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Circulation. 2025;152(suppl 2):S538–S577. DOI: 10.1161/CIR.0000000000001376 October 21, 2025 S553

Wigginton et al Advanced Life Support: 2025 AHA Guidelines for CPR and ECC

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ADJUNCTS FOR PERFORMANCE OF CPR

Recommendations for Adjuncts to CPR COR LOE Recommendations 2b B-NR 1.  An abrupt increase in end-tidal CO2 may be used to detect ROSC during chest compressions in adults in cardiac arrest or when a rhythm check reveals an organized rhythm. 2b C-LD 2.  Use of point-of-care ultrasonography during adult cardiac arrest resuscitation to diagnose reversible causes is not well established. 2b C-LD 3.  Use of point-of-care echocardiography to assess cardiac function for prognostication during adult cardiac arrest resuscitation is not well established. 2b C-LD 4.  When supplemental oxygen is available, it may be reasonable to use the maximal feasible inspired oxygen concentration during CPR for adults with cardiac arrest. 2b C-LD 5.  Measurement of arterial blood gases during CPR has uncertain benefit in adults with cardiac arrest. 2b C-LD 6.  In adult patients with cardiac arrest, it may be reasonable to use physiological parameters such as arterial blood pressure or end-tidal CO2 when feasible to monitor and optimize CPR quality. 2b C-EO 7.  Arterial pressure monitoring by arterial line may be used to detect ROSC during chest compressions or when a rhythm check reveals an organized rhythm in adults with cardiac arrest. 3: No Benefit C-LD 8.  Head-up cardiopulmonary resuscitation in adults with cardiac arrest is not recommended except in setting of clinical trials.

Synopsis The foundation of cardiac arrest resuscitation focuses on high-quality CPR, early defibrillation when indicated, and guideline-directed pharmacologic therapies and airway

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