2025 AHA CPR Guidelines: Every Change You Need to Know

The American Heart Association released its most comprehensive guidelines overhaul in five years on October 22, 2025. Published in Circulation (Volume 152, Supplement 2), the update includes 760 specific recommendations and introduces several changes that directly affect how CPR is taught, practiced, and certified across the country.

If you hold a current CPR or BLS certification, or if you are planning to get certified, these changes affect you right now. The mandatory transition deadline of March 1, 2026 has already passed, meaning every AHA training center in the country is now required to teach exclusively from the 2025 materials.

Here is everything that changed, what stayed the same, and what it means for your next certification class.

Browse our updated 2025 AHA-certified CPR and BLS classes in Denver and Boulder.

A Single Chain of Survival Now Covers All Ages

One of the most significant structural changes is the elimination of four separate Chains of Survival. Previously, the AHA maintained different chains for adult in-hospital, adult out-of-hospital, pediatric in-hospital, and pediatric out-of-hospital cardiac arrest. The 2025 guidelines replace all four with a single six-link chain that applies universally:

1. Early recognition of the emergency
2. Activation of the emergency response system
3. High-quality CPR
4. Early defibrillation
5. Post-cardiac arrest care
6. Recovery

A separate Neonatal Chain of Care was also introduced, covering everything from prenatal care through postnatal follow-up. This simplification makes the protocol easier to remember and teach, which was a deliberate goal of the update.

The Two-Finger Infant CPR Technique Has Been Eliminated

This is the change generating the most conversation among parents and healthcare providers alike. The two-finger technique for infant chest compressions, which had been the standard single-rescuer method since the early 1990s, is completely gone.

It was replaced by two approved methods:

Two-thumb encircling hands technique (preferred for all rescuers): Both thumbs are placed side-by-side on the lower half of the sternum, with fingers encircling and supporting the infant's back. This was previously recommended only for two-rescuer situations but is now the standard for all rescuers.

One-hand (heel of hand) technique: This is acceptable when the rescuer's hands physically cannot encircle the infant's chest.

The change was driven by research showing that compressions performed with the two-finger technique failed to achieve adequate depth in every single measured segment. The two-thumb technique consistently produces deeper, more effective compressions.

Read our detailed guide on the new infant CPR method and what parents need to know.

Back Blows Are Now Part of Adult Choking Response

For the first time ever, the AHA has included formal guidance for relieving choking in conscious adults. The updated protocol calls for alternating cycles of five back blows followed by five abdominal thrusts, starting with back blows, until the object is expelled or the person becomes unresponsive.

Previously, the AHA recommended abdominal thrusts only for adults and children. The inclusion of back blows aligns with international guidance and decades of evidence from other organizations.

For infants, the choking protocol was updated to use the heel of one hand for chest thrusts (replacing the now-eliminated two-finger technique). For children aged one year to puberty, back blows were added for the first time.

Compression Rates and Depth Have Not Changed

Despite the significant updates in other areas, the core mechanics of chest compressions remain the same:

- Rate: 100 to 120 compressions per minute for all ages
- Adult depth: At least 2 inches (5 cm) but no more than 2.4 inches (6 cm)
- Child depth: At least one-third of the chest diameter (approximately 5 cm)
- Infant depth: Approximately 1.5 inches (4 cm)
- Single-rescuer ratio: 30 compressions to 2 breaths
- Two-rescuer pediatric ratio: 15 compressions to 2 breaths

New emphasis was placed on performing CPR on a firm, flat surface, using a step stool for proper body mechanics when possible, and considering prone CPR if repositioning the patient would cause significant delays.

Check Our Updated Class Schedule - All Classes Now Teach 2025 Guidelines

Ventilation Guidance Has Shifted for Trained Bystanders

The 2025 update specifically advises trained lay rescuers to provide ventilations plus compressions (30:2 ratio) when they are willing and able to do so. This represents a shift from the previous strong emphasis on compression-only CPR for bystanders.

Hands-only CPR remains an acceptable option for untrained bystanders or for anyone who is unwilling or unable to provide rescue breaths. But the updated guidance reflects evidence that conventional CPR with ventilations produces better outcomes in many situations, particularly for children and for arrests caused by breathing problems.

Learn more about when hands-only CPR is enough and when it is not.

Ethics in CPR: A First-Time Addition

For the first time in its history, the AHA has included a dedicated chapter on the ethics of CPR and emergency cardiovascular care. The chapter covers core principles including beneficence, non-maleficence, autonomy, and justice. It specifically addresses documented disparities in cardiac arrest outcomes across racial and socioeconomic lines.

This addition reflects growing awareness that survival rates vary significantly based on where a cardiac arrest occurs, the demographics of the victim, and the likelihood of receiving bystander CPR.

New Recommendations for Healthcare Professionals

Several changes apply specifically to BLS and ACLS providers in clinical settings:

Cognitive aids (checklists, algorithms, and role cards) are now a Class 1 recommendation for use during resuscitation events. This is not recommended for lay rescuers but is considered essential for healthcare teams managing complex arrests.

Real-time CPR feedback devices (accelerometers, audiovisual feedback systems) have been elevated to a Class 1 recommendation for training environments. These devices help providers achieve and maintain proper compression depth and rate.

Opioid-associated emergencies and naloxone administration are now explicitly integrated into BLS algorithms, reflecting the ongoing impact of the opioid crisis.

AED protocol for infants and children now recommends immediate use with pediatric attenuator pads when available, simplifying the decision process for first responders.

Our BLS for Healthcare Providers guide covers everything clinicians need to know.

The March 2026 Transition Is Complete

The 90-day transition period ran from October 22, 2025 through February 28, 2026. As of March 1, 2026, only 2025 guideline courses may be taught. All 2020 course materials are retired. Every AHA instructor must have completed the relevant 2025 Instructor Update course for each discipline they teach.

This affected approximately 400,000 AHA instructors worldwide. Any instructor who did not complete their updates is currently restricted from teaching until they do so.

For students, this means that every AHA class you take from this point forward will teach the updated protocols. Your certification will reflect the current standard of care.

What This Means for Your Certification

If you hold a current certification that was issued before March 1, 2026, it is still valid until its printed expiration date. You do not need to recertify early. When you do renew, your renewal class will teach the 2025 guidelines.

If you are getting certified for the first time, you will learn the most current evidence-based techniques from day one.

CPR-Professionals LLC, as an AHA National Training Center, has fully transitioned to the 2025 guidelines. All of our instructors have completed their updates, and all classes in both our Denver and Boulder locations teach exclusively from the current materials.

Ready to Get Certified Under the New 2025 Guidelines? View Our Class Schedule and Book Today.