2025 AHA Guidelines Update

The 2025 American Heart Association guidelines are out, and they’ve sparked plenty of discussion online. A few updates and a few familiar recommendations are drawing strong reactions. We’ll look at what’s new, why some older guidance has resurfaced, and what’s driving the debate.

• The use of naloxone is now included in codes that result from suspected opioid overdoses. However, naloxone administration should not delay or impact the delivery of quality compressions and ventilation.

• Debriefing after codes is also recommended. The debrief doesn’t need to be formal. In EMS, this may be a “back step” debriefing after a call. These debriefings can discuss the code itself and offer an option to discuss any feelings related to it.

What’s controversial?

Some of the issues currently lighting up social media aren’t new guidelines. They are guidelines repeated from prior releases (often with the exact wording), with updates on the science (or lack thereof) supporting the recommendations.

Two areas have received the most comments from the EMS community: mechanical CPR and dual-sequential defibrillation. As mentioned earlier, these exact statements can be found in prior guidelines. The repeat of these in the 2025 guidelines only restates what was presented in the 2020 guidelines (and sometimes earlier).

Mechanical compressions were determined to provide no benefit over manual compressions and are classified as “routine use not recommended” in the new guidelines. Although the AHA included the same recommendation in the 2020 guidelines, it seems to have opened an old wound.

Mechanical compression devices (aka the Lucas) remain widespread in EMS despite the same recommendation in 2020. The AHA noted that providers could use the devices in some situations (e.g., during transport, where compressions may be dangerous).

Dual sequential defibrillation is in the same category as mechanical CPR: it is used in many EMS systems. However, the 2020 AHA guidelines are similar to the 2025 guidelines: it is not recommended.

Perhaps the bigger issues here aren’t with the guidelines themselves. They have to do with the strong hospital focus of the AHA guidelines, combined with the AHA speaking a language different from that used by EMS providers. EMS providers look at the guidelines as being more rigid than intended. The word "guidelines" itself doesn’t imply a directive or mandate. It is simply that—a guideline.

We don’t believe that the guidelines, as presented, prohibit the use of the Lucas in a code in an environment with only 2-3 providers available. In fact, in those situations, it is a necessity to run the code effectively. And if you are using different defibrillation models, these won’t change. They may actually help contribute to science and future guidelines.

Additional Guideline Changes

We’ll have more to say about the guidelines in the coming days as we delve deeper and deeper into them. These are a few standout updates from the guidelines that caught our attention:

• The post-ROSC recommendations for BP have changed to using only a MAP of 65 mmHg. Prior guidelines used a systolic BP of 90 or a MAP of 65. (Highlights Pg 17)

• Epinephrine is still included in the ACLS guidelines despite increasing opinions ranging from ineffectiveness to the harm it may cause. (Guidelines Part 9 Section 10)

• Prone CPR may be performed if the patient can’t be immediately placed in the supine position (also in prior guideline releases). No recommendation for hand placement is provided. (Guidelines Section 8.1)

• Guidelines on cord milking in neonates have been updated. (Highlights Pg 8)

Let us know your thoughts on the guidelines!

Full guidelines:

https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/executive-summary

Highlights (English):

https://cpr.heart.org/-/media/CPR-Files/2025-documents-for-cpr-heart-edits-posting/Resuscitation-Science/252500_Hghlghts_2025ECCGuidelines.pdf?sc_lang=en