Updated CPR Guidelines Introduce New Choking Response, Opioid Overdose Protocol and Unified Chain of Survival

The American Heart Association released updated guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, marking the first comprehensive revision since 2020. Published in the Association's flagship journal Circulation, the guidelines introduce substantial changes to choking response protocols, opioid overdose treatment, and emergency care systems that could significantly impact survival rates for various medical emergencies.

New choking guidance represents one of the most notable changes, recommending alternating five back blows followed by five abdominal thrusts for conscious children and adults until the object is expelled or the person becomes unresponsive. This marks a departure from previous guidelines that did not include specific choking guidance for adults and recommended only abdominal thrusts for children. For infants, rescuers should alternate between five back blows and five chest thrusts using the heel of one hand, with abdominal thrusts not recommended due to injury risks.

The guidelines address the growing opioid crisis by providing public access instruction on naloxone use for suspected opioid overdoses. According to the World Health Organization, opioid use affects breathing regulation and causes 80% of all drug overdose deaths worldwide. The new algorithm helps identify overdose signs including slow or no breathing, choking sounds, loss of consciousness, constricted pupils, and blue or grey skin coloring.

Emergency response systems underwent significant restructuring with the consolidation of multiple chains of survival into a single protocol for all forms of cardiac arrest, whether adult or pediatric, in-hospital or out-of-hospital. This unified approach emphasizes the importance of compressions and breaths, particularly for children and infants. The guidelines also recognize that children 12 years old or older can be taught effective CPR and defibrillation based on new scientific evidence.

The updates come at a critical time when approximately 350,000 people in the U.S. experience out-of-hospital cardiac arrests annually, with 90% resulting in death according to Association statistics. Only about 41% of adults experiencing cardiac arrest outside hospitals receive CPR before emergency medical services arrive, despite evidence that early CPR could double or triple survival chances. The guidelines recommend supporting media campaigns, instructor-led training, and community training to improve lay-rescuer response.

Pediatric and neonatal care received particular attention through collaboration with the American Academy of Pediatrics, with guidelines jointly published in Circulation and Pediatrics. For newborns not needing immediate resuscitation, the guidelines extend delayed umbilical cord clamping from 30 to at least 60 seconds, shown to improve blood health and iron levels. The unified pediatric recommendations reflect shared expertise between the organizations.

Ashish Panchal, M.D., Ph.D., volunteer chair of the American Heart Association Emergency Cardiovascular Care Science Committee, emphasized that the guidelines represent gold standard science reflecting rigorous examination of up-to-date evidence. The Association and Academy are releasing updated training materials simultaneously with publication to accelerate adoption of the new recommendations. The guidelines and training materials will be translated into multiple languages to broaden accessibility.

The American Heart Association supports guideline development without commercial support, relying on volunteer experts in resuscitation science. The organization has trained millions annually in CPR, first aid, and advanced cardiovascular care for over five decades and serves as scientific authority for CPR guidelines used in over 90 countries worldwide. Updated materials are available through the Association's resources at https://mycares.net/sitepages/uploads/2025/2024_flipbook/index.html and additional guideline details can be found in the manuscript at https://doi.org/10.1161/cir.0000000000001303.