In this lesson, we're going to summarize the latest information from the 2025 American Heart Association Emergency Cardiovascular Care guidelines as they relate to lay rescuer CPR.
The goal of these guideline changes is simple: improve survival by improving early recognition, high-quality CPR, and early defibrillation. For out-of-hospital cardiac arrest, survival rates depend heavily on what happens in the first few minutes. The 2025 ECC updates continue to emphasize that early action by lay rescuers is what saves lives. Many of the changes you'll see focus on improving CPR quality, reducing delays, and removing the barriers that prevent people from stepping in to help.
Initiation of Resuscitation for Adults
The ECC continues to reinforce the importance of CPR with breaths in adult cardiac arrest. For trained rescuers who are able to provide ventilations safely, compressions and breaths should be delivered together. If a rescuer is not trained or does not have the ability to give breaths, hands-only CPR can be used, as providing compressions alone is far 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 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.
When possible, chest compressions should be performed with the patient's torso positioned approximately at the level of the rescuer's knees to allow better body mechanics and improved compression depth. 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 is this: don't delay chest compressions. If high-quality CPR can be delivered safely where the patient is found, begin it immediately. This was re-emphasized to include the giving of breaths for high-quality CPR.
AED Use and Patient Dignity
AEDs have become more widely available and continue to prove their effectiveness everyday. However, statistically, women have a much lower rate of AED use than men. So while the 2025 guidelines address the importance of early AED use, the emphasis was 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 perfect. What this means is rather than the need to remove all clothing from the chest, it's reasonable to just adjust the clothing and apply AED pads under clothing, directly to the skin.>
Pro Tip #2: If needed, rather than removing all clothing from the chest, simply adjust clothing, including bras, to have appropriate pad placement on the skin. This has been shown to be safe and effective
Foreign Body Airway Obstruction
In 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. Ironically, the back blows are something that was taught years ago. However, this sequence reflects evidence suggesting that back blows may be more effective and cause fewer injuries than abdominal thrusts alone. Remember, for patients in late-stage pregnancy or the rescuer cannot reach their arms around the victim’s waist, chest thrusts should be used instead.
Pro Tip #3: 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
When an adult or child is rescued from the water and unconscious and not breathing, CPR with breaths should be started before AED application. Further, if you are in a position that full CPR cannot be started, just performing breaths can still be helpful. This is due to drowning-related cardiac arrest being caused by low oxygen levels. So the idea here is that If we apply the AED immediately without providing ventilations, we still have not addressed the cause of the cardiac arrest. If we delay the application of the AED for a short amount of time, we can provide the needed oxygen back into the victim to stabilize the underlying issue in the first place. Then, when applying and using an AED, resetting the heart should be more effective.
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 is showing 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 #4: 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 #5: 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. Though our main focus is getting the patient safely to the ground, keeping them warm and monitoring them for airway concerns, such as vomiting, 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. This unified approach emphasizes early recognition, early CPR, early defibrillation, advanced care, and 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 a lay rescuer is unable or unwilling to provide breaths to an infant or child in cardiac arrest, compression-only CPR is still reasonable. Large observational studies show that compression-only CPR is far better than providing no CPR at all, and significantly improves survival outcomes compared to no bystander intervention.
Lastly, further evidence shows that using 2 fingers for infant chest compressions or chest thrusts are minimally effective. Therefore, the ECC has eliminated the use of two-fingers and recommends using a two-thumb hand encircling technique or the heel of one hand. You will see further demonstrations of both techniques throughout the course.
Closing Thoughts
The 2025 ECC CPR guideline updates continue to reinforce a simple but powerful message: early recognition, early CPR, and early defibrillation save 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 new science emerges, 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 a measurable difference.