Developed by the American Heart Association, these Guidelines represent the first comprehensive update of education recommendations since 2020. Incorporating the results of structured evidence reviews from the International Liaison Committee on Resuscitation, these are guidelines for the design and delivery of resuscitation training for health care professionals and lay rescuers. This update emphasizes the continuous evolution of evidence evaluation and the necessity of adapting educational strategies to local needs and diverse community demographics. Existing guidelines remain relevant unless specifically updated in this publication. Key topics that are new, are substantially revised, or have significant new literature include the use of cardiopulmonary resuscitation feedback devices in training, rapid-cycle deliberate practice, teamwork and leadership training, manikin fidelity, gamified learning, virtual and augmented reality, use of cognitive aids, stepwise training, blended learning, scripted debriefing, instructor training, alternative objects for lay rescuer chest compression training, and special considerations for training in the management of opioid overdose. How certain personal considerations may influence the overall impact of education are also reviewed, including disparities accordingly related to gender, race, socioeconomic status, and language; the impact of training for school children; and factors that act as barriers or facilitators to lay rescuer willingness to perform cardiopulmonary resuscitation. We conclude with a summary of current knowledge gaps in resuscitation education science and a discussion of future directions for optimizing the impact of resuscitation training programs.

Cardiac arrest is common and deadly, affecting up to 700 000 people in the United States annually. Advanced cardiac life support measures are commonly employed to improve outcomes. This 2025 guideline on adult post-cardiac arrest care from the American Heart Association summarizes the most recent published evidence for and recommendations on several important areas of post-cardiac arrest management. Based on structured evidence reviews, guidelines are provided for initial blood pressure, oxygen, ventilation, and glucose goals. Evidence evaluating the routine use of antibiotics after return of spontaneous circulation is reviewed. The update also reviews diagnostic testing modalities, temperature control goals and duration, and the use of percutaneous coronary intervention and mechanical circulatory support in the patient resuscitated from cardiac arrest. New data regarding the detection and management of seizures have been incorporated, along with updates regarding the timing and modalities used in neuroprognostication. These guidelines now differentiate prognostication for favorable versus unfavorable outcome. New sections on the utility of advanced neuromonitoring, along with definitions and treatment options for myoclonus, are included to guide the clinician. Expanded recommendations regarding how to optimize survivorship for patients, caregivers, and rescuers are reviewed. Finally, the potential role of organ donation in the patient resuscitated from cardiac arrest is reviewed.

This executive summary provides an overview of the 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, which is organized around the Utstein Formula for Survival and provides updated recommendations aimed at improving survival rates and neurological outcomes following cardiac arrest. This executive summary outlines key changes, emphasizing the importance of high-quality chest compressions, early defibrillation, and the integration of advanced resuscitation techniques. These Guidelines also highlight critical post-cardiac arrest care strategies, including targeted temperature management and hemodynamic stabilization. Additionally, they stress the need for population-specific resuscitation approaches, particularly for pediatric patients, pregnant individuals, and individuals with cardiac arrest due to special circumstances. A strong focus is placed on continuous training and education for both medical professionals and lay rescuers to enhance the implementation and effectiveness of these lifesaving interventions. The 2025 Guidelines also highlight the importance of an integrated system of people, protocols, policies, and resources to achieve quality improvement in cardiac arrest care. An overview of ethical considerations relevant to emergency cardiovascular care, resuscitation, and approaches to decision-making surrounding cardiac arrest is also included. By following these updated recommendations, the American Heart Association seeks to optimize resuscitation efforts and improve patient outcomes in cardiac emergencies.

The 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care is based on the extensive evidence evaluation performed in conjunction with the International Liaison Committee on Resuscitation. The Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Resuscitation, Resuscitation Education Science, Special Circumstances, Post-Cardiac Arrest Care, Ethics, and Systems of Care Writing Groups drafted, reviewed, and approved recommendations, assigning to each recommendation a Class of Recommendation (ie, strength) and Level of Evidence (ie, quality). The 2025 Guidelines are organized in knowledge chunks that are grouped into discrete modules of information on specific topics or management issues. Each chapter of the 2025 Guidelines underwent blinded peer review by subject matter experts and was also reviewed and approved for publication by the American Heart Association Science Advisory and Coordinating Committee and the American Heart Association Executive Committee. Chapters with pediatric content (Neonatal Resuscitation, Pediatric Basic and Advanced Life Support) were also co-led by the American Academy of Pediatrics, and thereby the content was reviewed and approved by the American Academy of Pediatrics Board of Directors. The American Heart Association has rigorous conflict of interest policies and procedures to minimize the risk of bias or improper influence during development of the guidelines. Anyone involved in any part of the guideline development process disclosed all commercial relationships and other potential conflicts of interest.

Codeveloped by the American Heart Association and the American Academy of Pediatrics, this publication presents the 2025 guidelines for basic life support during cardiopulmonary resuscitation and emergency cardiovascular care of the pediatric patient, excluding the newborn infant, and represents the first comprehensive update of treatment recommendations since 2020. Incorporating the results of structured evidence reviews from the International Liaison Committee on Resuscitation, these guidelines are for lay rescuers and health care professionals with recommendations designed to improve survival from sudden cardiac arrest and acute life-threatening cardiopulmonary problems. Existing guidelines remain relevant unless specifically updated in this publication. Topics reviewed include the initiation of cardiopulmonary resuscitation; pulse check; components of high-quality cardiopulmonary resuscitation; chest compression technique; support surfaces for cardiopulmonary resuscitation; opening the airway; coordination of shock and cardiopulmonary resuscitation; types of defibrillators or automated external defibrillators; defibrillator paddle or pad size, type, position; treatment of inadequate breathing with a pulse; and foreign-body airway obstruction. Key topics that are new, are substantially revised, or have significant new literature include the elimination of 2-finger chest compressions in infants due to ineffectiveness of achieving proper depth with a recommendation of 1-hand or 2 thumb-encircling hands technique; the immediate application and use of an automated external defibrillator with a pediatric attenuator if available for cardiac arrest; and in infants with severe foreign-body airway obstruction repeated cycles of 5 back blows alternating with 5 chest thrusts (no abdominal thrusts), and in children with severe foreign-body airway obstruction repeated cycles of 5 back blows alternating with 5 abdominal thrusts.

In this chapter, the American Heart Association provides guidance on ethical considerations relevant to cardiopulmonary resuscitation and emergency cardiovascular care. An overview is provided of ethical frameworks that provide a structure through which difficult decisions can be analyzed. These include principlism, currently the predominant medical ethical framework, which considers moral principles of beneficence, nonmaleficence, respect for autonomy, and justice. Additional consideration is given to the value of dignity, and other ethical frameworks such as narrative ethics, crisis standards of care, utilitarianism, virtue ethics, and deontology. The importance of equity and the imperative for health care professionals and their organizations to actively address structural inequities, social determinants of health and resulting disparities related to Emergency Cardiovascular Care is highlighted. Processes for decision-making are discussed, including guidance on advance directives and shared decision-making. Decisions to initiate or withhold and subsequently to continue or terminate resuscitation are reviewed at length. In addition to considering this decision in adults and geriatric patients, specific attention is given to decision-making in children, newborn infants, and pregnant patients. The impact of prognostic uncertainty on these decisions is discussed, as well as the evaluation of potentially ineffective therapies and cultural and religious considerations. Other ethical topics are addressed briefly, including processes for research and knowledge generation; the impact of resuscitation on health care professionals, survivors, laypersons, families, and caregivers; family presence during resuscitation; crisis standards of care; advanced therapies, including extracorporeal support; and organ and tissue donation.

https://www.ahajournals.org/journal/circ In these guidelines, the American Heart Association provides updated guidance for resuscitation of adults and children in cardiac arrest or with a life-threatening condition due to special circumstances, including anaphylaxis, asthma, cardiac arrest in the cardiac intervention suite, cardiac arrest following cardiac surgery, drowning, electrocution, gas embolism, high-consequence respiratory pathogens, hyperkalemia, hyperthermia, hypothermia, left ventricular assist device failure, pregnancy, pulmonary embolism, and poisoning due to benzodiazepines, β-blockers, calcium channel blockers, cocaine, cyanide, digoxin and related cardiac glycosides, local anesthetic systemic toxicity, methemoglobinemia, opioids, organophosphates and carbamates, sodium channel blockers, sympathomimetics, and volatile hydrocarbons. Recommendations are also provided for alternatives to cardiopulmonary resuscitation and the use of extracorporeal membrane oxygenation for poisoned patients. Adults and children with these conditions require modification of basic life support and advanced life support. These guidelines are based on systematic evidence reviews and provide separate graded recommendations for adults and children.

The American Heart Association's 2025 Adult Basic Life Support Guidelines build upon prior versions with updated recommendations for assessment and management of persons with cardiac arrest, as well as respiratory arrest and foreign-body airway obstruction. The chapter addresses the important elements of adult basic life support including initial recognition of cardiac arrest, activation of emergency response, provision of high-quality cardiopulmonary resuscitation, and use of an automated external defibrillator. In addition, there are updated recommendations on the treatment of foreign-body airway obstruction. The use of opioid antagonists (eg, naloxone) during respiratory or cardiac arrest is incorporated into the adult basic life support algorithms, with more detailed information provided in "Part 10: Adult and Pediatric Special Circumstances of Resuscitation."

The guidelines in this document from the American Heart Association and the American Academy of Pediatrics focus upon optimal care of the newborn infant, including those who are proceeding to a normal transition from the fluid-filled uterine environment to birth. Newborn infants who are proceeding to normal transition can benefit from deferred cord clamping for at least 60 seconds in most instances, skin-to-skin with their parent soon after birth, and appropriate assistance with thermoregulation. Some newborn infants require assistance during transition, with interventions ranging from warming and tactile stimulation to advanced airway management, assisted ventilation, oxygen therapy, intravascular access, epinephrine, and volume expansion. In this context, individuals, teams, and health care settings that care for newborn infants should be prepared and have access to appropriate training and resources for neonatal resuscitation. The newborn chain of care provides guidance on considerations that may lead to optimal outcomes for newborn infants starting from prenatal care to recovery and follow-up.

Improving survival and quality of life after cardiac arrest requires integrated systems of people, protocols, policies, and resources along with ongoing data acquisition and review. Such systems of care, which are highly influenced by the environment in which they operate, produce efficiency and effectiveness in responding to cardiac arrest. Part 4 of the 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care focuses on systems of care, emphasizing elements that are relevant to a broad range of resuscitation situations. The chapter follows the Chain of Survival, beginning with prevention and preparedness to resuscitate, proceeding to early identification of cardiac arrest, and moving to effective resuscitation through to post-cardiac arrest care, survivorship, and recovery. This Part provides cardiac arrest systems of care guidelines on how to train specific personnel, protocols that have been demonstrated to be effective, as well as the incorporation of nonhuman resources to optimize cardiac arrest care with ongoing debriefing and quality improvement strategies. Specific to out-of-hospital cardiac arrest, included are recommendations about emergency medical services team composition and transport recommendations, community initiatives to promote lay rescuer response, public access defibrillation and naloxone, and an enhanced role for emergency telecommunicators. Germane to in-hospital cardiac arrest are recommendations about cardiac arrest prevention and code team composition. Specific recommendations about extracorporeal membrane oxygenation cardiopulmonary resuscitation, transport to specialized cardiac arrest centers, organ donation, survivorship systems, and performance measurement across the continuum of resuscitation situations are also included.

The American Heart Association and the American Academy of Pediatrics provide these pediatric advanced life support guidelines focusing on resuscitation during cardiopulmonary resuscitation and emergency cardiovascular care. These guidelines are intended to be a resource for health care professionals to identify and treat infants and children up to 18 years of age (excluding newborn infants) in the prearrest, intra-arrest, and post-cardiac arrest states as well as select other emergency care situations. These guidelines apply to infants and children in various settings, including the community, prehospital environments, and hospital environments. Topics presented include ventilation and advanced airway strategies during cardiopulmonary resuscitation; drug administration and weight-based dosing of medications during cardiopulmonary resuscitation; energy doses for defibrillation; measuring cardiopulmonary resuscitation physiology and quality; extracorporeal cardiopulmonary resuscitation; post-cardiac arrest care related to management of core temperature, blood pressure, oxygenation/ventilation, neurologic monitoring, and seizures; neurological prognostication post-cardiac arrest; post-cardiac arrest survivorship; family presence during cardiopulmonary resuscitation; evaluation of sudden unexplained cardiac arrest; management of shock types; airway/intubation management; arrhythmia management including bradycardia and tachycardia (narrow and wide complex); treatment of myocarditis/cardiomyopathies; resuscitation of patients with single ventricle congenital heart disease; management of pulmonary hypertension; and management of traumatic cardiac arrest. Lastly, important gaps in resuscitation science knowledge are identified, aiming to encourage further scientific inquiry and provide additional evidence for future pediatric advanced life support guidelines.

In these 2025 Advanced Life Support Guidelines, the American Heart Association provides comprehensive recommendations for the resuscitation and management of adults experiencing cardiac arrest, respiratory arrest, and life-threatening cardiovascular emergencies. Based on structured evidence reviews and the latest clinical research, these guidelines offer evidence-based strategies to optimize survival and patient outcomes. The 2025 guidelines provide guidance for the treatment of cardiac arrest, including ventricular fibrillation, pulseless ventricular tachycardia, asystole, and pulseless electrical activity, as well as peri-arrest conditions such as atrial fibrillation and flutter with rapid ventricular response. Recommendations are made for defibrillation, electrical cardioversion, advanced airway management, drug therapies, and intravenous access. Additionally, guidelines are provided for the use of double sequential defibrillation, head-up cardiopulmonary resuscitation, and point-of-care ultrasound in the advanced life support setting. Termination of resuscitation rules have been refined to guide decision-making based on the emergency medical services professional's scope of practice. Finally, these guidelines also underscore the importance of identifying causative versus secondary arrhythmias to inform the appropriate timing of therapeutic strategies.

The International Liaison Committee on Resuscitation conducts continuous review of new, peer-reviewed published cardiopulmonary resuscitation science, and publishes more comprehensive reviews every 5 years. The Basic Life Support Task Force chapter of the 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations addressed all published resuscitation evidence reviewed by the Basic Life Support Task Force science experts since 2020. Topics addressed by systematic reviews in the last year include chest compression-only cardiopulmonary resuscitation, starting cardiopulmonary resuscitation with compressions or airway and breathing, chest compression and ventilation ratios, durations of cardiopulmonary resuscitation cycles, hand positioning during compressions, head-up cardiopulmonary resuscitation, ventilation feedback devices, and pad and paddle size and placement. Members from the Basic Life Support Task Force have assessed, discussed, and debated the quality of the evidence, based on Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task force are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task force lists priority knowledge gaps for further research.

The International Liaison Committee on Resuscitation conducts continuous reviews of new, peer-reviewed published cardiopulmonary resuscitation science and publishes more comprehensive reviews every 5 years. The Advanced Life Support Task Force chapter of the 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations addresses all resuscitation evidence reviewed by the task force in the past year, as well as brief summaries of topics reviewed since 2020, to provide a comprehensive update. Newly updated topics this year include defibrillator pad placement, mechanical cardiopulmonary resuscitation devices, mechanical circulatory support after return of spontaneous circulation, intravenous versus intraosseous access, vasopressor choice and hemodynamic targets after return of spontaneous circulation, treatment of cardiac arrest related to hyperkalemia and opioid toxicity, and neuroprotective drugs, among others. Task Force members have assessed, discussed, and debated the certainty of the evidence based on Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task force are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task force lists priority knowledge gaps for further research.

Risk assessment plays a central role in the primary prevention of cardiovascular disease. The 2017 High Blood Pressure Clinical Practice Guideline incorporated quantitative risk assessment for the first time to guide the initiation of antihypertensive drug therapy and recommended calculation of 10-year risk of atherosclerotic cardiovascular disease with the Pooled Cohort Equations. Although the 2025 High Blood Pressure Guideline reaffirmed this overarching paradigm for risk-based initiation of antihypertensive drug therapy, it updated the recommended risk model to the Predicting Risk of Cardiovascular Disease Events equations, which estimate 10-year risk of total cardiovascular disease (including atherosclerotic cardiovascular disease and heart failure), and defined a new risk threshold for initiation of antihypertensive therapy in patients with stage 1 hypertension. This American Heart Association/American College of Cardiology scientific statement summarizes the rationale to recommend the use of the Predicting Risk of Cardiovascular Disease Events equations, the evidence base for the new threshold of 10-year risk of cardiovascular disease of ≥7.5%, and the population-level implications of these revised recommendations. This scientific statement also offers practical advice for implementing risk assessment as the first step in the comprehensive approach to hypertension management with shared decision-making between patients and clinicians. Remaining gaps in awareness and treatment of hypertension underscore the need for innovative strategies to improve implementation of and adherence to risk-based guideline recommendations, including automation of risk assessment in electronic health records, decision-support aids, and refinement of risk assessment, to equitably improve the initiation of antihypertensive drug therapy, blood pressure control, and outcomes.

The "2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults" retires and replaces the "2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults."

Chronic coronary disease (CCD) is the leading cause of death in the United States. There is an ongoing imperative to disseminate evidence-based and patient-centered care recommendations that further align the management of patients with CCD to updated evidence-based guidelines. The writing committee developed a comprehensive CCD measure set comprising 10 performance measures and 3 quality measures, the focus of which is to include practical steps to specifically advance care in the CCD population. The measure set begins with an assessment of tobacco use and evidence-based cessation interventions. Also included are topics such as antiplatelet therapy, lipid assessment and low-density lipoprotein cholesterol goals, and guideline-directed management and therapy for hypertension and reduced left ventricular dysfunction in patients with CCD. The measure set concludes with an emphasis on the importance of cardiac rehabilitation referral and patient education, including symptom management and lifestyle modification.

The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" incorporates new evidence since the "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction" and the corresponding "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes" and the "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction." The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" and the "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization" retire and replace, respectively, the "2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease."

Peripheral artery disease (PAD) is an atherosclerotic condition that affects a growing number of individuals worldwide, with estimates exceeding 220 million. One of the central hallmarks of PAD is lower extremity pain, which may present as intermittent claudication and atypical leg pain, and, in more severe cases, ischemic rest pain, neuropathic pain, or phantom limb pain in those who underwent amputation. Although the majority of individuals with PAD may experience pain that is chronic in nature, the pathogenesis and phenomenology of pain may differ. Nociceptive, inflammatory, and neuropathic mechanisms all play a role in the generation of pain. Pain in PAD results in severe disability and can copresent with distress, sickness behaviors such as avoidance and further deconditioning, and concomitant depression, anxiety, and addiction secondary to opioid use. These factors potentially lead to chronic pain interacting with a multitude of domains of functioning, including physical, emotional, and behavioral. Whereas pain is a normal adaptive response, self-defeating behaviors and cognitions contribute to the persistence or worsening of the chronic pain experience, disability, and distress. Much remains unknown about the phenomenology of pain in PAD and its clinical subgroups and how it affects outcomes. Borrowing from other chronic pain syndromes, multimodal pain management strategies that emphasize a biopsychosocial model have generated a solid evidence base for the use of cognitive behavioral approaches to manage pain. Multimodal pain management in PAD is not the norm, but theoretical pathways and road maps for further research, assessment, and clinical implementation are presented in this scientific statement.

Transradial arterial access has transformed the field of coronary interventions, where it has several advantages over femoral access, such as reduced bleeding and access site complications, improved patient comfort, shorter time to ambulation after the procedure, reduced length of hospital stay, and potentially reduced mortality rates. Because of these benefits, as well as the concurrent expanding indications for various endovascular therapies, there is growing interest in adopting radial access for peripheral vascular interventions. However, radial access can present challenges, and specialized equipment for peripheral interventions through this route are under development. Nevertheless, a growing number of studies, largely comprising single-center and registry data, have broadly suggested that transradial arterial access is likely to be safe and associated with reduced bleeding and local access site complications for most peripheral interventions compared with transfemoral access. Large, prospective randomized trials are lacking, and the question of any effect on mortality rates has not been addressed. Whereas the field of transradial arterial access for peripheral vascular interventions is in development, it is clear that this approach, at least with available equipment, will not be suitable for all patients, and careful case selection is paramount. Furthermore, the remaining knowledge gaps must be addressed, and robust outcome data obtained, to allow full understanding of the factors that determine optimal patient, lesion, and equipment selection. Nevertheless, the use of transradial arterial access for peripheral vascular interventions holds great promise, particularly if the necessary technologic advances are rapid and favorable clinical trial data continue to emerge.