2032–2040. doi: 10.1161/CIRCULATIONAHA.117.033067 127.	 Andersen LW, Kurth T, Chase M, Berg KM, Cocchi MN, Callaway C, Donnino MW; on behalf of the American Heart Association’s Get With The Guidelines-Resuscitation Investigators. Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis. BMJ. 2016;353:i1577. doi: 10.1136/bmj.i1577 128.	 Evans E, Swanson MB, Mohr N, Boulos N, Vaughan-Sarrazin M, Chan PS, Girotra S; on behalf of the American Heart Association’s Get With The Guidelines-Resuscitation investigators. Epinephrine before defibrillation in patients with shockable in-hospital cardiac arrest: propensity matched analysis. BMJ. 2021;375:e066534. doi: 10.1136/bmj-2021-066534 129.	 Berg RA, Sutton RM, Reeder RW, Berger JT, Newth CJ, Carcillo JA, McQuillen PS, Meert KL, Yates AR, Harrison RE, et al; on behalf of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) PICqCPR (Pediatric Intensive Care Quality of Cardio-Pulmonary Resuscitation) Investigators. Association between diastolic blood pressure during pediatric in-hospital cardiopulmonary resuscitation and survival. Circulation. 2018;137:1784–1795. doi: 10.1161/CIRCULATIONAHA.117.032270 130.	 Berg RA, Morgan RW, Reeder RW, Ahmed T, Bell MJ, Bishop R, Bochkoris M, Burns C, Carcillo JA, Carpenter TC, et al. Diastolic blood pressure threshold during pediatric cardiopulmonary resuscitation and survival outcomes: a multicenter validation study. Crit Care Med. 2023;51:91–102. doi: 10.1097/CCM.0000000000005715 131.	 Sutton RM, Wolfe HA, Reeder RW, Ahmed T, Bishop R, Bochkoris M, Burns C, Diddle JW, Federman M, Fernandez R, et al; on behalf of the ICU-RESUS and Eunice Kennedy Shriver National Institute of Child Health. Effect of physiologic point-of-care cardiopulmonary resuscitation training on survival with favorable neurologic outcome in cardiac arrest in pediatric ICUs: a randomized clinical trial. JAMA. 2022;327:934–945. doi: 10.1001/jama.2022.1738 132.	 Fowler JC, Morgan RW, O’Halloran A, Gardner MM, Appel S, Wolfe H, Kienzle MF, Raymond TT, Scholefield BR, Guerguerian AM, et al; on behalf of the American Heart Association’s Get With The Guidelines®- Resuscitation Investigators. The impact of pediatric post-cardiac arrest care on survival: A multicenter review from the AHA get with the Guidelines®-resuscitation post-cardiac arrest care registry. Resuscitation. 2024;202:110301. doi: 10.1016/j.resuscitation.2024.110301 133.	 Topjian AA, Telford R, Holubkov R, Nadkarni VM, Berg RA, Dean JM, Moler

FW; on behalf of the Therapeutic Hypothermia After Pediatric Cardiac Arrest (THAPCA) Trial Investigators. Association of early postresuscitation hypotension with survival to discharge after targeted temperature management for pediatric out-of-hospital cardiac arrest: secondary

Downloaded from http://ahajournals.org by on October 7, 2026

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Del Rios et al Executive Summary: 2025 AHA Guidelines for CPR and ECC

analysis of a randomized clinical trial. JAMA Pediatr. 2018;172:143–153. doi: 10.1001/jamapediatrics.2017.4043 134.	 Topjian AA, French B, Sutton RM, Conlon T, Nadkarni VM, Moler FW, Dean JM, Berg RA. Early postresuscitation hypotension is associated with increased mortality following pediatric cardiac arrest. Crit Care Med. 2014;42:1518–1523. doi: 10.1097/CCM.0000000000000216 135.	 Laverriere EK, Polansky M, French B, Nadkarni VM, Berg RA, Topjian AA. Association of duration of hypotension with survival after pediatric cardiac arrest. Pediatr Crit Care Med. 2020;21:143–149. doi: 10.1097/PCC.0000000000002119 136.	 Gardner MM, Hehir DA, Reeder RW, Ahmed T, Bell MJ, Berg RA, Bishop R, Bochkoris M, Burns C, Carcillo JA, et al. Identification of postcardiac arrest blood pressure thresholds associated with outcomes in children: an ICU-Resuscitation study. Crit Care. 2023;27:388. doi: 10.1186/s13054-023-04662-9 137.	 Ushpol A, Je S, Niles D, Majmudar T, Kirschen M, Del Castillo J, Buysse C, Topjian A, Nadkarni V, Gangadharan S; on behalf of the PediRES-Q investigators. Association of blood pressure with neurologic outcome at hospital discharge after pediatric cardiac arrest resuscitation. Resuscitation. 2024;194:110066. doi: 10.1016/j.resuscitation.2023.110066 138.	 Liu R, Majumdar T, Gardner MM, Burnett R, Graham K, Beaulieu F, Sutton RM, Nadkarni VM, Berg RA, Morgan RW, et al. Association of postarrest hypotension burden with unfavorable neurologic outcome after pediatric cardiac arrest. Crit Care Med. 2024;52:1402–1413. doi: 10.1097/CCM.0000000000006339 139.	 Meert K, Telford R, Holubkov R, Slomine BS, Christensen JR, Berger J, Ofori-Amanfo G, Newth CJL, Dean JM, Moler FW. Paediatric in-­ hospital cardiac arrest: Factors associated with survival and neurobehavioural outcome one year later. Resuscitation. 2018;124:96–105. doi: 10.1016/j.resuscitation.2018.01.013 140.	 Ichord R, Silverstein FS, Slomine BS, Telford R, Christensen J, Holubkov R, Dean JM, Moler FW; on behalf of the THAPCA Trial Group. Neurologic outcomes in pediatric cardiac arrest survivors enrolled in the THAPCA trials. Neurology. 2018;91:e123–e131. doi: 10.1212/WNL.0000000000005773 141.	 Meert KL, Telford R, Holubkov R, Slomine BS, Christensen JR, Dean JM, Moler FW; on behalf of the Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) Trial Investigators. Pediatric out-of-hospital cardiac arrest characteristics and their association with survival and neurobehavioral outcome. Pediatr Crit Care Med. 2016;17:e543–e550. doi: 10.1097/PCC.0000000000000969 142.	 Del Castillo J, López-Herce J, Matamoros M, Cañadas S, Rodríguez-Calvo A, Cecchetti C, Rodriguez-Núñez A, Álvarez AC; on behalf of the Iberoamerican Pediatric Cardiac Arrest Study Network RIBEPCI. Longterm evolution after in-hospital cardiac arrest in children: prospective multicenter multinational study. Resuscitation. 2015;96:126–134. doi: 10.1016/j.resuscitation.2015.07.037 143.	 Conlon TW, Falkensammer CB, Hammond RS, Nadkarni VM, Berg RA, Topjian AA. Association of left ventricular systolic function and vasopressor support with survival following pediatric out-of-­ hospital cardiac arrest. Pediatr Crit Care Med. 2015;16:146–154. doi: 10.1097/PCC.0000000000000305 144.	 Starling RM, Shekdar K, Licht D, Nadkarni VM, Berg RA, Topjian AA. Early head ct findings are associated with outcomes after pediatric outof-hospital cardiac arrest. Pediatr Crit Care Med. 2015;16:542–548. doi: 10.1097/PCC.0000000000000404 145.	 Alsoufi B, Awan A, Manlhiot C, Guechef A, Al-Halees Z, Al-Ahmadi M, McCrindle BW, Kalloghlian A. Results of rapid-response extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest following cardiac surgery. Eur J Cardio Thorac Surg. 2014;45:268–275. doi: 10.1093/ejcts/ezt319 146.	 Polimenakos AC, Rizzo V, El-Zein CF, Ilbawi MN. Post-cardiotomy rescue extracorporeal cardiopulmonary resuscitation in neonates with single ventricle after intractable cardiac arrest: attrition after hospital discharge and predictors of outcome. Pediatr Cardiol. 2017;38:314–323. doi: 10.1007/s00246-016-1515-3 147.	 Scholefield BR, Gao F, Duncan HP, Tasker RC, Parslow RC, Draper ES, McShane P, Davies P, Morris KP. Observational study of children admitted to United Kingdom and Republic of Ireland paediatric intensive care units after out-of-hospital cardiac arrest. Resuscitation. 2015;97:122–128. doi: 10.1016/j.resuscitation.2015.07.011 148.	 Kramer P, Miera O, Berger F, Schmitt K. Prognostic value of se-

rum biomarkers of cerebral injury in classifying neurological outcome after paediatric resuscitation. Resuscitation. 2018;122:113–120. doi: 10.1016/j.resuscitation.2017.09.012 149.	 Yang D, Ryoo E, Kim HJ. Combination of early EEG, brain CT, and ammonia

level is useful to predict neurologic outcome in children resuscitated from cardiac arrest. Front Pediatr. 2019;7:223. doi: 10.3389/fped.2019.00223 150.	 Brooks GA, Park JT. Clinical and electroencephalographic correlates in pediatric cardiac arrest: experience at a tertiary care center. Neuropediatrics. 2018;49:324–329. doi: 10.1055/s-0038-1657757 151.	 Scholefield BR, Tijssen J, Ganesan SL, Kool M, Couto TB, Topjian A, Atkins DL, Acworth J, McDevitt W, Laughlin S, et al; on behalf of the International Liaison Committee on Resuscitation (ILCOR) and ILCOR Pediatric Life Support Task Force. Prediction of good neurological outcome after return of circulation following paediatric cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2025;207:110483. doi: 10.1016/j.resuscitation.2024.110483 152.	 Wigginton JG, Agarwal S, Bartos JA, Coute RA, Drennan IR, Haamid A, Kudenchuk P, Link MS, Panchal AR, Pelter MM, et al. Part 9: Adult advanced life support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S538–S577. doi: 10.1161/CIR.0000000000001376 153.	 Perman SM, Elmer J, Maciel CB, Uzendu A, May T, Mumma BE, Bartos JA, Rodriguez AJ, Kurz MC, Panchal AR, et al; on behalf of the American Heart Association. American Heart Association focused update on adult advanced cardiovascular life support: an update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2024;149:e254–e273. doi: 10.1161/CIR.0000000000001194 154.	 Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, Gazmuri RJ, Travers AH, Rea T. Part 5: Adult basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S414–S435. doi: 10.1161/CIR.0000000000000259 155.	 Hirsch KG, Amorim E, Coppler PJ, Drennan IR, Elliott A, June Gordon A, Jentzer JC, Johnson NJ, Moskowitz A, et al. Part 11: Post–cardiac arrest care: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S673– S718. doi: 10.1161/CIR. 0000000000001375 156.	 Nguyen ST, Belley-Côté EP, Ibrahim O, Um KJ, Lengyel A, Adli T, Qiu Y, Wong M, Sibilio S, Benz AP, et al. Techniques improving electrical cardioversion success for patients with atrial fibrillation: a systematic review and meta-analysis. Europace. 2023;25:318–330. doi: 10.1093/europace/euac199 157.	 Spies DM, Kiekenap J, Rupp D, Betz S, Kill C, Sassen MC. Time to change the times? Time of recurrence of ventricular fibrillation during OHCA. Resuscitation. 2020;157:219–224. doi: 10.1016/j.resuscitation.2020.09.029 158.	 Cheskes S, Verbeek PR, Drennan IR, McLeod SL, Turner L, Pinto R, Feldman M, Davis M, Vaillancourt C, Morrison LJ, et al. Defibrillation strategies for refractory ventricular fibrillation. N Engl J Med. 2022;387:1947– 1956. doi: 10.1056/NEJMoa2207304 159.	 Jaeger D, Kosmopoulos M, Voicu S, Kalra R, Gaisendrees C, Schlartenberger G, Bartos JA, Yannopoulos D. Cerebral hemodynamic effects of headup CPR in a porcine model. Resuscitation. 2023;193:110039. doi: 10.1016/j.resuscitation.2023.110039 160.	 Moore JC, Pepe PE, Scheppke KA, Lick C, Duval S, Holley J, Salverda B, Jacobs M, Nystrom P, Quinn R, et al. Head and thorax elevation during cardiopulmonary resuscitation using circulatory adjuncts is associated with improved survival. Resuscitation. 2022;179:9–17. doi: 10.1016/j.resuscitation.2022.07.039 161.	 Lavonas EJ, Akpunonu PD, Arens AM, Babu KM, Cao D, Hoffman RS, Hoyte CO, Mazer-Amirshahi ME, Stolbach A, St-Onge M, et al; on behalf of the American Heart Association. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2023;148:e149–e184. doi: 10.1161/CIR.0000000000001161 162.	 Dezfulian C, McCallin TE, Bierens J, Dunne CL, Idris AH, Kiragu A,

Mahgoub M, Shenoi RP, Szpilman D, Terry M, et al. American Heart Association and American Academy of Pediatrics focused update on special circumstances: resuscitation following drowning: an update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation

Downloaded from http://ahajournals.org by on October 7, 2026

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Del Rios et al Executive Summary: 2025 AHA Guidelines for CPR and ECC

and Emergency Cardiovascular Care. Circulation. 2024;150:e501–e516. doi: 10.1161/CIR.0000000000001274 163.	 Chan VW, Ng HH, Rahman L, Tang A, Tang KP, Mok A, Liu JHP, Ho KSC, Chan SM, Wong S, et al. Transmission of severe acute respiratory syndrome coronavirus 1 and severe acute respiratory syndrome coronavirus 2 during aerosol-generating procedures in critical care: a systematic review and meta-analysis of observational studies. Crit Care Med. 2021;49:1159– 1168. doi: 10.1097/CCM.0000000000004965 164.	 Couper K, Taylor-Phillips S, Grove A, Freeman K, Osokogu O, Court R, Mehrabian A, Morley PT, Nolan JP, Soar J, et al. COVID-19 in cardiac arrest and infection risk to rescuers: a systematic review. Resuscitation. 2020;151:59–66. doi: 10.1016/j.resuscitation.2020.04.022 165.	 Jackson T, Deibert D, Wyatt G, Durand-Moreau Q, Adisesh A, Khunti K, Khunti S, Smith S, Chan XHS, Ross L, et al. Classification of aerosolgenerating procedures: a rapid systematic review. BMJ Open Respir Res. 2020;7:e000730. doi: 10.1136/bmjresp-2020-000730 166.	 Kay JK, Parsel SM, Marsh JJ, McWhorter AJ, Friedlander PL. Risk of SARS-CoV-2 transmission during flexible laryngoscopy: a systematic review. JAMA Otolaryngol Head Neck Surg. 2020;146:851–856. doi: 10.1001/jamaoto.2020.1973 167.	 Thamboo A, Lea J, Sommer DD, Sowerby L, Abdalkhani A, Diamond C, Ham J, Heffernan A, Cai Long M, Phulka J, et al. Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology - head and neck surgery during the COVID-19 pandemic. J Otolaryngol Head Neck Surg. 2020;49:28. doi: 10.1186/s40463-020-00425-6 168.	 Tian C, Lovrics O, Vaisman A, Chin KJ, Tomlinson G, Lee Y, Englesakis M, Parotto M, Singh M. Risk factors and protective measures for healthcare worker infection during highly infectious viral respiratory epidemics: A systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2022;43:639–650. doi: 10.1017/ice.2021.18 169.	 Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012;7:e35797. doi: 10.1371/journal.pone.0035797 170.	 Brown A, Schwarcz L, Counts CR, Barnard LM, Yang BY, Emert JM, Latimer A, Drucker C, Lynch J, Kudenchuk PJ, et al. Risk for acquiring coronavirus disease illness among emergency medical service personnel exposed to aerosol-generating procedures. Emerg Infect Dis. 2021;27:2340–2348. doi: 10.3201/eid2709.210363 171.	 Djakow J NK, Raymond T, Atkins D, Acworth J, Scholefield B; on behalf of the International Liaison Committee on Resuscitation Pediatric Life Support Task Force. Pharmacological interventions for the treatment of hyperkalaemia in paediatric patients with cardiac arrest – paediatric consensus on science and treatment recommendations. November 23, 2024. Accessed January 16, 2025. https://costr.ilcor.org/document/pharmacological-interventions-for-the-treatment-of-hyperkalaemia-in-paediatricpatients-with-cardiac-arrest-pls-4160-17-tfsr 172.	 Granfeldt A HM, Andersen LW, Ng KC; Jana Djakow; on behalf of the Advanced Life Support and Pediatric Life Support Task Forces. Pharmacological interventions for the acute treatment of hyperkalemia: a systematic review. International Liaison Committee on Resuscitation Consensus on Science with Treatment Recommendations (CoSTR). November 2024. Accessed January 16, 2025. https://costr.ilcor.org/ document/pharmacological-interventions-for-the-acute-treatment-ofhyperkalemia-als-3403-tf-sr 173.	 Filep EM, Murata Y, Endres BD, Kim G, Stearns RL, Casa DJ. Exertional heat stroke, modality cooling rate, and survival outcomes: a systematic review. Medicina (Kaunas). 2020;56:589. doi: 10.3390/medicina56110589 174.	 Douma MJ, Aves T, Allan KS, Bendall JC, Berry DC, Chang WT, Epstein J, Hood N, Singletary EM, Zideman D, et al; First Aid Task Force of the International Liaison Committee on Resuscitation. First aid cooling techniques for heat stroke and exertional hyperthermia: a systematic review and meta-analysis. Resuscitation. 2020;148:173–190. doi: 10.1016/j.resuscitation.2020.01.007 175.	 Peberdy MA, Gluck JA, Ornato JP, Bermudez CA, Griffin RE, Kasirajan V,

Kerber RE, Lewis EF, Link MS, Miller C, et al; on behalf of the American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiopulmonary, Critical Care, Perioperative, and Resuscitation; Council on Cardiovascular Diseases in the Young; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Cardiopulmonary resuscitation in adults and children with mechanical circulatory support: a scientific statement from the American Heart Association. Circulation. 2017;135:e1115– e1134. doi: 10.1161/CIR.0000000000000504 176.	 Ford ND, DeSisto CL, Galang RR, Kuklina EV, Sperling LS, Ko JY. Cardiac

arrest during delivery hospitalization: a cohort study. Ann Intern Med. 2023;176:472–479. doi: 10.7326/M22-2750 177.	 Jeejeebhoy FM, Zelop CM, Lipman S, Carvalho B, Joglar J, Mhyre JM, Katz VL, Lapinsky SE, Einav S, Warnes CA, et al; on behalf of the American Heart Association Emergency Cardiovascular Care Committee, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Cardiovascular Diseases in the Young, and Council on Clinical Cardiology. Cardiac arrest in pregnancy: a scientific statement from the American Heart Association. Circulation. 2015;132:1747–1773. doi: 10.1161/CIR.0000000000000300 178.	 Zelop CM, Einav S, Mhyre JM, Lipman SS, Arafeh J, Shaw RE, Edelson DP, Jeejeebhoy FM; on behalf of the American Heart Association’s Get With the Guidelines-Resuscitation Investigators. Characteristics and outcomes of maternal cardiac arrest: a descriptive analysis of Get With the Guidelines data. Resuscitation. 2018;132:17–20. doi: 10.1016/j.resuscitation.2018.08.029 179.	 Enomoto N, Yamashita T, Furuta M, Tanaka H, Ng ESW, Matsunaga S, Sakurai A; on behalf of the Japan Resuscitation Council Maternal task force. Effect of maternal positioning during cardiopulmonary resuscitation: a systematic review and meta-analyses. BMC Pregnancy Childbirth. 2022;22:159. doi: 10.1186/s12884-021-04334-y 180.	 Kirkegaard H, Søreide E, de Haas I, Pettilä V, Taccone FS, Arus U, Storm C, Hassager C, Nielsen JF, Sørensen CA, et al. Targeted temperature management for 48 vs 24 hours and neurologic outcome after out-of-hospital cardiac arrest: a randomized clinical trial. JAMA. 2017;318:341–350. doi: 10.1001/jama.2017.8978 181.	 Hassager C, Schmidt H, Møller JE, Grand J, Mølstrøm S, Beske RP, Boesgaard S, Borregaard B, Bekker-Jensen D, Dahl JS, et al. Duration of device-based fever prevention after cardiac arrest. N Engl J Med. 2023;388:888–897. doi: 10.1056/NEJMoa2212528 182.	 Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Levin H, Ullén S, Rylander C, Wise MP, Oddo M, Cariou A, et al; on behalf of the TTM2 Trial Investigators. Hypothermia versus normothermia after out-of-hospital cardiac arrest. N Engl J Med. 2021;384:2283–2294. doi: 10.1056/NEJMoa2100591 183.	 Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, Horn J, Hovdenes J, Kjaergaard J, Kuiper M, et al; on behalf of the TTM Trial Investigators. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. N Engl J Med. 2013;369:2197– 2206. doi: 10.1056/NEJMoa1310519 184.	 Bhate TD, McDonald B, Sekhon MS, Griesdale DE. Association between blood pressure and outcomes in patients after cardiac arrest: A systematic review. Resuscitation. 2015;97:1–6. doi: 10.1016/j.resuscitation.2015.08.023 185.	 Jentzer JC, Chonde MD, Dezfulian C. Myocardial dysfunction and shock after cardiac arrest. Biomed Res Int. 2015;2015:314796. doi: 10.1155/2015/314796 186.	 Rui Q, Jiang Y, Chen M, Zhang N, Yang H, Zhou Y. Dopamine versus norepinephrine in the treatment of cardiogenic shock: a PRISMAcompliant meta-analysis. Medicine (Baltimore). 2017;96:e8402. doi: 10.1097/MD.0000000000008402 187.	 Léopold V, Gayat E, Pirracchio R, Spinar J, Parenica J, Tarvasmäki T, Lassus J, Harjola VP, Champion S, Zannad F, et al. Epinephrine and short-term survival in cardiogenic shock: an individual data metaanalysis of 2583 patients. Intensive Care Med. 2018;44:847–856. doi: 10.1007/s00134-018-5222-9 188.	 Levy B, Clere-Jehl R, Legras A, Morichau-Beauchant T, Leone M, Frederique G, Quenot JP, Kimmoun A, Cariou A, Lassus J, et al; on behalf of the Collaborators. Epinephrine versus norepinephrine for cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol. 2018;72:173– 182. doi: 10.1016/j.jacc.2018.04.051 189.	 Perkins GD, Callaway CW, Haywood K, Neumar RW, Lilja G, Rowland MJ, Sawyer KN, Skrifvars MB, Nolan JP. Brain injury after cardiac arrest. Lancet. 2021;398:1269–1278. doi: 10.1016/S0140-6736(21)00953-3 190.	 Rittenberger JC, Popescu A, Brenner RP, Guyette FX, Callaway CW. Frequency and timing of nonconvulsive status epilepticus in comatose post-cardiac arrest subjects treated with hypothermia. Neurocrit Care. 2012;16:114–122. doi: 10.1007/s12028-011-9565-0 191.	 Legriel S, Hilly-Ginoux J, Resche-Rigon M, Merceron S, Pinoteau J,

Henry-Lagarrigue M, Bruneel F, Nguyen A, Guezennec P, Troché G, et al. Prognostic value of electrographic postanoxic status epilepticus in comatose cardiac-arrest survivors in the therapeutic hypothermia era. Resuscitation. 2013;84:343–350. doi: 10.1016/j.resuscitation.2012.11.001

Downloaded from http://ahajournals.org by on October 7, 2026

October 21, 2025 Circulation. 2025;152(suppl 2):S284–S312. DOI: 10.1161/CIR.0000000000001372 S310

Del Rios et al Executive Summary: 2025 AHA Guidelines for CPR and ECC

192.	 Dragancea I, Backman S, Westhall E, Rundgren M, Friberg H, Cronberg T. Outcome following postanoxic status epilepticus in patients with targeted temperature management after cardiac arrest. Epilepsy Behav. 2015;49:173–177. doi: 10.1016/j.yebeh.2015.04.043 193.	 Ruijter BJ, van Putten MJ, Hofmeijer J. Generalized epileptiform discharges in postanoxic encephalopathy: quantitative characterization in relation to outcome. Epilepsia. 2015;56:1845–1854. doi: 10.1111/epi.13202 194.	 Lybeck A, Friberg H, Aneman A, Hassager C, Horn J, Kjærgaard J, Kuiper M, Nielsen N, Ullén S, Wise MP, et al; on behalf of the TTM-trial Investigators. Prognostic significance of clinical seizures after cardiac arrest and target temperature management. Resuscitation. 2017;114:146– 151. doi: 10.1016/j.resuscitation.2017.01.017 195.	 Beretta S, Coppo A, Bianchi E, Zanchi C, Carone D, Stabile A, Padovano G, Sulmina E, Grassi A, Bogliun G, et al. Neurologic outcome of postanoxic refractory status epilepticus after aggressive treatment. Neurology. 2018;91:e2153–e2162. doi: 10.1212/WNL.0000000000006615 196.	 Geocadin RG, Callaway CW, Fink EL, Golan E, Greer DM, Ko NU, Lang E, Licht DJ, Marino BS, McNair ND, et al; on behalf of the American Heart Association Emergency Cardiovascular Care Committee. Standards for studies of neurological prognostication in comatose survivors of cardiac arrest: a scientific statement from the American Heart Association. Circulation. 2019;140:e517–e542. doi: 10.1161/CIR.0000000000000702 197.	 Nigam JAS, Barker RM, Cunningham TR, Swanson NG, Chosewood LC. Vital signs: health worker-perceived working conditions and symptoms of poor mental health - quality of worklife survey, United States, 2018-2022. MMWR Morb Mortal Wkly Rep. 2023;72:1197–1205. doi: 10.15585/mmwr.mm7244e1 198.	 Cohen C, Pignata S, Bezak E, Tie M, Childs J. Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: a systematic review. BMJ Open. 2023;13:e071203. doi: 10.1136/bmjopen-2022-071203 199.	 Dewa CS, Loong D, Bonato S, Trojanowski L. The relationship between physician burnout and quality of healthcare in terms of safety and acceptability: a systematic review. BMJ Open. 2017;7:e015141. doi: 10.1136/bmjopen-2016-015141 200.	 Alexander GK, Rollins K, Walker D, Wong L, Pennings J. Yoga for selfcare and burnout prevention among nurses. Workplace Health Safety. 2015;63:462–70; quiz 471. doi: 10.1177/2165079915596102 201.	 Cheng ST, Tsui PK, Lam JH. Improving mental health in health care practitioners: randomized controlled trial of a gratitude intervention. J Consult Clin Psychol. 2015;83:177–186. doi: 10.1037/a0037895 202.	 Schroeder DA, Stephens E, Colgan D, Hunsinger M, Rubin D, Christopher MS. A brief mindfulness-based intervention for primary care physicians: a pilot randomized controlled trial. Am J Lifestyle Med. 2018;12:83–91. doi: 10.1177/1559827616629121 203.	 Dyrbye LN, Shanafelt TD, Gill PR, Satele DV, West CP. Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial. JAMA Intern Med. 2019;179:1406–1414. doi: 10.1001/jamainternmed.2019.2425 204.	 Hersch RK, Cook RF, Deitz DK, Kaplan S, Hughes D, Friesen MA, Vezina M. Reducing nurses’ stress: a randomized controlled trial of a web-based stress management program for nurses. Appl Nurs Res. 2016;32:18–25. doi: 10.1016/j.apnr.2016.04.003 205.	 Mistretta EG, Davis MC, Temkit M, Lorenz C, Darby B, Stonnington CM. resilience training for work-related stress among health care workers: results of a randomized clinical trial comparing in-person and smartphonedelivered interventions. J Occup Environ Med. 2018;60:559–568. doi: 10.1097/JOM.0000000000001285 206.	 Profit J, Adair KC, Cui X, Mitchell B, Brandon D, Tawfik DS, Rigdon J, Gould JB, Lee HC, Timpson WL, et al. Randomized controlled trial of the “WISER” intervention to reduce healthcare worker burnout. J Perinatol. 2021;41:2225–2234. doi: 10.1038/s41372-021-01100-y 207.	 Cheng A, Overly F, Kessler D, Nadkarni VM, Lin Y, Doan Q, Duff JP, Tofil NM, Bhanji F, Adler M, et al; on behalf of the International Network for Simulation-based Pediatric Innovation, Research, Education (INSPIRE) CPR Investigators. Perception of CPR quality: influence of CPR feedback, Just-in-Time CPR training and provider role. Resuscitation. 2015;87:44– 50. doi: 10.1016/j.resuscitation.2014.11.015 208.	 Jones A, Lin Y, Nettel-Aguirre A, Gilfoyle E, Cheng A. Visual assessment of CPR quality during pediatric cardiac arrest: does point of view matter? Resuscitation. 2015;90:50–55. doi: 10.1016/j.resuscitation.2015.01.036 209.	 Hsieh TC, Wolfe H, Sutton R, Myers S, Nadkarni V, Donoghue A. A com-

parison of video review and feedback device measurement of chest compressions quality during pediatric cardiopulmonary resuscitation. Resuscitation. 2015;93:35–39. doi: 10.1016/j.resuscitation.2015.05.022 210.	 Brookoff D, Kellermann AL, Hackman BB, Somes G, Dobyns P. Do blacks

get bystander cardiopulmonary resuscitation as often as whites? Ann Emerg Med. 1994;24:1147–1150. doi: 10.1016/s0196-0644(94)70246-2 211.	 Vadeboncoeur TF, Richman PB, Darkoh M, Chikani V, Clark L, Bobrow BJ. Bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest in the Hispanic vs the non-Hispanic populations. Am J Emerg Med. 2008;26:655–660. doi: 10.1016/j.ajem.2007.10.002 212.	 Anderson ML, Cox M, Al-Khatib SM, Nichol G, Thomas KL, Chan PS, Saha-Chaudhuri P, Fosbol EL, Eigel B, Clendenen B, et al. Rates of cardiopulmonary resuscitation training in the United States. JAMA Intern Med. 2014;174:194–201. doi: 10.1001/jamainternmed.2013.11320 213.	 Fosbøl EL, Dupre ME, Strauss B, Swanson DR, Myers B, McNally BF, Anderson ML, Bagai A, Monk L, Garvey JL, et al. Association of neighborhood characteristics with incidence of out-of-hospital cardiac arrest and rates of bystander-initiated CPR: implications for communitybased education intervention. Resuscitation. 2014;85:1512–1517. doi: 10.1016/j.resuscitation.2014.08.013 214.	 Blewer AL, Schmicker RH, Morrison LJ, Aufderheide TP, Daya M, Starks MA, May S, Idris AH, Callaway CW, Kudenchuk PJ, et al; on behalf of the Resuscitation Outcomes Consortium Investigators. Variation in bystander cardiopulmonary resuscitation delivery and subsequent survival from out-of-hospital cardiac arrest based on ­neighborhood-level ethnic characteristics. Circulation. 2020;141:34–41. doi: 10.1161/CIRCULATIONAHA.119.041541 215.	 Garcia RA, Spertus JA, Girotra S, Nallamothu BK, Kennedy KF, McNally BF, Breathett K, Del Rios M, Sasson C, Chan PS. Racial and ethnic differences in bystander CPR for witnessed cardiac arrest. N Engl J Med. 2022;387:1569–1578. doi: 10.1056/NEJMoa2200798 216.	 Sasson C, Haukoos JS, Eigel B, Magid DJ. The HANDDS program: a systematic approach for addressing disparities in the provision of bystander cardiopulmonary resuscitation. Acad Emerg Med. 2014;21:1042–1049. doi: 10.1111/acem.12455 217.	 Root ED, Gonzales L, Persse DE, Hinchey PR, McNally B, Sasson C. A tale of two cities: the role of neighborhood socioeconomic status in spatial clustering of bystander CPR in Austin and Houston. Resuscitation. 2013;84:752–759. doi: 10.1016/j.resuscitation.2013.01.007 218.	 Mitchell MJ, Stubbs BA, Eisenberg MS. Socioeconomic status is associated with provision of bystander cardiopulmonary resuscitation. Prehosp Emerg Care. 2009;13:478–486. doi: 10.1080/10903120903144833 219.	 Vaillancourt C, Lui A, De Maio VJ, Wells GA, Stiell IG. Socioeconomic status influences bystander CPR and survival rates for out-of-­ hospital cardiac arrest victims. Resuscitation. 2008;79:417–423. doi: 10.1016/j.resuscitation.2008.07.012 220.	 Chiang WC, Ko PC, Chang AM, Chen WT, Liu SS, Huang YS, Chen SY, Lin CH, Cheng MT, Chong KM, et al. Bystander-initiated CPR in an Asian metropolitan: does the socioeconomic status matter? Resuscitation. 2014;85:53–58. doi: 10.1016/j.resuscitation.2013.07.033 221.	 Dahan B, Jabre P, Karam N, Misslin R, Tafflet M, Bougouin W, Jost D, Beganton F, Marijon E, Jouven X. Impact of neighbourhood socio-economic status on bystander cardiopulmonary resuscitation in Paris. Resuscitation. 2017;110:107–113. doi: 10.1016/j.resuscitation.2016.10.028 222.	 Moncur L, Ainsborough N, Ghose R, Kendal SP, Salvatori M, Wright J. Does the level of socioeconomic deprivation at the location of cardiac arrest in an English region influence the likelihood of receiving bystander-initiated cardiopulmonary resuscitation? Emerg Med J. 2016;33:105–108. doi: 10.1136/emermed-2015-204643 223.	 Brown TP, Booth S, Hawkes CA, Soar J, Mark J, Mapstone J, Fothergill RT, Black S, Pocock H, Bichmann A, et al. Characteristics of neighbourhoods with high incidence of out-of-hospital cardiac arrest and low bystander cardiopulmonary resuscitation rates in England. Eur Heart J Qual Care Clin Outcomes. 2019;5:51–62. doi: 10.1093/ehjqcco/qcy026 224.	 Naim MY, Griffis HM, Burke RV, McNally BF, Song L, Berg RA, Nadkarni VM, Vellano K, Markenson D, Bradley RN, et al. Race/ethnicity and neighborhood characteristics are associated with bystander cardiopulmonary resuscitation in pediatric out-of-hospital cardiac arrest in the united states: a study from CARES. J Am Heart Assoc. 2019;8:e012637. doi: 10.1161/JAHA.119.012637 225.	 van Nieuwenhuizen BP, Oving I, Kunst AE, Daams J, Blom MT, Tan HL,

van Valkengoed IGM. Socio-economic differences in incidence, bystander cardiopulmonary resuscitation and survival from out-of-hospital cardiac arrest: A systematic review. Resuscitation. 2019;141:44–62. doi: 10.1016/j.resuscitation.2019.05.018

Downloaded from http://ahajournals.org by on October 7, 2026

Circulation. 2025;152(suppl 2):S284–S312. DOI: 10.1161/CIR.0000000000001372 October 21, 2025 S311

Del Rios et al Executive Summary: 2025 AHA Guidelines for CPR and ECC

226.	 Uny I, Angus K, Duncan E, Dobbie F. Barriers and facilitators to delivering bystander cardiopulmonary resuscitation in deprived communities: a systematic review. Persp Public Health. 2023;143:43–53. doi: 10.1177/17579139211055497 227.	 Møller S, Wissenberg M, Starkopf L, Kragholm K, Hansen SM, Ringgren KB, Folke F, Andersen J, Malta Hansen C, Lippert F, et al. Socioeconomic disparities in prehospital factors and survival after out-of-hospital cardiac arrest. Heart. 2021;107:627–634. doi: 10.1136/heartjnl-2020-317761 228.	 Blewer AL, Ibrahim SA, Leary M, Dutwin D, McNally B, Anderson ML, Morrison LJ, Aufderheide TP, Daya M, Idris AH, et al. Cardiopulmonary resuscitation training disparities in the United States. J Am Heart Assoc. 2017;6:e006124. doi: 10.1161/JAHA.117.006124 229.	 Abdulhay NM, Totolos K, McGovern S, Hewitt N, Bhardwaj A, Buckler DG, Leary M, Abella BS. Socioeconomic disparities in layperson CPR training within a large U.S. city. Resuscitation. 2019;141:13–18. doi: 10.1016/j.resuscitation.2019.05.038 230.	 Yoon W, Ro YS, Cho SI. A mediation analysis of the effect of practical training on the relationship between demographic factors, and bystanders’ self-efficacy in CPR performance. PLoS One. 2019;14:e0215432. doi: 10.1371/journal.pone.0215432 231.	 Ko YC, Hsieh MJ, Schnaubelt S, Matsuyama T, Cheng A, Greif R. Disparities in layperson resuscitation education: a scoping review. Am J Emerg Med. 2023;72:137–146. doi: 10.1016/j.ajem.2023.07.033 232.	 Ng TP, Eng SW, Ting JXR, Bok C, Tay GYH, Kong SYJ, Stassen W, Zhang L, de Kleijn DPV, Ong MEH, et al; on behalf of the GOALS Workgroup. Global prevalence of basic life support training: a systematic review and meta-analysis. Resuscitation. 2023;186:109771. doi: 10.1016/j.resuscitation.2023.109771 233.	 Blewer AL, McGovern SK, Schmicker RH, May S, Morrison LJ, Aufderheide TP, Daya M, Idris AH, Callaway CW, Kudenchuk PJ, et al; on behalf of the Resuscitation Outcomes Consortium (ROC) Investigators. Gender disparities among adult recipients of bystander cardiopulmonary resuscitation in the public. Circ Cardiovasc Qual Outcomes. 2018;11:e004710. doi: 10.1161/CIRCOUTCOMES.118.004710 234.	 Souers A, Zuver C, Rodriguez A, Van Dillen C, Hunter C, Papa L. Bystander CPR occurrences in out of hospital cardiac arrest between sexes. Resuscitation. 2021;166:1–6. doi: 10.1016/j.resuscitation.2021.06.021 235.	 Becker TK, Gul SS, Cohen SA, Maciel CB, Baron-Lee J, Murphy TW, Youn TS, Tyndall JA, Gibbons C, Hart L, et al; on behalf of the Florida Cardiac Arrest Resource Team. Public perception towards bystander cardiopulmonary resuscitation. Emerg Med J. 2019;36:660–665. doi: 10.1136/emermed-2018-208234 236.	 Perman SM, Shelton SK, Knoepke C, Rappaport K, Matlock DD, Adelgais K, Havranek EP, Daugherty SL. Public perceptions on why women receive less bystander cardiopulmonary resuscitation than men in out-of-hospital cardiac arrest. Circulation. 2019;139:1060–1068. doi: 10.1161/CIRCULATIONAHA.118.037692 237.	 Yip MP, Ong B, Tu SP, Chavez D, Ike B, Painter I, Lam I, Bradley SM, Coronado GD, Meischke HW. Diffusion of cardiopulmonary resuscitation training to chinese immigrants with limited english proficiency. Emerg Med Int. 2011;2011:685249. doi: 10.1155/2011/685249 238.	 Meischke H, Taylor V, Calhoun R, Liu Q, Sos C, Tu SP, Yip MP, Eisenberg D. Preparedness for cardiac emergencies among Cambodians with limited English proficiency. J Community Health. 2012;37:176–180. doi: 10.1007/s10900-011-9433-z 239.	 Sasson C, Haukoos JS, Bond C, Rabe M, Colbert SH, King R, Sayre M, Heisler M. Barriers and facilitators to learning and performing cardiopulmonary resuscitation in neighborhoods with low bystander cardiopulmonary resuscitation prevalence and high rates of cardiac arrest in Columbus, OH. Circ Cardiovasc Qual Outcomes. 2013;6:550–558. doi: 10.1161/CIRCOUTCOMES.111.000097 240.	 Liu KY, Haukoos JS, Sasson C. Availability and quality of cardiopulmonary resuscitation information for Spanish-speaking population on the Internet. Resuscitation. 2014;85:131–137. doi: 10.1016/j.resuscitation.2013.08.274 241.	 Sasson C, Haukoos JS, Ben-Youssef L, Ramirez L, Bull S, Eigel B, Magid DJ, Padilla R. Barriers to calling 911 and learning and performing cardiopulmonary resuscitation for residents of primarily Latino, high-risk neighborhoods in Denver, Colorado. Ann Emerg Med. 2015;65:545–552.e2. doi: 10.1016/j.annemergmed.2014.10.028 242.	 King R, Heisler M, Sayre MR, Colbert SH, Bond-Zielinski C, Rabe M, Eigel

B, Sasson C. Identification of factors integral to designing communitybased CPR interventions for high-risk neighborhood residents. Prehosp Emerg Care. 2015;19:308–312. doi: 10.3109/10903127.2014.964889 243.	 Sasson C, Keirns CC, Smith DM, Sayre MR, Macy ML, Meurer WJ, McNally

BF, Kellermann AL, Iwashyna TJ. Examining the contextual effects of neighborhood on out-of-hospital cardiac arrest and the provision of bystander cardiopulmonary resuscitation. Resuscitation. 2011;82:674–679. doi: 10.1016/j.resuscitation.2011.02.002 244.	 Dobbie F, Uny I, Eadie D, Duncan E, Stead M, Bauld L, Angus K, Hassled L, MacInnes L, Clegg G. Barriers to bystander CPR in deprived communities: findings from a qualitative study. PLoS One. 2020;15:e0233675. doi: 10.1371/journal.pone.0233675 245.	 Naqvi S, Siddiqi R, Hussain SA, Batool H, Arshad H. School children training for basic life support. J College Phys Surg Pakistan. 2011;21:611–615. doi: 10.2011/JCPSP.611615 246.	 Lorem T, Palm A, Wik L. Impact of a self-instruction CPR kit on 7th graders’ and adults’ skills and CPR performance. Resuscitation. 2008;79:103–108. doi: 10.1016/j.resuscitation.2008.04.030 247.	 Berthelot S, Plourde M, Bertrand I, Bourassa A, Couture MM, Berger-Pelletier E, St-Onge M, Leroux R, Le Sage N, Camden S. Push hard, push fast: quasi-experimental study on the capacity of elementary schoolchildren to perform cardiopulmonary resuscitation. Scand J Trauma Resusc Emerg Med. 2013;21:41. doi: 10.1186/1757-7241-21-41 248.	 Chamdawala H, Meltzer JA, Shankar V, Elachi D, Jarzynka SM, Nixon AF. Cardiopulmonary resuscitation skill training and retention in teens (CPR START): A randomized control trial in high school students. Resusc Plus. 2021;5:100079. doi: 10.1016/j.resplu.2021.100079 249.	 Ko JS, Kim SR, Cho BJ. Hands-only cardiopulmonary resuscitation education for elementary school students in Korea: tracking by school grade, physical characteristics, and physical strength. Int J Public Health. 2023;68:1606054. doi: 10.3389/ijph.2023.1606054 250.	 Zeleke BG, Biswas ES, Biswas M. Teaching cardiopulmonary resuscitation to young children (<12 years old). Am J Cardiol. 2019;123:1626–1627. doi: 10.1016/j.amjcard.2019.02.011 251.	 Luria JW, Smith GA, Chapman JI. An evaluation of a safety education program for kindergarten and elementary school children. Arch Pediatr Adolesc Med. 2000;154:227–231. doi: 10.1001/archpedi.154.3.227 252.	 Bollig G, Myklebust AG, Ostringen K. Effects of first aid training in the ­kindergarten--a pilot study. Scand J Trauma Resusc Emerg Med. 2011;19:13. doi: 10.1186/1757-7241-19-13 253.	 Ammirati C, Gagnayre R, Amsallem C, Nemitz B, Gignon M. Are schoolteachers able to teach first aid to children younger than 6 years? A comparative study. BMJ Open. 2014;4:e005848. doi: 10.1136/bmjopen-2014-005848 254.	 Banfai B, Pek E, Pandur A, Csonka H, Betlehem J. ‘The year of first aid’: effectiveness of a 3-day first aid programme for 7-14-yearold primary school children. Emerg Med J. 2017;34:526–532. doi: 10.1136/emermed-2016-206284 255.	 Bollig G, Wahl HA, Svendsen MV. Primary school children are able to perform basic life-saving first aid measures. Resuscitation. 2009;80:689–692. doi: 10.1016/j.resuscitation.2009.03.012 256.	 Barsom EZ, Duijm RD, Dusseljee‐Peute LW, Landman‐van der Boom EB, van Lieshout EJ, Jaspers MW, Schijven MP. Cardiopulmonary resuscitation training for high school students using an immersive 360‐degree virtual reality environment. Br J Educ Technol. 2020;51:2050–2062. doi: 10.1111/bjet.13025 257.	 Liu ZM, Fan X, Liu Y, Ye X. Effects of immersive virtual reality cardiopulmonary resuscitation training on prospective kindergarten teachers’ learning achievements, attitudes and self‐efficacy. Br J Educ Technol. 2022;53:2050–2070. doi: 10.1111/bjet.13237 258.	 Kim EA, Cho KJ. Comparing the effectiveness of two new CPR training methods in Korea: medical virtual reality simulation and flipped learning. Iran J Public Health. 2023;52:1428–1438. doi: 10.18502/ijph.v52i7.13244 259.	 Aksoy E. Comparing the effects on learning outcomes of tablet-based and virtual reality-based serious gaming modules for basic life support training: randomized trial. JMIR Serious Games. 2019;7:e13442. doi: 10.2196/13442 260.	 Leary M, McGovern SK, Chaudhary Z, Patel J, Abella BS, Blewer AL. Comparing bystander response to a sudden cardiac arrest using a virtual reality CPR training mobile app versus a standard CPR training mobile app. Resuscitation. 2019;139:167–173. doi: 10.1016/j.resuscitation.2019.04.017 261.	 Nas J, Thannhauser J, Konijnenberg LSF, van Geuns RM, van Royen N,

Bonnes JL, Brouwer MA. Long-term effect of face-to-face vs virtual reality cardiopulmonary resuscitation (CPR) training on willingness to perform CPR, retention of knowledge, and dissemination of CPR awareness: a secondary analysis of a randomized clinical trial. JAMA Netw Open. 2022;5:e2212964. doi: 10.1001/jamanetworkopen.2022.12964

Downloaded from http://ahajournals.org by on October 7, 2026

October 21, 2025 Circulation. 2025;152(suppl 2):S284–S312. DOI: 10.1161/CIR.0000000000001372 S312

Del Rios et al Executive Summary: 2025 AHA Guidelines for CPR and ECC

262.	 Castillo J, Rodriguez-Higueras E, Belmonte R, Rodriguez C, Lopez A, Gallart A. Efficacy of virtual reality simulation in teaching basic life support and its retention at 6 months. Int J Environ Res Public Health. 2023;20:4095. doi: 10.3390/ijerph20054095. 263.	 Hubail D, Mondal A, Al Jabir A, Patel B. Comparison of a virtual reality compression-only Cardiopulmonary Resuscitation (CPR) course to the traditional course with content validation of the VR course - a randomized control pilot study. Ann Med Surg (2012). 2022;73:103241. doi: 10.1016/j.amsu.2022.103241 264.	 Chang YT, Wu KC, Yang HW, Lin CY, Huang TF, Yu YC, Hu YJ. Effects of different cardiopulmonary resuscitation education interventions among university students: A randomized controlled trial. PLoS One. 2023;18:e0283099. doi: 10.1371/journal.pone.0283099 265.	 Jeffers JM, Schreurs BA, Dean JL, Scott B, Canares T, Tackett S, Smith B, Billings E, Billioux V, Sampathkumar HD, et al. Paediatric chest compression performance improves via novel augmented-reality cardiopulmonary resuscitation feedback system: A mixed-methods pilot study in a simulation-based setting. Resusc Plus. 2022;11:100273. doi: 10.1016/j.resplu.2022.100273 266.	 Leary M, McGovern SK, Balian S, Abella BS, Blewer AL. A pilot study of CPR quality comparing an augmented reality application vs. a standard audio-visual feedback manikin. Front Digital Health. 2020;2:1. doi: 10.3389/fdgth.2020.00001 267.	 Hou L, Dong X, Li K, Yang C, Yu Y, Jin X, Shang S. Comparison of augmented reality-assisted and instructor-assisted cardiopulmonary resuscitation: a simulated randomized controlled pilot trial. Clin Simul Nurs. 2022;68:9–18. doi: 10.1016/j.ecns.2022.04.004 268.	 Hou L, Dong X, Li K, Yang C, Yu Y, Jin X, Shang S. Effectiveness of a novel augmented reality cardiopulmonary resuscitation self-training environment for laypeople in China: a randomized controlled trial. Interdisciplinary Nurs Res. 2022;1:43–50. doi: 10.1097/nr9.0000000000000010 269.	 Zaric N, Roepke R, Lukarov V, Schroeder U. Gamified learning theory: the moderating role of learners’ learning tendencies. Int J Serious Games. 2021;8:71–91. doi: 10.17083/ijsg.v8i3.438 270.	 Cheng A, Davidson J, Wan B, St-Onge-St-Hilaire A, Lin Y. Data-informed debriefing for cardiopulmonary arrest: a randomized controlled trial. Resusc Plus. 2023;14:100401. doi: 10.1016/j.resplu.2023.100401 271.	 Cheng A, Hunt EA, Donoghue A, Nelson-McMillan K, Nishisaki A, Leflore J, Eppich W, Moyer M, Brett-Fleegler M, Kleinman M, et al; on behalf of the EXPRESS Investigators. Examining pediatric resuscitation education using simulation and scripted debriefing: a multicenter randomized trial. JAMA Pediatr. 2013;167:528–536. doi: 10.1001/jamapediatrics.2013.1389 272.	 Snelling PJ, Dodson L, Monteagle E, Ware RS, Acworth J, Symon B, Lawton B. PRE-scripted debriefing for paediatric simulation associated with resuscitation education (PREPARED): a multicentre, cluster randomised controlled trial. Resusc Plus. 2022;11:100291. doi: 10.1016/j.resplu.2022.100291 273.	 Hunt EA, Duval-Arnould JM, Nelson-McMillan KL, Bradshaw JH,

Diener-West M, Perretta JS, Shilkofski NA. Pediatric resident resuscitation skills improve after “rapid cycle deliberate practice” training. Resuscitation. 2014;85:945–951. doi: 10.1016/j.resuscitation.2014.02.025 274.	 Lemke DS, Young AL, Won SK, Rus MC, Villareal NN, Camp EA,

Doughty C. Rapid-cycle deliberate practice improves time to defibrillation and reduces workload: a randomized controlled trial of simulation-based education. AEM Educ Training. 2021;5:e10702. doi: 10.1002/aet2.10702 275.	 Magee MJ, Farkouh-Karoleski C, Rosen TS. Improvement of immediate performance in neonatal resuscitation through rapid cycle deliberate practice training. J Graduate Med Educ. 2018;10:192–197. doi: 10.4300/JGME-D-17-00467.1 276.	 de Castro LT, Coriolano AM, Burckart K, Soares MB, Accorsi TAD, Rosa VEE, de Santis Andrade Lopes AS, Couto TB. Rapid-cycle deliberate practice versus after-event debriefing clinical simulation in cardiopulmonary resuscitation: a cluster randomized trial. Adv Simul (London, England). 2022;7:43. doi: 10.1186/s41077-022-00239-8 277.	 Won SK, Doughty CB, Young AL, Welch-Horan TB, Rus MC, Camp EA, Lemke DS. Rapid cycle deliberate practice improves retention of pediatric resuscitation skills compared with postsimulation debriefing. Simul Healthc. 2022;17:e20–e27. doi: 10.1097/SIH.0000000000000568 278.	 Wanner GK, Osborne A, Greene CH. Brief compression-only cardiopulmonary resuscitation training video and simulation with homemade mannequin improves CPR skills. BMC Emerg Med. 2016;16:45. doi: 10.1186/s12873-016-0110-5 279.	 Van Raemdonck V, Monsieurs KG, Aerenhouts D, De Martelaer K. Teaching basic life support: a prospective randomized study on low-cost training strategies in secondary schools. Eur J Emerg Med. 2014;21:284–290. doi: 10.1097/MEJ.0000000000000071 280.	 Tanaka S, White AE, Sagisaka R, Chong G, Ng E, Seow J, Mj NA, Tanaka H, Ong MEH. Comparison of quality of chest compressions during training of laypersons using Push Heart and Little Anne manikins using blinded CPRcards. Int J Emerg Med. 2017;10:20. doi: 10.1186/s12245-017-0147-6 281.	 Shafiq U, Ali B, Masahuling A, Khanji MY. The use of a ‘pillow partner’ as a simple, cost-effective, and accessible tool to teach bystander cardiopulmonary resuscitation skills. Resuscitation. 2022;181:26–27. doi: 10.1016/j.resuscitation.2022.10.007 282.	 Ohle R, Moskalyk M, Boissonneault E, Bilgasem A, Tissot E, McIsaac S. Is a homemade cardiopulmonary resuscitation (CPR) trainer non-inferior to a commercially available CPR mannequin in teaching high-quality CPR? A non-inferiority randomized control trial. Resusc Plus. 2021;6:100134. doi: 10.1016/j.resplu.2021.100134 283.	 Nehra A, Ravindra P, Bhat R, Nagesh SK, Alok Y, Nisarg S, Shanmukhappa Maddani S, Balakrishnan JM. Comparison between a low-cost model (CPR Pillow) and a mannequin in training hands only cardiopulmonary resuscitation (CPR): a randomised trial. Resusc Plus. 2024;17:100518. doi: 10.1016/j.resplu.2023.100518 284.	 Barry M, Dixon M, Armstrong C, Keane F. The Pillow project, infant choking,

and basic life support training for prospective parents: a low-cost intervention for widespread application. J Perinatal Neonatal Nurs. 2019;33:260– 267. doi: 10.1097/JPN.0000000000000397

Downloaded from http://ahajournals.org by on October 7, 2026