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October 21, 2025 Circulation. 2025;152(suppl 2):S538–S577. DOI: 10.1161/CIR.0000000000001376 S560

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

52%) found both higher survival to hospital discharge and higher survival to hospital discharge with good neurologic outcome in the patients managed with SGA.13 A recent systematic review noted that while SGAs may be associated with faster placement and increased rate of ROSC, there is no clear survival benefit to SGA or ETI, and the effect of SGA versus ETI on neurological survival remains uncertain.14 Outcomes likely depend on patient and professional characteristics, especially EMS professional exposure to initial and ongoing advanced airway training and experience. Precise thresholds for high or low ETI success rates have not been identified. The decision to place an advanced airway requires an understanding of patient and professional

Figure 5. Schematic representation of ALS recommendations for use of advanced airways during CPR. *Frequent experience or frequent retraining is recommended for health care professionals who perform endotracheal intubation. ALS indicates advanced life support; CPR, cardiopulmonary resuscitation; and EMS, emergency medical services.

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