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October 21, 2025 Circulation. 2025;152(suppl 2):S538–S577. DOI: 10.1161/CIR.0000000000001376 S542 Wigginton et al Advanced Life Support: 2025 AHA Guidelines for CPR and ECC Synopsis Along with CPR, early defibrillation is critical to survival when sudden cardiac arrest is caused by ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT).1,2 Defibrillation is most successful when administered as soon as possible after the onset of VF/pVT. Conversely, when VF/pVT is prolonged, depletion of the heart’s energy reserves can compromise the efficacy of defibrillation unless replenished by a prescribed period of CPR before rhythm analysis. Figure 1 describes the algorithm for performing shocks and other ALS interventions. Minimizing disruptions in CPR surrounding shock administration is a high priority. Currently marketed defibrillators use proprietary shock waveforms that differ in their electrical characteristics. These deliver different peak currents even at the same programmed energy setting, making comparisons of shock efficacy between devices chal- lenging. Technologies have been developed to diagnose the underlying cardiac rhythm during CPR and to derive prognostic information from the ventricular waveform that may guide patient management. These technologies require further validation before routine use. While investigations continue to evaluate the optimal waveform and current, escalating energy may also be effective in termination of VF or pVT. Furthermore, optimized pad placement for defibrillation is an important factor in shock success (see Recommendation-Specific Supportive Text, items 4 and 5, and the section Vector Change and Double Sequential Defibrillation). Recommendation-Specific Supportive Text 1 Emergent electric defibrillation is highly effec- tive at terminating VF/pVT and other hemodynamic destabilizing tachyarrhythmias (please Figure 1. Adult Cardiac Arrest Circular Algorithm. CPR indicates cardiopulmonary resuscitation; ET, endotracheal; IO, intraosseous; IV, intravenous; pVT, pulseless ventricular tachycardia; and VF, ventricular fibrillation. Downloaded from http://ahajournals.org by on October 7, 2026