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Circulation. 2025;152(suppl 2):S538–S577. DOI: 10.1161/CIR.0000000000001376 October 21, 2025 S561

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

characteristics that are not easily defined in a global recommendation. There is a need for further research, specifically on the interface between patient factors and the experience, training, tools and skills of the professional. 7.	 IHCA recommendations on advanced airway management have been extrapolated from OHCA. There is currently no high-certainty evidence that suggests benefit for any specific airway management strategy for IHCA. There is a need for further research to identify the IHCA patient and professional characteristics in airway management that impact clinical outcomes. 8.	A 2024 ILCOR CoSTR summary15 demonstrated no new data to change the recommendation regarding the use of BMV or advanced airway strategies. One large RCT of OHCA comparing BMV to ETI in a physician-based EMS system showed no significant benefit for either technique for 28-day survival or survival with favorable neurological outcome.16 The success rate of ETI in this study was 98%, suggesting a relatively optimal setting for the potential success of ETI as an intervention. Further research is required to determine equivalence or superiority between the two approaches for acute airway management, as well as any potential benefit of a stepwise approach (eg, BVM followed by advanced airway placement). 9.	A 2017 systematic review identified 1 observa-

tional human study and 10 animal studies comparing different ventilation rates after advanced airway placement.17 While no clear benefit from a rate of 10 breaths per minute was identified, no other rate was found to be superior. A 2017 ILCOR systematic review did not identify any new evidence to alter this recommendation, which was reiterated in the “2017 AHA Focused Update on Adult BLS and CPR Quality: An Update to the AHA Guidelines for CPR and Emergency Cardiovascular Care.”18,19

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