In this lesson, we're going to summarize and highlight the latest information from the 2025 American Heart Association Emergency Cardiovascular Care guidelines as they relate to Healthcare Provider CPR.
Just like in previous updates, the goal of these guideline changes is simple: to improve the survival of our patients by improving early recognition, high-quality CPR, and early defibrillation. Despite decades of public education, bystander CPR and AED use uremain inconsistent, and outcomes for out-of-hospital cardiac arrest still depend heavily on what happens in the first few minutes. The 2025 ECC updates continue to emphasize that early action by healthcare providers is what truly saves lives. Many of the changes you'll see focus on improving CPR quality, reducing delays, and removing barriers that prevent people from stepping in to help.
Initiation of Resuscitation for Adults
The ECC continues to reinforce the importance of performing CPR with breaths. If a rescuer is not trained or does not have the ability to safely give breaths, hands-only CPR can be used, as providing compressions alone is still better than doing nothing at all.
Whenever feasible, and without delaying chest compressions, CPR should be performed where the person is found, as long as high-quality CPR can be delivered safely and effectively. It's preferred that the patient be in the supine position — meaning on their back — on a firm surface, since firm surfaces improve compression depth and effectiveness. Delays caused by unnecessary movement of the patient are associated with worse outcomes.
Chest compressions should be performed with the patient's torso positioned approximately at the level of the rescuer's knees. This positioning improves rescuer body mechanics and reduces fatigue. Rescuers may also consider placing their dominant hand on the sternum when performing compressions, which may further improve overall CPR quality.
Pro Tip #1:The key takeaway here is don't delay chest compressions. High-quality CPR, including breaths, can significantly increase the chance of survival.
When providing ventilations with a bag-mask device during adult cardiac arrest, it's reasonable for one rescuer to use two hands to open the airway and seal the mask, while a second rescuer squeezes the bag to improve ventilation effectiveness
AED Use and Patient Dignity
The 2025 guidelines re-emphasized an important barrier to public access defibrillation, particularly for women. Evidence suggests that the need to expose the chest may contribute to lower rates of AED use in female patients. While proper pad placement is always preferred, current evidence shows that successful defibrillation can still occur even when pad placement is not exactly perfect.
Because of this, it is reasonable to apply AED pads directly to the skin by simply adjusting clothing or undergarments rather than removing them entirely, when appropriate. The priority remains rapid pad placement and early defibrillation, while maintaining patient dignity and reducing hesitation that can delay care.
Mechanical CPR Devices
In adult cardiac arrest, the use of a mechanical CPR device should only be considered in specific settings where delivering high-quality manual compressions may be challenging or dangerous. When mechanical CPR is used, rescuers must strictly limit interruptions in chest compressions during deployment and removal of the device. High-quality manual CPR should never be delayed while preparing or positioning a mechanical device.
Foreign Body Airway Obstruction
For conscious adults and children with severe foreign body airway obstruction, rescuers should perform repeated cycles of 5 back blows followed by 5 abdominal thrusts until the object is expelled or the person becomes unresponsive. This sequence reflects evidence suggesting that back blows may be more effective and cause fewer injuries than abdominal thrusts alone.
In special circumstances — such as late-stage pregnancy or when abdominal thrusts are impractical — chest thrusts should be used instead.
For infants, abdominal thrusts are still not recommended. Instead, back blows and chest thrusts continue to be used.
Pro Tip #2: A key update in 2025 is that chest thrusts for infants should now be performed using the heel of one hand, placed in the center of the chest, rather than the previously recommended two-finger technique. This change is based on evidence showing improved compression depth and effectiveness during severe airway obstruction.
Cardiac Arrest Following Drowning
For adults and children in cardiac arrest following drowning, CPR with breaths should be started before AED application. Drowning-related cardiac arrest is typically hypoxic in nature, meaning oxygen deprivation is the primary issue. Early ventilations are critical, and applying an AED first may delay the initiation of effective CPR with breaths — especially since shockable rhythms are less common in drowning cases.
Eye Injuries with an Embedded Foreign Object
A small but important update: when caring for a person with a foreign object embedded in the eye, rescuers should now cover only the affected eye rather than both eyes. This change is intended to reduce anxiety in the patient by allowing them to maintain vision in the unaffected eye. The previous concept was that if you covered both eyes, then that would reduce the movement of the good and the injured eye. Data shows that with the increased anxiety and potential for further injury caused by the temporary blindness, it would be safe to just bandage the injured eye.
ProTip #3: Our goal is to prevent any further injury to the eyes. Protect the injured eye(s) from any excessive pressure with a shield or cup and seek immediate medical attention.
Managing Shock
When caring for a person showing signs of shock who remains alert, it is reasonable to place or maintain them on their back. If the person is at risk for airway obstruction — such as decreased alertness or active vomiting — or if they cannot be continuously monitored, it is reasonable to place them in the recovery position, on their side. While elevating the feet has been shown occasionally to help the patient, the effects are often short lasting only a few minutes.
Pro Tip #4: In situations where there is no evidence of trauma or injury, such as fainting or dehydration, some studies suggest that raising the feet approximately 6 to 12 inches may still be beneficial. The priority remains placing the patient safely on the ground, keeping them warm, and monitoring for airway compromise or the need for CPR
A Unified Chain of Survival
The 2025 guidelines introduce a single, standardized Chain of Survival that now applies to infants, children, and adults. It excludes neonates, who follow a separate neonatal chain of survival. This unified approach emphasizes early recognition, early CPR, early defibrillation, and advanced care, as well as recovery as a continuous process across all age groups.
CPR in Infants and Children
In infants and children, studies consistently show that CPR with both compressions and breaths provides the best chance of survival. However, if providers are unable to give breaths to an infant or child in cardiac arrest due to safety concerns, compression-only CPR is reasonable. Large observational studies show that compression-only CPR is far better than no CPR at all, and significantly improves survival outcomes compared to no bystander intervention.
A Word About Left Ventricular Assist Devices (LVADs)
An LVAD, or left ventricular assist device, is a mechanical pump that is surgically implanted to help the heart's main pumping chamber — the left ventricle — circulate blood throughout the body. It is used for patients with end-stage heart failure.
In unresponsive adults and children with durable LVADs, chest compressions should be performed when there are signs of impaired perfusion. The presence of an LVAD does not eliminate the need for CPR during cardiac arrest.
Closing Thoughts
The 2025 ECC CPR guideline updates continue to reinforce a simple but powerful message: early recognition, early CPR, and early defibrillation saves lives. These updates are designed to improve CPR quality, reduce delays, and remove the barriers that prevent rescuers from acting — whether that rescuer is a parent, a bystander, or a trained professional.
Guidelines will continue to evolve as science advances, but the mission remains the same: recognize the emergency, take action, and do the best you can. CPR doesn't need to be perfect to save a life. Doing something is always better than doing nothing, and confident, informed rescuers make all the difference.