AHA's guidelines update: CPR, choking, and opioid protocols simplified

The American Heart Association’s 2025 update to its “Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC)” is out, and it’s the first full revision since 2020.^[]

“As the science continues to evolve, it’s important that we continue to review new research specific to the scientific questions considered of greatest clinical significance that affect how we deliver life-saving care," said Ashish Panchal, MD, PhD, volunteer chair of the AHA’s Emergency Cardiovascular Care Science Committee, in the AHA's news release.

What’s changed

1. Choking response refined:

• For conscious children and adults: Alternate between five back blows and five abdominal thrusts until the object is expelled or the person becomes unresponsive.

• For infants: Alternate between five back blows and five chest thrusts using the heel of one hand until the object expelled or the person becomes unresponsive. Do not use abdominal thrusts for infants due to injury risk.

• Prior guidance was less specific, especially for adults, on this alternating-pattern approach.

2. Opioid-overdose response added:

• Recognizes that suspected opioid OD (ie, slow, shallow, or no breathing; choking or gurgling sounds; small pupils; and blue or grey skin) can lead rapidly to cardiac arrest.

• For the first time, the guidelines include public access guidance on the use of naloxone in suspected opioid overdoses.

3. One unified chain of survival for cardiac emergencies:

• Previously, there were separate chains of survival for adults and children and for in-hospital and out-of-hospital cardiac arrest. The 2025 guidelines drop that separation and revert to a single chain of survival applicable to all ages and locations.

• The steps: recognition and emergency activation → high-quality CPR → defibrillation → advanced resuscitation → post-cardiac arrest care → recovery and survivorship.

• The rationale: simplifying the messaging, aligning with new scientific evidence, and facilitating lay-rescuer intervention.

4. Training and societal engagement emphasized:

• Only around 41% of adults suffering out-of-hospital cardiac arrest receive bystander CPR before EMS arrives.

• To improve lay-rescuer intervention, the guidelines call for media awareness campaigns, instructor-led and community training, and teaching children aged 12 or older to use CPR and defibrillation.

5. Neonatal/infant specifics:

• Umbilical cord clamping in most term and preterm infants not needing immediate resuscitation should be delayed for at least 60 seconds—up from the previously recommended 30 seconds.

Why this matters

For emergency medicine, hospitalists, pediatricians, critical care physicians, and others, the guidelines signal that resuscitation science is increasingly inclusive of nontraditional arrest triggers and early community response.

The unified chain of survival simplifies messaging across patient populations, which, in turn, can help in educating trainees and interdisciplinary teams (eg, ER, ICU, ward, and pediatrics).

Choking remains a major cause of respiratory emergencies. Clear, simple, and actionable steps will improve consistency of teaching to families and staff.

Actionable takeaways for your practice

In your next departmental or unit meeting, consider committing to this three-point action plan:

1. Update your in-house resuscitation algorithm, posters, and training to reflect the new guidelines.

2. Engage your community-facing team (eg, ED, TICU outreach, trauma service, and pediatrics) to review whether your institution has accessible naloxone training and materials and link with EMS and public health bodies on opioid‐related arrest response. Consider a brief staff “scenario drill” including opioid-related collapse and use of naloxone and CPR.

3. Revisit your education and training schedule to ensure that nonclinical staff are exposed to the unified chain of survival messaging.

By doing so, you’ll align your team with the latest evidence, reinforce a culture of immediate response, and help translate guideline updates into meaningful practice change.