Impact of 2025 CPR Guidelines on Emergency Care and Resuscitation Education

In a significant move toward improving outcomes for infants and children experiencing cardiac emergencies, the American Academy of Pediatrics (AAP) and the American Heart Association (AHA) have jointly released the 2025 Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC).

This comprehensive update, published simultaneously in Pediatrics and Circulation, marks the most substantial revision since 2020 and reflects the latest science-backed strategies for pediatric and neonatal life support across a range of clinical settings. Each year in the United States, over 7,000 children experience out-of-hospital cardiac arrest, while another 20,000 suffer such events within healthcare facilities.

The updated guidelines are rooted in the understanding that "children are not little adults"—a principle that guided the expert-led restructuring of both Pediatric Basic and Advanced Life Support protocols, as well as Neonatal Resuscitation procedures. Importantly, writing responsibilities for each chapter were evenly split between members of both organizations, ensuring an interdisciplinary and balanced approach.

At the heart of the pediatric update is a more unified chain of survival that now applies to both adult and pediatric in- and out-of-hospital cardiac arrest. This integrated model emphasizes prevention and preparedness before cardiac arrest occurs, followed by early recognition, timely EMS activation, and immediate initiation of high-quality CPR—with compressions as the first step.

One notable refinement addresses foreign body airway obstruction (FBAO), a common cause of pediatric emergencies. For infants with severe FBAO, the new guidelines recommend alternating five back blows with five chest thrusts, explicitly discouraging abdominal thrusts due to their potential harm. In contrast, for children beyond infancy, a combination of back blows and abdominal thrusts is now endorsed—superseding prior recommendations that relied solely on abdominal thrusts.

Changes also extend to chest compression techniques in infants. The widely taught two-finger method has been phased out, replaced by more effective alternatives: the one-hand method, two-thumbs–encircling technique, or compressions using the heel of one hand if full encirclement isn’t feasible. These changes reflect mounting evidence on optimal depth and efficacy of compressions in the smallest patients.

For neonates—those undergoing the delicate transition from intrauterine to extrauterine life—the revisions emphasize system-level preparedness as much as technical skill. A new newborn chain of care begins with prenatal care and continues through delivery, immediate postnatal management, and long-term follow-up. It calls on institutions to ensure that a trained clinician is present for every delivery, equipped not only with the necessary tools but also with the current knowledge and team-based coordination to provide effective resuscitation.

The updated neonatal guidelines now support delaying cord clamping for at least 60 seconds, expanding on the previous 30-second recommendation, and reinforce the benefits of skin-to-skin contact post-delivery when clinically appropriate.

Other refinements include adjusted targets for ventilation rates—now expanded to a range of 30–60 inflations per minute for neonates—as well as enhanced guidance on pulse oximeter placement, chest compression techniques, and corrective ventilation steps, reflecting the latest data from clinical trials and observational studies.

These updates are not just academic; they’re designed for implementation. The guidelines are accompanied by updated training materials in multiple languages and are already accessible online, ensuring global dissemination and integration into clinical practice. Two major educational hubs have been refreshed in tandem: the AHA's Pediatric Advanced Life Support resources and the AAP’s Neonatal Resuscitation Program, now in its 9th edition.

Volunteer writing group chairs—drawn from both the AAP and AHA—joined international colleagues in Rotterdam, Netherlands, to debut the guidelines during the 2025 International Liaison Committee on Resuscitation (ILCOR) meeting, underscoring the global relevance of these standards.

Ultimately, the revised recommendations reflect more than a list of procedural updates—they affirm a continued commitment to precision, preparedness, and patient-centered care in one of the most vulnerable populations in medicine. And in doing so, they aim to turn more pediatric resuscitations into survivals—and more survivals into recoveries.