p.3 抽出テキスト

October 21, 2025 Circulation. 2025;152(suppl 2):S538–S577. DOI: 10.1161/CIR.0000000000001376 S540

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

ing, and education, along with AHA staff and science editors. Members disclosed potential conflicts of interest before and every 90 days during appointment, aligning with the AHA’s policies to ensure unbiased guideline development. Disclosure information for writing group members is in Appendix 1.

METHODOLOGY AND EVIDENCE REVIEW These guidelines are based on evidence evaluation conducted by the ALS Writing Group.5 Evidence review processes included systematic reviews, scoping reviews, and annual focused evidence updates, composed by ILCOR, affiliates, and individual Writing Group Members, to support robust and transparent guideline development. Each of these resulted in a description of the literature and exhaustive discussion among Writing Group members that facilitated guideline development. Details of evidence evaluation can be found in Part 2: Evidence Evaluation and Guidelines Development.6

Class of Recommendation and Level of Evidence Each recommendation in the 2025 ALS guidelines is assigned a Class of Recommendation (COR) to reflect its strength and a Level of Evidence (LOE). The LOE is based on the quality, quantity, relevance, and consistency of the available evidence. In determining the COR, the writing group considered the LOE and other factors, including systems issues, economic factors, and ethical factors such as equity, acceptability, and feasibility. Criteria for each COR and LOE are described in Table 1. For further explanation, refer to Part 2: Evidence Evaluation and Guidelines Development.6

Guideline Structure The 2025 ALS guidelines are organized into knowledge chunks, which are modular, and organized into sections addressing specific clinical topics.7 Each module includes a table of recommendations, a brief synopsis, supporting rationale, and references. Flow diagrams and tables clarify the cascade of clinical decision-making, and hyperlinked references provide access to studies and resources.

Document Review and Approval Each section of the 2025 ALS guidelines underwent rigorous review by subject matter experts and independent peer reviewers. All guidelines were reviewed and approved for publication by the AHA Science Advisory and Coordinating Committee and the AHA Executive Committee. Disclosure information for peer reviewers is listed in Appendix 2.

REFERENCES

1 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 educa- tion 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 2.	 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: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2):S353–S384. doi: 10.1161/CIR.0000000000001378 3.	 Hirsch KG, Amorim E, Coppler PJ, Drennan IR, Elliott A, Gordon AJ, 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 4.	 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 5.	 Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, et al; 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 6.	 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 7.	 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

DEFIBRILLATION

Recommendations for Defibrillation Indication, Type, and Energy COR LOE Recommendations

1 B-NR 1.  In adult patients with cardiac arrest, defibrillators (using biphasic or monophasic waveforms) are recommended to treat tachyarrhythmias requiring a shock such as ventricular fibrillation or pulseless ventricular tachycardia.

2a B-R 2.  Biphasic waveform defibrillation is preferred over monophasic waveform defibrillation for treatment of tachyarrhythmias in adult patients with cardiac arrest. 2a B-NR 3.  A single shock strategy is preferred to stacked shocks for defibrillation in adult patients with cardiac arrest.

2a C-LD 4.  It is reasonable that selection of fixed versus escalating energy levels for subsequent shocks for adults in cardiac arrest with presumed shockrefractory arrhythmias be based on the specific manufacturer’s instructions for that waveform.

2b B-R 5.  If using a defibrillator capable of escalating energies, higher energy for second and subsequent shocks may be considered if the initial shock fails to restore a perfusing rhythm in adult patients with cardiac arrest.

2b C-LD 6.  In the absence of conclusive evidence that one biphasic waveform is superior to another in termination of ventricular fibrillation, it may be reasonable to use the manufacturer’s recommended energy dose for the first shock in adult patients with cardiac arrest. If this is not known, defibrillation at the maximal dose may be considered.

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