The American Academy of Pediatrics and the American Heart Association have published updated guidelines for cardiopulmonary resuscitation and emergency cardiovascular care for newborn and pediatric populations. The "2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" mark a comprehensive update to the guidelines for pediatric basic and advanced life support and neonatal resuscitation since 2020.
These updated guidelines are critically important because they address the approximately 7,000 out-of-hospital cardiac arrests and 20,000 in-hospital cardiac arrests that occur annually in infants and children across the United States. The recommendations recognize that children have unique physiological needs that differ from adults, requiring specialized approaches to resuscitation.
"Children are not little adults, and these guidelines offer specific recommendations that reflect the unique needs of children," said Javier Lasa, M.D., FAHA, FAAP, associate professor in critical care and cardiology at Children's Health in Dallas and volunteer co-chair of the 2025 Pediatric Advanced Life Support Writing Group.
Significant changes in the pediatric guidelines include the establishment of a single chain of survival intended to apply to both adult and pediatric in- and out-of-hospital cardiac arrest. The guidelines continue to emphasize early recognition of cardiac arrest in infants and children, early activation of emergency medical services, and initiation of high-quality CPR beginning with chest compressions.
For infants with severe foreign body airway obstruction, or choking, the guidelines now recommend repeated cycles of 5 back blows alternating with 5 chest thrusts, eliminating abdominal thrusts entirely for this age group. For children with severe choking, repeated cycles of 5 back blows alternating with 5 abdominal thrusts are now recommended, whereas earlier guidance called for performing abdominal thrusts only.
Infant compression techniques have been updated to recommend using either the one-hand technique or the two thumbs-encircling hands technique. The use of two fingers along the sternum was eliminated due to ineffectiveness in achieving proper depth. If the rescuer cannot physically encircle the chest, compressing with the heel of one hand is now recommended.
Henry Lee, M.D., FAAP, professor of pediatrics and neonatologist from the University of California San Diego and American Heart Association volunteer co-chair of the 2025 Neonatal Writing Group emphasized the importance of proper training: "The guidelines also observe that one out of every 10-20 newborns each year needs help transitioning from the fluid-filled environment of the womb to the air-filled room. It is essential that every newborn infant has a health care professional dedicated to facilitating that transition who is trained and equipped for the role using these recommendations."
While a unified chain of survival has been developed for adults and children, a separate newborn chain of care was created that provides a framework for essential elements of the health care system relating to neonatal health. The newborn chain of care starts with prenatal care and extends to recovery and appropriate follow-up in the postnatal period to ensure optimal short- and long-term health for the infant and family.
Key neonatal updates include that most newborn infants can be evaluated and monitored during deferred cord clamping for 60 seconds or more, extended from the previous recommendation of at least 30 seconds. Effective ventilation of the lungs remains the priority in newborn infants who need resuscitation, and it is now considered reasonable to provide ventilation at a rate of 30-60 inflations per minute, expanded from the prior recommendation of 40-60 inflations per minute.
The updated guidelines and CPR training materials are available in U.S. and international English, with many additional translated languages planned. These educational materials can be accessed at Pediatric Advanced Life Support and the Neonatal Resuscitation Program, 9th Edition.
