2025 American Heart Association (AHA) Instructor Update and Product and Course Orientation Bundle

2025 ACLS Instructor Update and Product & Course Orientation Bundle

Welcome to the ACLS Instructor Updates and Product & Course Orientation (P&CO) Bundle!

NOTE: All United States (US) Palm Desert Resuscitation Education LLC (PDRE) AHA Instructors must complete their required science update by 11:59 p.m. February 28, 2026, to continue teaching AHA courses. The P&CO provides different and separate updates from the 2025 AHA Guidelines Instructor Update Course for ACLS. Completion of the P&CO is optional for current ACLS Instructors.

2025 ACLS Instructor Update

The 2025 AHA Guidelines Advanced Cardiovascular Life Support (ACLS) Instructor Update Course provides AHA Instructors updates on new science and key changes published in the 2025 AHA Guidelines for CPR and ECC.
Quick Facts:
- Online Instructions
- Possible CEH
- 1 Hour Online Course
- 25-1638 Course code

The American Heart Association (AHA) recently released new science and education recommendations for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) that are documented in the 2025 AHA Guidelines for CPR and ECC.

Learning Objectives

At the end of this course, you’ll be able to do the following:

Describe the 2025 ACLS science updates and their rationale
Describe the 2025 ACLS education updates and their rationale
Describe the 2025 ACLS course updates, their rationale, and their application to ACLS training

2025 ACLS Science Updates

Temperature Control

The 2023 focused update to the adult ACLS guidelines brings new insight into multiple areas of science. The focus of this statement redefines the concept of targeted temperature management (TTM) to temperature control, thereby including strategies of hypothermic temperature control, normo-thermic temperature control, and temperature control with fever prevention. Temperature control includes choosing 1 temperature between 32 °C and 37.5 °C. This recommendation applies to all adults with return of spontaneous circulation (ROSC), regardless of arrest location (eg, in or out of the hospital) or presenting rhythm. Patients with spontaneous hypothermia after ROSC who are unresponsive to verbal commands should not routinely be actively or passively rewarmed faster than 0.5 °C per hour. It is also recommended that hospitals develop protocols for post-arrest temperature control.

The 2023 focused update to the adult ACLS guidelines reaffirms that routine use of rapid infusion of cold intravenous (IV) fluids for prehospital cooling of patients after ROSC is not recommended.

Temperature Control After Cardiac Arrest

2025 (Updated): It is reasonable that temperature control be maintained for at least 36 hours in adult patients who remain unresponsive to verbal commands after ROSC.

Why: Recognizing evolution of evidence and definitions with respect to temperature control, 36 hours of total temperature control is the shortest recommended duration.

Chain of Survival

The systems of care guidelines follow the unified cardiac arrest Chain of Survival, beginning with prevention and preparedness to resuscitate, and then proceeding with early identification of cardiac arrest, followed by effective resuscitation through to post-cardiac arrest care, survivorship, and recovery.

A single Chain of Survival is intended to apply to adult and pediatric in-hospital cardiac arrest and out-of-hospital cardiac arrest. In creating this singular chain, it is acknowledged that before cardiac arrest, prevention and preparedness can both avoid the need for and optimize resuscitation.

The links in the updated Chain of Survival are recognition and emergency activation, high-quality CPR, defibrillation, advanced resuscitation, post-cardiac arrest care, and recovery and survivorship.

Recognition and Emergency Activation
High-Quality CPR
Defibrillation
Advanced
Resuscitation
Post-Cardiac
Arrest Care
Recovery and Survivorship

Ventilation

2025 (Updated): When a rescuer is providing ventilation (breaths) for an adult patient in cardiac arrest, it is reasonable for them to give enough tidal volume to produce visible chest rise.

Rescuers should avoid hypoventilation (too few breaths or too little volume) or hyperventilation (too many breaths or too large a volume). Tidal volumes should be enough to see the chest rise, which can be achieved with about one third to one half of a squeeze of an adult ventilation bag, depending on the size of the bag.

Why: Recent studies have shown that rescuers often fail to deliver ventilation in accordance with guidelines. In these studies, CPR with both effective ventilation and chest compressions was associated with improved outcomes.

Atrial Fibrillation or Flutter With Rapid Ventricular Response

Higher first-shock energy settings (≥200 J) are preferable to lower settings for cardioversion of atrial fibrillation (AF) and atrial flutter.

2025 (Updated): For synchronized cardioversion of AF in adults using any currently US-approved biphasic waveform defibrillator, an initial energy setting of at least 200 J is reasonable and incremented in the event of shock failure, depending on the biphasic defibrillator used.

Why: Recent randomized trials together with a network meta-analysis involving more than 3000 AF patients found that 200-J shocks achieved greater than 90% cumulative cardioversion success across all 3 biphasic platforms currently available in the United States. Low-energy monophasic shocks were significantly more likely to provoke ventricular fibrillation when cardioverting AF and AF when cardioverting atrial flutter than a 200-J or greater setting.

2025 (Updated): For synchronized cardioversion of atrial flutter in adults, an initial energy setting of 200 J may be reasonable and incremented in the event of shock failure, depending on the biphasic defibrillator used

Why: Recent studies support the likelihood of greater efficacy, efficiency, and simplicity, without safety concerns, when a starting energy of 200 J with any currently US-marketed biphasic defibrillator is used for flutter cardioversion and incremented in the event of shock failure, depending on the defibrillator’s features.

Blood Pressure in Post-Cardiac Arrest Adults

2025 (Updated): Hypotension should be avoided in adults after ROSC by maintaining a minimum mean arterial pressure (MAP) of at least 65 mm Hg.

Why: Four randomized trials compared lower to higher MAP targets after out-of-hospital cardiac arrest. These studies did not demonstrate better overall survival or favorable neurologic outcome with higher MAP.

Life-Threatening Asthma Exacerbation

2025 (New): It may be reasonable to use extracorporeal life support (ECLS) for adults and children with life-threatening asthma refractory to standard therapies.

2025 (New): Treatment with volatile anesthetics for adults and children with life-threatening asthma refractory to standard therapies may be considered.

Why: Asthma can cause cardiac arrest from lower airway obstruction that leads to hypoxemia, hypercarbia, respiratory acidosis, and increased intrathoracic pressure, which leads to decreased cardiac output. Adult and pediatric observational studies of ECLS or volatile anesthetics (eg, desflurane, isoflurane, or sevoflurane) demonstrate survival rates between 83.5% and 100%. Either venovenous or venoarterial extracorporeal membrane oxygenation can be considered depending on the needs of the particular patient.

Life-Threatening Hyperkalemia

2025 (Updated): The effectiveness of IV calcium administration for adults and children in cardiac arrest from suspected hyperkalemia is not well established.

Why: For adults and children in cardiac arrest from suspected hyperkalemia, human evidence of improved survival or favorable neurological status following IV calcium administration is limited. Initiating IV calcium must be carefully weighed against the potential for detracting from time-sensitive, guideline-directed resuscitative interventions, including high-quality CPR, defibrillation of shockable rhythms, and administration of epinephrine.

Life-Threatening Hypothermia

2025 (New): It is reasonable to use prognostication scores to guide the decision for initiating ECLS rewarming for adults and children in hypothermic cardiac arrest.

2025 (New): It may be reasonable to rewarm adults and children with severe environmental hypothermia (core temperature, <28 °C) and not in cardiac arrest using ECLS.

Why: Severe environmental hypothermia (core temperature, <30 °C) can cause cardiac arrest as well as findings that mimic death. Reduced metabolic rate and oxygen consumption increase the likelihood of neurologically intact survival. Studies show improved survival in hypothermic cardiac arrest when ECLS is provided compared with when conventional CPR is provided. Rewarming adults and children not in cardiac arrest with ECLS can be faster but risks complications related to its use. The Hypothermia Outcome Prediction after Extracorporeal Life Support probability score and Immune-Effector Cell-Associated Encephalopathy survival score are better validated for predicting survival after hypothermic cardiac arrest compared with other prognostic factors in isolation.

Life-Threatening Hyperthermia

2025 (New): It is reasonable to choose immersion in ice water (1-5 °C) over other cooling methods in adults and children with life-threatening hyperthermia.

2025 (New): It is reasonable to cool adults and children with life-threatening hyperthermia as rapidly as possible with a decrease of at least 0.15°C/min.

Why: Cardiac arrest from life-threatening hyperthermia (≥40 °C) may be preventable by rapid cooling. A systematic review of human clinical and observational studies found cooling by ice water immersion to be most efficient and most likely to achieve the optimal cooling rate of at least 0.15°C/min compared with other strategies. These recommendations apply to environmental hyperthermia as well as hyperthermia associated with sympathomimetic and cocaine poisoning.

Left Ventricular Assist Devices

2025 (New): In unresponsive adults and children with durable left ventricular assist devices (LVADs) and impaired perfusion, chest compressions should be performed.

2025 (New): In unresponsive adults and children with durable LVADs and impaired perfusion, it may be reasonable to start chest compressions immediately while simultaneously assessing for device-related reversible causes.

Why: The absence of a palpable pulse can make confirming cardiac arrest in adults and children with an LVAD difficult. Perfusion is assessed using skin color, skin temperature, capillary refill, MAP, and partial pressure of end-tidal carbon dioxide, and if perfusion is impaired, cardiac arrest is likely. Outcomes of cardiac arrest with and without CPR in this population are difficult to assess due to bias in these studies, but the potential benefit of CPR outweighs the theoretical risk of device dislodgment. Treatment should prioritize CPR while simultaneously attempting to restore LVAD function if a second rescuer is available. The LVAD algorithm details the treatment steps.

Cardiac Arrest During Pregnancy

2025 (Updated): Preparation for resuscitative delivery for a pregnant patient in cardiac arrest should begin at the recognition of cardiac arrest, with the goal to complete delivery by 5 minutes.

2025 (New): It is reasonable to use extracorporeal CPR in pregnant or peri-partum patients in cardiac arrest not responsive to standard resuscitation.

2025 (New): A massive transfusion protocol with a balanced transfusion strategy should be used for peri-partum patients with suspected life-threatening amniotic fluid embolism.

Why: In addition to team planning, manual left lateral uterine displacement, and standard resuscitation, resuscitative delivery (replacing the term peri-mortem cesarean delivery) should be completed by 5 minutes to improve outcomes for the pregnant patient. Studies for extracorporeal CPR reported survival rates between 55% and 75% for pregnant patients. Amniotic fluid embolism in peri-partum patients can lead to cardiac arrest and is characterized by hemodynamic compromise, respiratory distress, and disseminated intravascular coagulation with resultant hemorrhage. A balanced massive transfusion strategy for red blood cells, plasma, and platelets equivalent reduces the risk of death. The Cardiac Arrest in Pregnancy Algorithm details the treatment steps.

Toxicology: Opioid Overdose

2025 (New): For lay and trained rescuers, opioid antagonist administration may be reasonable for adults and children in cardiac arrest with suspected opioid overdose, provided that opioid antagonist (eg, naloxone) administration does not interfere with the delivery of standard resuscitation, including high-quality CPR with breaths.

2025 (New): Adults and children who are treated for opioid overdose should receive an opioid antagonist and instruction on how to use it at the time of discharge from a health care setting.

Why: Opioid antagonists restore protective airway reflexes and reverse respiratory arrest from opioid overdose in adults and children and should be administered whenever opioid overdose is suspected. No clinical trials have evaluated the role of opioid antagonists in adults or children with cardiac arrest. The efficacy of naloxone administration in animal studies and adult observational studies for undifferentiated cardiac arrest or cardiac arrest with suspected opioid overdose is conflicting.

However, there is no known harm from administering naloxone to a person in cardiac arrest, provided that opioid antagonist administration does not interfere with standard resuscitation. People who survive an opioid overdose are at high risk of a subsequent overdose. In addition to brief psychosocial interventions and referral to evidence-based treatment programs, providing “take-home” or “leave-behind” doses of opioid antagonists with teaching may prevent future fatal overdoses.

2025 ACLS Education Updates

Use of Feedback Devices During CPR Training

2025 (Updated): Feedback devices are recommended for use during CPR training for health care professionals.

Why: A meta-analysis of several new randomized controlled trials conducted with health care professionals demonstrated that CPR feedback devices had a moderate to large effect on all CPR quality metrics. Three randomized controlled trials conducted with lay rescuers demonstrated that feedback devices were effective in increasing mean CPR quality metrics.

Teamwork and Leadership Training

2025 (Updated): It is recommended that life support training for health care professionals include a specific emphasis on teamwork competencies.

Why: Twelve of 14 randomized controlled trials reviewed reported superior performance after specific teamwork training in outcomes related to communication, leadership behavior, nontechnical skills, workload management, and overall teamwork at course completion.

Scripted Debriefing

2025 (New): It may be reasonable for an instructor to use a debriefing script during resuscitation education.

Why: Scripted debriefing involves the creation of a written plan for debriefing learners during and/or following life support training. Standardized debriefing helps to maintain consistency in the delivery of debriefings across training centers and resuscitation programs. Six studies with varying outcomes were identified.

Use of Cognitive Aids

2025 (New): It may be reasonable for health care professionals to use cognitive aids during resuscitation.

2025 (New): It is not recommended for lay rescuers to use cognitive aids during resuscitation.

Why: Cognitive aids are resources that provide prompts aimed at encouraging recall of information and increasing the likelihood of correct performance and behaviors. Published simulation data suggest that cognitive aid use by health care professionals may improve resuscitation performance. In lay rescuers, cognitive aid use was associated with significant delays in starting CPR, leading to a recommendation against their use for lay rescuers.

2025 ACLS Course Updates

Video Prework and Precourse Self-Assessment

Video prework
- Video prework is optional depending on the agenda that the Instructor or Training
  Center Coordinator chooses
- Students review the course content through interactive online videos with knowledge check questions if the agenda includes video pre-work
Pre-course self-assessment
- All students must complete and pass the pre-course self-assessment
- Students must achieve a score of at least 70%
- Students must bring their score report with them to the course

Course Agendas

Instructor-Led Training Agenda
- Seven ACLS agendas
  - ACLS Course With Video Pre-work
  - ACLS Update Course With Video Pre-work
  - ACLS Course
  - ACLS Update Course
  - HeartCode® ACLS Hands-On Skills Session
  - ACLS Course Card and BLS Card With Video Prework
  - ACLS Update Course Card and BLS Card With Video
- Important
  - Agendas should be followed as written.
- Agendas
  - Traditional ACLS Agenda
    - Does not include pre-work
    - Video lessons are conducted in class along with discussions
  - ACLS Agenda With Video Prework
    - Videos reviewed before class
    - Prepares students for classroom participation

Provider Manual

Please take a moment to review these updates, which can be found in the Science Summary Table in the Appendix of the 2025 ACLS Provider Manual.

Tachycardia
- Synchronized cardioversion initial recommended doses:
  - Narrow-complex tachycardia: 100 J
  - Monomorphic ventricular tachycardia: 100 J
  - Atrial fibrillation: 200 J
  - Atrial flutter: 200 J
  - Polymorphic ventricular tachycardia: defibrillation dose (not synchronized)
- Removed sotalol from the algorithm
- Changed supraventricular tachycardiac to narrow-complex tachycardia
Post-Cardiac Arrest Care
- Temperature control
  - 32 to 37.5 °C
  - Hold temperature for at least 36 hours
  - OK to give out-of-hospital cardiac arrest patients with ROSC temperature control as long as it is not cold IV saline infusion
- Hypotension:
  - MAP ≥65 mm Hg
- Oxygen saturation:
  - 90% to 98%
Stroke
- Added tenecteplase as a thrombolytic agent
Acute Coronary Syndrome
- Removed left bundle branch block as a definitive diagnosis for ST-segment elevation myocardial infarction
- Removed clopidogrel as a primary anticoagulant
- Added fentanyl (opioids) for secondary pain control (in addition to morphine)
- Added enoxaparin or fondaparinux (anticoagulants)
- Added angiotensin-converting enzyme inhibitors
Airway
- Removed 600 mL to 800 mL for ventilations, adding “one third” squeeze and focusing on chest rise: “Squeeze the bag one third to one half, enough to see visible chest rise.”
- Removed delivering medications down an endotracheal tube

ACLS High-Quality BLS Learning and Testing Station

Learning and Testing Stations

Learning Stations
- They offer a chance for high-performance teams to improve
- Learning stations are required
- Skills and understanding are built through practice and repetition
Examples
- Cardiac arrest learning and testing stations include the CPR Coach role using the CPR triangle
- Cardiac Arrest, Post-Cardiac Arrest Care, and Megacode stations focus on chest compression fraction (CCF) measurements
- Pre-briefing and debriefing are also a focus
Testing Stations
- Conduct testing stations in real time with full equipment
- Measure CCF during Megacode Testing

Learning Stations

Before instructors initiate the 3 case-based scenarios with the team, they should briefly provide instruction on first-degree heart blocks, both types of second-degree heart blocks, and third-degree heart blocks.
They should also review the Adult Bradycardia Algorithm and any necessary monitor functions, such as
transcutaneous pacing.

Megacode Learning Station

Pre-briefing
- Conduct pre-briefing before each simulation to
  - Establish a safe environment
  - Set expectations
  - Build rapport
  - Set goals for the case, including a goal for CCF, depending on the learning station
Debriefing
- Students should reflect on their actions
- Focus on
  - Why students did what they did
  - Sustaining good performance
  - Closing performance gaps
- Structured debriefing is an evidence-based, student-focused process
- Discuss the goals set in prebriefing
- Teams that debrief after every code tend to perform better
- Students should be conducting debriefings without much help from the instructor by the end of the course
High-Performance Teams
- Essential
  - Are essential to successful resuscitation attempts
  - Can achieve goals through team dynamics
- Considerations
  - High-performance teams should consider
    - Their purpose and goals
    - Each team member’s skills
    - Motivation
    - Conflict resolution and communication
- Evaluation
  - High-performance teams
    - Measure performance
    - Analyze data
    - Identify areas for improvement
    - Implement revised strategies
- Evaluation Guidelines
  - Timing
    - Time to first compression
    - Time to first shock
    - Optimizing CCF
    - Minimizing preshock pause
    - Early EMS response time
  - Quality
    - Rate, depth, and recoil
    - Minimizing interruptions
    - Switching compressors
    - Avoiding excessive ventilation
    - Use of a feedback device
  - Coordination
    - Team dynamics: team members working together, proficient in their roles
  - Administration
    - Leadership
    - Measurement
    - Continuous quality improvement
    - Number of code team members

CPR Coach

Studies
- Resuscitation teams with a CPR Coach perform higher-quality CPR with higher CCF.
Duties
- The CPR Coach should
  - Verbalize the data from a real-time audiovisual feedback device
  - Provide corrective feedback
  - Coordinate efforts to keep all pauses to 10 seconds or less when possible
Role
- Can be a separate role or combined with the Monitor/Defibrillator
- Needs a direct line of sight to the Compressor

Measuring CCF

Why
- Measuring CCF allows you to evaluate students objectively
- With good teamwork, rescuers can often achieve a CCF ideally greater than
  80%
- Scenarios should be run in real time with a required feedback device
How
- Calculate CC mechanically by using a feedback device or an app, or manually by using 2 timers
- When using 2 timers
  - One timer measures the total code time from start to stop (ROSC)
  - A second timer measures the total chest compression time by starting the timer each time compressions begin or resume and stopping the timer during each pause
  - Divide chest compression time by the total code time

Required Feedback Devices

The AHA requires the use of an instrumented directive feedback device or manikin
At a minimum, they must offer audio, visual, or both types of feedback

Skill Testing Checklists and Objective Testing

Importance
- Checklists are important for
  - Preventing errors
  - Improving consistency
  - Reducing bias
Objectivity
- Objective evaluation requires obtaining accurate measurements to reflect a student’s actual performance
- This approach shifts the focus from perception to data-driven analysis of performance
Roster
- Transfer students’ final CCF to the roster at the end of the course
Review
- Please review the updated Skills Testing Checklists in Parts 4 and 5 of your 2025 ACLS Instructor Manual

Megacode Testing Station

The Megacode Testing Station assesses mastery of course objectives
Students are tested as a team on
- Achieving a CCF of 81% or more
- Effective team communication
- Knowledge of ACLS algorithms
Instructors must ensure students are ready before testing
Each student’s readiness impacts the entire team’s performance
Provide respectful feedback if a student is not ready before they proceed to testing

Online Exams

Exams are administered online
Online exams enhance test security
Saves instructors time by automatically scoring results
Contact your Training Center for questions regarding online exams

Conclusion

American Heart Association®

This concludes the 2025 ACLS Instructor Update.
The information in this course is based on updated science and education recommendations in the 2025 Guidelines; key issues and changes are summarized in the Highlights document of the 2025 Guidelines.
For more information, please refer to these resources.
- 2025 AHA Guidelines (full chapters) and AHA Highlights of the 2025 Guidelines: eccguidelines.heart.org
- Resuscitation education resources: cpr.heart.org
- Interim training materials: atlas.heart.org

2025 ACLS Product & Course Orientation

The 2025 Advanced Cardiovascular Life Support (ACLS) Product & Course Orientation (P&CO) is designed to help ACLS Instructors understand the new, 2025 ACLS Course design and teaching strategies, and to quickly get up to speed on the latest and most important updates to the ACLS Course materials.
Quick Facts:
- Online Instructions
- Possible CEH
- 1 Hour Online Course
- KJ-1889 Course code

2025 PALS Instructor Update and Product & Course Orientation Bundle

Welcome to the Pediatric Advanced Life Support (PALS) Instructor Updates and Product & Course Orientation (P&CO) Bundle!

NOTE: All United States (US) Palm Desert Resuscitation Education LLC (PDRE) AHA Instructors must complete their required science update by 11:59 p.m. February 28, 2026, to continue teaching AHA courses. The P&CO provides different and separate updates from the 2025 AHA Guidelines Instructor Update Course for PALS. Completion of the P&CO is optional for current PALS Instructors.

PALS Instructor Update

The 2025 AHA Guidelines Pediatric Advanced Life Support (PALS) Instructor Update Course provides AHA Instructors updates on new science and key changes published in the 2025 AHA Guidelines for CPR and ECC.
Quick Facts:
- Online Instructions
- Possible CEH
- 1 Hour Online Course
- 25-1639 Course code

PALS Product & Course Orientation

The Pediatric Advanced Life Support (PALS) Product & Course Orientation (P&CO) is designed to help PALS Instructors understand the new, 2025 PALS Course design and teaching strategies, and to quickly get up to speed on the latest and most important updates to the PALS Course materials.
Quick Facts:
- Online Instructions
- Possible CEH
- 1 Hour Online Course
- KJ-1890 Course code

The American Heart Association (AHA) recently released new science and education recommendations for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) that are documented in the 2025 AHA Guidelines for CPR and ECC.

Learning Objectives

At the end of this course, you’ll be able to do the following:

Describe the 2025 pediatric advanced life support (PALS) science updates and their rationale
Describe the 2025 PALS education updates and their rationale
Describe the 2025 PALS course updates, their rationale, and their application to PALS training

2025 PALS Science Updates

Chain of Survival

The links in the updated Chain of Survival are recognition and emergency activation, high-quality CPR, defibrillation, advanced resuscitation, post-cardiac arrest care, and
recovery and survivorship.

Recognition and Emergency Activation
High-Quality CPR
Defibrillation
Advanced Resuscitation
Post-Cardiac Arrest Care
Recovery and Survivorship

Components of High-Quality CPR

2025 (New): For infants and children in cardiac arrest, interruptions in CPR should be minimized and pauses in chest compressions should be less than 10 seconds.

Why: Evidence from a multinational, multi-institutional observational cohort registry demonstrated that increased frequency and duration of pauses in CPR were significantly associated with a lower probability of achieving return of spontaneous circulation.

Sequence of Resuscitation

2025 (Updated): For infants, rescuers should compress the sternum with the heel of 1 hand or use the 2 thumb-encircling hands technique. If the rescuer cannot physically encircle the chest, it is recommended to compress the chest with the heel of 1 hand.

Why: Systematic reviews and meta-analyses from simulation studies suggest that the 2 thumb–encircling hands technique is the superior technique for giving compressions to infants when compared with the 2-finger technique, particularly for achieving adequate depth. In a multicenter prospective observational registry study, the single-hand technique resulted in greater compression depth than the 2 thumb-encircling hands technique with infants, with no difference in chest compression rate between hand positions. The 2-finger technique was used rarely in this study, but when used, no chest compression segments were compliant with AHA guidelines. Given this, the heel-of-1-hand or 2 thumb-encircling hands technique is recommended for infants. The long-used 2-finger technique for infant CPR is no
longer recommended.

Foreign Body Airway Obstruction: Children

Child Foreign-Body Airway Obstruction Algorithm

Verify scene safety.
heck for signs of severe FBAO (Weak or absence of cough, Unable to speak,
Change in color (cyanosis), Altered mental status, Apnea).
If Absent: Encourage cough. Continue to check for signs of severe FBAO.
If Present: Activate emergency response system.
Is the child responsive?
If Yes: Start repeated cycles of 5 back blows (slaps), followed by 5 abdominal
thrusts. Repeat until object is expelled or the child becomes unresponsive. If
object is expelled, continue to monitor until advanced care arrives.
If No: Start CPR until advanced care arrives; refer to pediatric BLS algorithm.
Start with compressions. Check for visible object in mouth before giving
breaths.

2025 (Updated): For children with severe foreign-body airway obstruction (FBAO), repeated cycles of 5 back blows alternating with abdominal thrusts should be performed until the object is expelled or the child becomes unresponsive (see the new FBAO algorithm). Rescuers should activate the emergency response system.

Why: Many FBAOs are relieved by allowing the patient to cough or, if severe, by lay rescuers using chest or abdominal thrusts. A recent observational study of adult and pediatric FBAOs suggests improved clearance of a foreign body with the use of back blows over abdominal thrusts. To create consistency for instructional purposes, and in the absence of inferiority from pediatric data, management of severe FBAO in children now starts with a series of back blows instead of abdominal thrusts.Repeated cycles of 5 back blows followed by 5 abdominal thrusts are performed until the obstruction is cleared or the child becomes unresponsive.

Foreign Body Airway Obstruction: Infant

Infant Foreign-Body Airway Obstruction Algorithm

Verify scene safety.
Check for signs of severe FBAO (Weak or absence of cough, Unable to cry, Change in color (cyanosis), Altered mental status, Apnea).
If Absent: Encourage cough. Continue to check for signs of severe FBAO.
If Present: Activate emergency response system.
Is the infant responsive?
If Yes: Start repeated cycles of 5 back blows (slaps), followed by 5 chest thrusts. Repeat until object is expelled or the infant becomes unresponsive. If object is expelled, continue to monitor until advanced care arrives.
If No: Start CPR until advanced care arrives; refer to pediatric BLS algorithm. Start with compressions. Check for visible object in mouth before giving breaths.

2025 (Updated): For infants with severe FBAO, repeated cycles of 5 back blows alternating with 5 chest thrusts should be performed until the object is expelled or the infant becomes unresponsive. Rescuers should activate the emergency response system.

Why: Abdominal thrusts are not recommended for infants, given the potential to cause abdominal organ injury. The heel-of-1-hand technique for chest thrusts is now recommended for infants with severe FBAO. While the heel-of-1-hand technique for chest thrusts resembles chest compressions that are used as part of CPR, there is no focus on the other components of high-quality CPR chest compressions (eg, rate, recoil), so the term chest compression is not used. If infants and children develop severe FBAO, emergency medical services should be promptly activated because these patients can rapidly deteriorate into cardiac arrest.

Drug Administration During Cardiac Arrest

2025 (Updated): For infants and children in cardiac arrest with initial nonshockable rhythm, it is reasonable to administer the initial dose of epinephrine as early as possible.

Why: A recent systematic review of 7 observational studies identified that shorter time to administration of epinephrine in out-of-hospital cardiac arrest and in-hospital cardiac arrest was associated with increased rates of favorable outcome. A time to first dose of epinephrine of less than 3 minutes was associated with highest rates of favorable outcome, although there was no direct comparison across time to first epinephrine dose intervals (eg, <5 min, <10 min).

Measuring Physiology During CPR

2025 (Updated): For infants and children with invasive airways in place during CPR, end-tidal carbon dioxide (ETCO2) monitoring may be considered to monitor CPR quality.

2025 (New): A specific ETCO2 cutoff value alone should not be used as an indication to end resuscitative efforts in infants and children.

Why: Monitoring exhaled carbon dioxide levels among patients receiving CPR with an invasive airway is important because ETCO2 reflects native cardiac output and ventilation efficacy as well as feedback on CPR quality. In a recent prospective multicenter study that evaluated average ETCO2 during the first 10 minutes of in-hospital CPR in children, ETCO2 values of 20 mm Hg or greater during CPR were associated with increased odds of return of spontaneous circulation and survival to discharge as well as higher intra-arrest blood pressures. There was no association with CPR quality metrics, such as chest compression rate and depth. However, when rescuers are considering termination of resuscitative efforts, it is vital that they avoid using a specific ETCO2 cutoff value alone because survival has been noted in patients with average ETCO2 less than 20 mm Hg.

2025 (New): For infants and children with continuous invasive arterial blood pressure monitoring in place during CPR, it may be reasonable for health care professionals to target a diastolic blood pressure of 25 mm Hg or greater in infants and 30 mm Hg or greater in children 1 year of age or older.

Why: A new study shows that among pediatric patients receiving CPR with an invasive arterial line in place, rates of survival with favorable neurologic outcome were improved if the diastolic blood pressure was at least 25 mm Hg in infants and at least 30 mm Hg in children.

Post-Cardiac Arrest Management

2025 (Updated): After cardiac arrest in infants and children, it is recommended to maintain systolic and mean arterial blood pressure greater than the 10th percentile for age.

Why: Because blood pressure is often labile in the post-cardiac arrest period, recognition of hypotension (less than fifth percentile for age and sex) is important. Hypotension is common following return of circulation from cardiac arrest, occurring in 25% to 50% of infants and children. Two observational studies associated systolic blood pressure below the fifth percentile for age in the first 12 hours following cardiac arrest with decreased rates of survival to discharge.

In addition, a secondary analysis of the Intensive Care Unit-Resuscitation trial of pediatric in-hospital cardiac arrest found higher rates of survival to hospital discharge as well as survival to hospital discharge with favorable neurologic outcome when blood pressure targets were above a threshold of systolic blood pressure greater than 10th percentile for age and diastolic blood pressure greater than 50th percentile for age during the first 6 hours post-cardiac arrest.

Prognostication After Cardiac Arrest

2025 (Updated): It is recommended that health care professionals consider multiple modalities when they are predicting neurological outcomes (favorable or unfavorable after resuscitation from cardiac arrest in infants and children).

2025 (New): The usefulness of cough or gag reflexes or response to pain to support a favorable or unfavorable neurological prognosis at any time point after cardiac arrest in infants and children is not well established.

2025 (New): When interpreted in the context of other prognostic criteria, it is reasonable to use electroencephalography (EEG) up to 72 hours after cardiac arrest in infants and children to support a favorable or unfavorable neurological prognosis.

Why: Two systematic reviews evaluated the association of neurological examination, biomarkers, EEG, and neurological imaging modalities with favorable and unfavorable outcomes after resuscitation from pediatric cardiac arrest. None of these modalities were assessed in isolation, and none met prespecified accuracy to be used as a lone prognostic criterion at any time point. Therefore, despite recommendations around individual tests, none should be used in isolation to predict outcome.

EEG is a modality that may be used in conjunction with other tests based on numerous studies to prognosticate outcome. However, data are lacking to support the use of a cough or gag reflex to predict favorable or unfavorable outcome. Clinicians should consider multiple modalities when assessing the neurological prognosis of survivors after cardiac arrest.

Post-Cardiac Arrest Recovery and Survivorship

2025 (Updated): It is reasonable that infants and children who survive cardiac arrest be evaluated for physical, cognitive, and emotional needs to guide follow-up care within the first year following cardiac arrest.

Why: There is growing recognition that recovery from cardiac arrest continues long after initial hospitalization. Survivors may require ongoing integrated medical, rehabilitative, caregiver, and community support in the months to years after their cardiac arrest. A recent AHA scientific statement highlights the importance of supporting patients and families during this time to achieve the best possible long-term outcome.

Knowledge Check

What are the links in the new Chain of Survival that was updated in 2025?

Recognition and emergency activation, high-quality CPR, defibrillation, advanced resuscitation, post-cardiac arrest care, and recovery and survivorship
- The following are the links in the new Chain of Survival that was updated in 2025: recognition and emergency activation, high-quality CPR, defibrillation, advanced resuscitation, post-cardiac arrest care, and recovery and survivorship.

Which technique is no longer recommended for infant compressions?

2-finger technique
- The heel-of-1-hand or 2 thumb-encircling hands technique is recommended for infants. The long-used 2-finger technique for infant CPR is no longer recommended in the 2025 Guidelines.

Education Updates

Use of Feedback Devices During CPR Training

2025 (Updated): Feedback devices are recommended for use during CPR training for health care professionals.

2025 (Updated): Feedback devices are recommended for use during CPR training for lay rescuers.

Teamwork and Leadership Training

2025 (Updated): It is recommended that life support training for health care professionals includes a specific emphasis on teamwork competencies.

Why: Of the 14 randomized controlled trials reviewed, 12 reported superior performance after specific teamwork training in outcomes related to communication, leadership behavior, nontechnical skills, workload management, and overall teamwork at course completion.

Scripted Debriefing

2025 (New): It may be reasonable for an instructor to use a debriefing script during resuscitation education.

Why: Scripted debriefing involves the creation of a written plan for debriefing students during or after life support training. Standardized debriefing helps to maintain consistency in the delivery of debriefings across training centers and resuscitation programs. Six studies with varying outcomes were identified.

Use of Cognitive Aids

2025 (New): It may be reasonable for health care professionals to use cognitive aids during resuscitation.

2025 (New): It is not recommended for lay rescuers to use cognitive aids during resuscitation.

Why: Cognitive aids are resources that provide prompts aimed at encouraging recall of information and increasing the likelihood of correct performance and behaviors. Published simulation data suggest that cognitive aid use by health care professionals may improve resuscitation performance. For lay rescuers, cognitive aid use was associated with significant delays in starting CPR, leading to a recommendation against their use for lay rescuers.

2025 PALS Course Updates

Course Agendas

Six agendas for PALS instructor-led training
Follow agendas as written
Conduct video lessons in class for the traditional PALS agenda
Students view the course videos before class for the agenda with video prework

Skills Updates

Infant BLS
- No longer teaching 2-finger chest compressions
- Instead, use the heel-of-1-hand or the 2 thumb-encircling hands technique

Child Choking
- Administer sets of 5 back blows followed by 5 abdominal thrusts
- Alternate between the 2 until the object is dislodged or the child becomes unresponsive

Infant Choking
- Administer sets of 5 back blows followed by 5 chest thrusts
- Use the heel of 1 hand in the middle of the chest for chest thrusts

Learning and Testing Stations

PALS learning stations
- Provide hands-on skills practice
- Incorporate prebriefing and debriefing
- Are required

PALS testing stations must be conducted in real time with full equipment

Prebriefing
- Conducted before each simulation
  - - Establish a safe environment
    - Set expectations
    - Build rapport
    - Set goals for the case, including a goal for chest compression fraction (CCF)

Prebriefing (Setting the stage)
- Ensure safe learning environment/mutual respect
- Set expectations
- Explain rules for simulation
- Discuss realism for simulation
- Set team goals for each case

Case Scenario
- Repeat for each case (apply what they learned)
Structured Debriefing
- Gather: Code recorder, team
- Analyze: What happened, why, and team goals
- Summarize: Key points for next case

Debriefing
- Students should reflect on their actions
- Structured debriefing is an evidence-based, student-focused proces
- Focus on
  - Discussing why students did what they did
  - Sustaining good performance
  - Closing performance gaps
  - Achieving the goals set in prebriefing

High-Performance Teams
- Essential
  - Are essential to successful resuscitation attempts
  - Can achieve goals through team dynamics

Diagram Components:
- Timing: Time to first compression, Time to first shock, Optimizing CCF, Minimizing preshock pause, Early EMS response time
- Quality: Rate, depth, and recoil, Minimizing interruptions, Switching compressors, Avoiding excessive ventilation, Use of a feedback device
- Coordination: Team dynamics: team members working together, proficient in their roles
- Administration: Leadership, Measurement, Continuous quality improvement, Number of code team members

High-Performance Teams

Considerations
- High-performance teams should consider
  - Their purpose and goals
  - Each team member’s skills
  - Motivation
  - Conflict resolution and communication

Evaluation
- High-performance teams
  - Measure performance
  - Analyze data
  - Identify areas for improvement
  - Implement revised strategies

CPR Coach

Studies
- Resuscitation teams with a CPR Coach perform higher-quality CPR with higher
Duties
- The CPR Coach should
  - Verbalize the data from a real-time audiovisual feedback device
  - Provide corrective feedback
  - Coordinate efforts to keep all pauses to 10 seconds or less when possible
Role
- Can be a separate role or combined with the Monitor/Defibrillator
- Needs a direct line of sight to the Compressor

Knowledge Check

What is one of the goals of prebriefing?

To set team goals for the case scenario
- One of the goals of prebriefing is to set team goals for the case scenario.

Regardless of which agenda you choose, each student must complete which of the following?

The precourse self-assessment
- Each student must complete the precourse self-assessment, regardless of which agenda you use.

Measuring CCF

Measuring CCF allows you to evaluate students objectively
High-performing systems target a CCF of at least 60%, with 80% or higher being a frequent goal
Scenarios should be run in real time with a required feedback device

CPR Coach and High-Performance Teams

Purpose
- Simulate real-life challenges of CPR by using 3-minute practice rounds
- Help participants recognize their limits
- Develop skills for optimal outcomes in pediatric cardiac arrest

Setup
- Divide students into groups of 3 to 4
- Assign a CPR Coach to each group to act as the Monitor/Defibrillator
- Complete as many rounds as there are students
- Ensure every student practices in the CPR Coach role

Practice Rounds
- Compressor switch required at least once per round
- Ideal to switch before the 2-minute pulse check, especially if fatigue affects compression quality
- Challenge teams to minimize interruptions in chest compressions to less than 5 seconds

Required Feedback Devices
- The AHA requires the use of an instrumented directive feedback device or manikin
- At a minimum, they must offer audio, visual, or both types of feedback

Skills Testing Checklists and Objective Testing

Importance
- Checklists are important for
  - Preventing errors
  - Improving consistency
  - Reducing bias

Objectivity
- Objective evaluation requires obtaining accurate measurements to reflect a student’s actual performance
- This approach shifts the focus from perception to data-driven analysis of performance

Appendixes
- Review
  - Please review the updated Skills Testing Checklists in Part 5 of your 2025 instructor manual

Infant and Child High-Quality BLS Testing

Structure
- Conducted in groups of 3 or 4 students
- Testing checklists must be completed for each student
- Stations run in 10-minute rounds
- The number of rounds equals the number of students in each group
- Instructors have 15 to 20 minutes to evaluate all students as they rotate

Breakdown
- Each rotation will last 10 minutes
  - 5 minutes of CPR practice
  - 5 minutes of peer-to-peer debriefing
At least 2 compressor switches
- Switch sooner if fatigue impacts compression quality

CPR Coach remains in their role for the CPR practice portion

Debriefing
- Led by students
- Focus on performance, areas for improvement, and key takeaways

Conclusion

American Heart Association.
This concludes the 2025 PALS Instructor Update.
The information in this course is based on updated science and education recommendations in the 2025 Guidelines; key issues and changes are summarized in the Highlights document of the 2025 Guidelines.
For more information, please refer to these resources.
2025 AHA Guidelines (full chapters) and AHA Highlights of the 2025 Guidelines:

PEARS Instructor Update

Welcome to the PEARS Instructor Updates and Product & Course Orientation (P&CO) Bundle!

NOTE: All United States (US) Palm Desert Resuscitation Education LLC (PDRE) AHA Instructors must complete their required science update by 11:59 p.m. February 28, 2026, to continue teaching AHA courses. The P&CO provides different and separate updates from the 2025 AHA Guidelines Instructor Update Course for PEARS. Completion of the P&CO is optional for current PEARS Instructors.

2025 PEARS Instructor Update

The 2025 AHA Guidelines Pediatric Emergency Assessment Recognition and Stabilization (PEARS) Instructor Update Course provides AHA Instructors updates on new science and key changes published in the 2025 AHA Guidelines for CPR and ECC.
Quick Facts:
- Online Instructions
- Possible CEH
- 0.2 Hour Online Course
- 25-1640 Course code

2025 BLS Instructor Update and Product & Course Orientation Bundle

Welcome to the BLS Instructor Updates & Product & Course Orientation (P&CO) Bundle!

NOTE: All United States (US) Palm Desert Resuscitation Education LLC (PDRE) AHA Instructors must complete their required science update by 11:59 p.m. February 28, 2026, to continue teaching AHA courses. The P&CO provides different and separate updates from the 2025 AHA Guidelines Instructor Update Course for BLS. Completion of the P&CO is optional for current BLS Instructors.

BLS Product & Course Orientation

The Basic Life Support (BLS) Product & Course Orientation (P&CO) is designed to help BLS Instructors understand the new, 2025 BLS Course design and teaching strategies, and to quickly get up to speed on the latest and most important updates to the BLS Course materials.
Quick Facts:
- Online Instructions
- Possible CEH
- 0.5 Hour Online Course
- KJ-1888 Course code

2025 BLS Instructor Update

The 2025 AHA Guidelines Basic Life Support (BLS) Instructor Update Course provides AHA Instructors updates on new science and key changes published in the 2025 AHA Guidelines for CPR and ECC.
Quick Facts:
- Online Instructions
- Possible CEH
- 1 Hour Online Course
- 25-1637 Course code

BLS 2025 Instructor Update

The American Heart Association (AHA) recently released new science and education recommendations that are documented in the 2024 AHA and American Red Cross Guidelines for First Aid and the 2025 AHA Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC).

Learning Objectives

At the end of this course, you’ll be able to
- Describe the 2025 basic life support (BLS) science updates and their rationale
- Describe the 2025 BLS education updates and their rationale
- Describe the 2025 BLS course updates, their rationale, and their application to BLS training

Science Updates

Age Identification

Infants are younger than 1 year (excluding the newly born), and children range from 1 year to puberty. Signs of puberty include chest or underarm hair on boys and any breast development in girls. For children with signs of puberty and older, follow adult BLS guidelines.

Recognition of Stroke in Children

2024 (New): If pediatric stroke is suspected, EMS should be activated, and the child should be transported to an emergency department.

2024 (New): It is reasonable to consider stroke when common pediatric symptoms are present in association with other neurological signs and symptoms.

2024 (New): Adult stroke scores are not validated in the pediatric population and should not solely be used to identify the broad presentation of stroke in children.

Why: While previous first aid guidelines have included recognition of stroke in adults, approximately 40,000 children worldwide experience stroke each year. The initial signs and symptoms of stroke in children are often missed. This results in delayed diagnosis and potentially missing the opportunity to intervene. Although pediatric stroke can present in similar ways to adult stroke, it can also present in nonspecific ways and mimic other childhood diseases.

Common Signs and Symptoms of Stroke in Children
- Focal signs and symptoms
  - Hemiparesis
  - Limb weakness
  - Facial droop
  - Altered sensation
  - Visual disturbance
  - Speech disturbance
- General signs and symptoms
  - Altered mental status
  - Seizure
  - Headache
  - Ataxia
  - Vertigo/dizziness
  - Nausea/vomiting

Recognition of Stroke in Adults

2024 (New): If stroke is suspected, the EMS system should be activated immediately.

2024 (New): The use of a stroke recognition tool, such as Face, Arms, Speech, Time (F.A.S.T.) or the Cincinnati Prehospital Stroke Scale, is recommended to aid in the recognition of acute stroke in adults.

2024 (New): It is reasonable for first aid providers to measure capillary blood glucose in adults with suspected stroke if it is available and does not delay activating EMS.

Why: Stroke is a serious and time-sensitive medical emergency affecting 800 000 people in the United States annually. New data show that F.A.S.T. and the Cincinnati Prehospital Stroke Scale can be accurately performed by first aid providers and members of the general public, particularly with coaching from EMS telecommunicators.

SPOT A STROKE™
- F.A.S.T.
  - FACE Drooping
  - ARM Weakness
  - SPEECH Difficulty
  - TIME to Call 911
- Learn more at stroke.org

Seizures

2024 (Updated): First aid providers should activate EMS for individuals with first-time seizure; seizures lasting more than 5 minutes; more than 1 seizure that occurs without the person returning to baseline mental status in between; seizures occurring in the water; seizures with traumatic injuries, difficulty breathing, or choking; seizure in an infant younger than 6 months; seizure in pregnant individuals; or if the individual does not return to baseline within 5 to 10 minutes once seizure activity has stopped.

2024 (Updated): First aid providers should minimize the risk of injury to the individual who is having a seizure by helping the person to the ground, placing the person on their side in the recovery position, and clearing the area around them.

2024 (Updated): First aid providers should stay with the person having a seizure.

2024 (Updated): For children who have experienced a febrile seizure, administration of antipyretics such as acetaminophen, ibuprofen, or paracetamol is not effective for stopping a seizure or preventing a subsequent febrile seizure.

2024 (Updated): The person having the seizure should not be restrained.

2024 (Updated): Nothing should be put in the mouth and no food, liquids, or oral medicines should be given to a person who is experiencing a seizure or who has decreased responsiveness after a seizure.

Why: Seizures are a common medical condition. Almost 3 million US adults live with epilepsy. Febrile seizures occur in 2% to 4% of children, most commonly between 6 months and 2 years of age. Although seizures are dramatic, many seizures do not require treatment from a health care professional. First aid providers can help by protecting the person experiencing a seizure from injury and calling EMS in appropriate situations. The 2024 Guidelines for First Aid include greatly expanded recommendations for first aid for seizure.

Chain of Survival

The systems of care guidelines follow the unified cardiac arrest Chain of Survival, beginning with prevention and preparedness to resuscitate. Next is early identification of cardiac arrest. This is followed by effective resuscitation through to post-cardiac arrest care, survivorship, and recovery.

A single Chain of Survival applies to adult and pediatric in-hospital cardiac arrest and out-of-hospital cardiac arrest. In creating this singular chain, we acknowledge that before cardiac arrest, prevention and preparedness can avoid the need for and optimize resuscitation.

Recognition and Emergency Activation
High-Quality CPR
Defibrillation
Advanced Resuscitation
Post-Cardiac Arrest Care
Recovery and Survivorship

Newborn Chain of Care

There is a separate newborn chain of care that provides a framework for considering essential elements of the health care system related to neonatal health. A strong newborn chain of care has the potential to improve health in the neonatal period and long-term outcomes.

Although the newborn population is not a main focus for BLS, many BLS professionals may encounter situations where they would need to know the initial steps and immediate response before the arrival of the advanced neonatal resuscitation team.

Newborn resuscitation requires anticipation and preparation by health care professionals who train individually and as teams:

The links include prevention, recognition and activation, initial steps, ventilation, advanced resuscitation, postnatal care, and recovery:

Prevention
Recognition and Activation
Initial Steps
Ventilation
Advanced Resuscitation
Postnatal Care
Recovery

Chest Compressions

For adult cardiac arrest, rescuers should perform chest compressions with the patient on a firm surface and with the patient’s torso at approximately the level of the rescuer’s knees.

Ventilation

2025 (Updated): When a rescuer is providing ventilation (breaths) for an adult patient in cardiac arrest, it is reasonable for them to give enough tidal volume to produce visible chest rise. Rescuers should avoid hypoventilation (ie, too few breaths or too little volume) or hyperventilation (ie, too many breaths or too large a volume).

Why: Recent studies have shown that rescuers often don’t deliver ventilation in accordance with guidelines. In these studies, CPR with both effective ventilation and chest compressions was associated with improved outcomes.

Compression-to-Ventilation Ratio

2025 (Updated): It is reasonable for lay rescuers and health care professionals to perform CPR with cycles of 30 compressions followed by 2 breaths before placement of an advanced airway (eg, supraglottic airway or endotracheal tube).

Why: The majority of studies report no difference in patient outcomes between interrupted CPR with ventilation pauses and continuous chest compressions. However, recent evidence has shown that ventilation is often not adequate. The use of CPR with cycles of 30 compressions followed by 2 breaths—as opposed to continuous chest compressions—allows the rescuer to monitor for chest rise. By doing so, they can check for adequate ventilation.

AED Pad Placement

Anterolateral Placement

- Place both pads on the person’s bare chest. Place one pad vertically on the person’s right upper chest. The top of the pad should be just under the clavicle. Place the second pad horizontally on the person’s left lateral ribs. The middle of the pad should be below the axilla at the midaxillary line.
Anteroposterior (AP) Placement
- Options for AP pad placement include:
  - Placing one pad in the center of the person’s bare chest (anterior) and the other pad in the center of the person’s back (posterior)
  - Placing one AED pad on the left side of the chest, between the left side of the person’s sternum and left nipple, and the other pad on the left side of the person’s back, next to the spine
    Select the magnifier icon to zoom in on the image.

Defibrillation Pads

2025 (New): It might be reasonable for a rescuer to adjust the position of a patient’s bra instead of removing it when they are placing pads for defibrillation on an adult in cardiac arrest.

Why: Women experience significantly lower rates of public-access defibrillation compared with men. The need to apply pads or paddles directly to the bare chest may be a contributing factor. The option to adjust rather than remove a bra could mitigate factors like a rescuer’s discomfort with exposing a woman’s chest.

CPR for Adults With Obesity

2025 (New): CPR should be provided for adults with obesity who are in cardiac arrest by using the same techniques used for patients without obesity.

Why: A 2024 International Liaison Committee on Resuscitation scoping review included 34 observational studies evaluating cardiac arrest in adult patients with obesity and found no evidence to support changes from standard CPR.

Components of High-Quality CPR

2025 (New): For infants and children in cardiac arrest, interruptions in CPR should be minimized and pauses in chest compressions should be less than 10 seconds.

Sequence of Resuscitation

Why: Systematic reviews and meta-analyses from simulation studies suggest that the 2 thumb-encircling hands technique is superior for giving compressions to infants when compared with the 2-finger technique, particularly for achieving adequate depth. In a multicenter prospective observational registry study, the single-hand technique resulted in greater compression depth than the 2 thumb-encircling hands technique with infants. Additionally, there was no difference in chest compression rate between hand positions. The 2-finger technique was rarely used in this study, but when used, no chest compression segments were compliant with AHA guidelines. Given this, the heel-of-1-hand or 2 thumb-encircling hands technique is recommended for infants. The long-used 2-finger technique for infant CPR is no longer recommended.

Adult BLS Algorithm for Health Care Professionals

The Adult BLS Algorithm for Health Care Professionals was updated to illustrate the role of opioid antagonists (eg, naloxone) for suspected opioid overdose during respiratory and cardiac arrest.

Adult* Basic Life Support Algorithm for Health Care Professionals

Verify scene safety.
Check for responsiveness. Shout for nearby help. Activate emergency response system. Send someone to get AED/defibrillator.
Look for no breathing or only gasping, and check pulse (simultaneously). Is pulse definitely felt within 10 seconds?
Normal breathing, pulse felt: Monitor until advanced care arrives.
Abnormal breathing, pulse felt: Provide breaths, 1 breath every 6 seconds or 10 breaths/min. Check pulse every 2 minutes; if no pulse, start CPR. If suspected opioid overdose, administer opioid antagonist (eg, naloxone) if available.
No breathing or only gasping, pulse not felt: Start CPR. Perform cycles of 30 compressions and 2 breaths. Use AED/defibrillator as soon as it is available. If suspected opioid overdose, consider opioid antagonist (eg, naloxone).
AED arrives.
Check rhythm. Shockable rhythm?
Yes, shockable: Give 1 shock. Resume CPR immediately for 2 minutes (until prompted by AED/defibrillator to allow rhythm check). Continue until ALS professionals take over or person starts to move.
No, nonshockable: Resume CPR immediately for 2 minutes (until prompted by AED/defibrillator to allow rhythm check). Continue until ALS professionals take over or person starts to move.

Adult BLS for Lay Rescuers

Act Now. Save a Life.

Follow these steps to take action.

Unresponsive. No breathing, abnormal breathing (eg, gasping)
Activate emergency response. Get AED.
Start CPR. Press hard. Press fast in the center of the chest.
Apply AED pads. Follow AED prompts. Resume CPR for 2 minutes.
If suspected opioid overdose, give a dose of naloxone (if available). Resume CPR.
A simplified visual aid for lay rescuers emphasizes early activation of the EMS system and obtaining an automated external defibrillator (AED) in addition to initiation of chest compressions. (p. 20)

Toxicology: Opioid Overdose

2025 (New): For lay and trained rescuers, administering an opioid antagonist (eg, naloxone) may be reasonable for adults and children in cardiac arrest with suspected opioid overdose, provided that opioid antagonist administration does not interfere with the delivery of standard resuscitation, including high-quality CPR with breaths.

2025 (New): Adults and children who are treated for opioid overdose should receive an opioid antagonist and instruction on how to use it at the time of discharge from a health care setting.

Why: Opioid antagonists restore protective airway reflexes and reverse respiratory arrest from opioid overdose in adults and children. Opioid antagonists should be administered whenever opioid overdose is suspected.

No clinical trials have evaluated the role of opioid antagonists in adults or children with cardiac arrest. There is conflicting evidence about the efficacy of naloxone administration in animal studies and adult observational studies for undifferentiated cardiac arrest or cardiac arrest with suspected opioid overdose. However, there is no known harm from administering naloxone to someone in cardiac arrest, as long it does not interfere with standard resuscitation.

People who survive an opioid overdose are at high risk of a subsequent overdose. In addition to brief psychosocial interventions and referral to evidence-based treatment programs, providing take-home or “leave-behind” doses of opioid antagonists may prevent future fatal overdoses.

Public Access to Naloxone

NALOXONE OVERDOSE EMERGENCY KIT

2025 (New): Public policies should allow for possession, use, and immunity from civil and criminal liability for good-faith administration of naloxone by lay rescuers.

2025 (New): Naloxone distribution programs can be beneficial to increase naloxone availability among lay rescuers and decrease mortality from opioid-related overdose.

Why: Observational studies examined the impact of legislation that makes naloxone more readily available and protects lay rescuers from prosecution for possession or good-faith use. They also looked at programs aimed at distributing naloxone within communities. Researchers found that both are generally associated with reductions in mortality.

Clinical Debriefing

2025 (New): Incorporating immediate and delayed debriefing is reasonable and may identify different opportunities for system improvement.

Why: Studies examining debriefing use immediate and delayed methods. Neither has been proven to be superior, and the use of both may offer advantages.

Prevention of In-Hospital Cardiac Arrest

2025 (New): Implementation of safety huddles to improve situational awareness in scenarios involving high-risk hospitalized patients and mitigate their deterioration can be effective in reducing cardiac arrest rates.

Why: Two multicenter observational quality-improvement projects implemented a cardiac arrest bundle that included safety huddles around high-risk patients. These projects reduced in-hospital cardiac arrest within the pediatric cardiac and general intensive care units.

Post-Cardiac Arrest Recovery and Survivorship

Why: There is growing recognition that recovery from cardiac arrest continues long after initial hospitalization. Survivors may require ongoing integrated medical, rehabilitative, caregiver, and community support in the months and years after their cardiac arrest. A recent AHA scientific statement highlights the importance of supporting patients and families during this time to achieve the best possible long-term outcome.

Recovery and Survivorship After Cardiac Arrest

2025 (Updated): It is recommended that cardiac arrest survivors and their caregivers have structured assessment and treatment of or referral for emotional distress after medical stabilization and before hospital discharge.

Why: Approximately one fourth of cardiac arrest survivors and their caregivers experience emotional distress. Studies in survivor-caregiver pairs and in survivors showed improvements in emotional distress in those receiving a psychosocial intervention.

Foreign-Body Airway Obstruction: Adults

2025 (Updated): For adults with severe foreign-body airway obstruction (FBAO), repeated cycles of 5 back blows (slaps) followed by 5 abdominal thrusts should be performed until the object is expelled or the person becomes unresponsive.

Why: Studies of adults with FBAO showed that back blows were associated with improved rates of FBAO relief and fewer injuries compared with abdominal thrusts. The recommendation for alternating sets of 5 back blows and 5 abdominal thrusts is based on the value of consistency with existing infant and pediatric guidelines that use this approach.

Adult Foreign-Body Airway Obstruction

Verify scene safety.
Check for signs of severe FBAO: Weak or absence of cough, Unable to speak, Change in color (cyanosis), Altered mental status, Apnea.
Absent: Encourage cough. Continue to check for signs of severe FBAO.
Present: Activate emergency response system.
Is the adult responsive?
Yes: Start repeated cycles of 5 back blows (slaps), followed by 5 abdominal thrusts*. Repeat until object is expelled or the adult becomes unresponsive. If object is expelled, continue to monitor until advanced care arrives.
No: Start CPR until advanced care arrives; refer to adult BLS algorithm. Start with compressions. Check for visible object in mouth before giving breaths.

*For patients in the late stages of pregnancy, or when the rescuer is unable to encircle the patient’s abdomen, 5 chest thrusts should be used instead.

Foreign-Body Airway Obstruction: Children

2025 (Updated): For children with severe FBAO, repeated cycles of 5 back blows alternating with 5 abdominal thrusts should be performed until the object is expelled or the child becomes unresponsive (see the new FBAO algorithm). Rescuers should activate the emergency response system.

Why: Many FBAOs are relieved by allowing the patient to cough or, if severe, by lay rescuers using chest or abdominal thrusts. A recent observational study of adult and pediatric FBAOs suggests improved clearance of a foreign-body with the use of back blows over abdominal thrusts. For consistency in teaching, and in the absence of inferiority from pediatric data, managing severe FBAO in children now starts with a series of back blows instead of abdominal thrusts. Repeated cycles of 5 back blows followed by 5 abdominal thrusts are performed until the obstruction is cleared or the child becomes unresponsive. (p. 28)

Child Foreign-Body Airway Obstruction Algorithm

Verify scene safety.
Check for signs of severe FBAO: Weak or absence of cough, Unable to speak, Change in color (cyanosis), Altered mental status, Apnea.
Absent: Encourage cough. Continue to check for signs of severe FBAO.
Present: Activate emergency response system.
Is the child responsive?
Yes: Start repeated cycles of 5 back blows (slaps), followed by 5 abdominal thrusts. Repeat until object is expelled or the child becomes unresponsive. If object is expelled, continue to monitor until advanced care arrives.
No: Start CPR until advanced care arrives; refer to pediatric BLS algorithm. Start with compressions. Check for visible object in mouth before giving breaths.

Foreign-Body Airway Obstruction: Infants

Why: Abdominal thrusts are not recommended for infants, given the potential to cause abdominal organ injury. The heel-of-1-hand technique for chest thrusts is now recommended for infants with severe FBAO. While the heel-of-1-hand technique for chest thrusts resembles chest compressions that are used as part of CPR, there is no focus on the other components of high-quality CPR chest compressions (eg, rate, recoil). For that reason, the term chest compression is not used. If infants and children develop severe FBAO, EMS should be promptly activated because these patients can rapidly deteriorate into cardiac arrest. (p. 29)

Infant Foreign-Body Airway Obstruction Algorithm

Verify scene safety.
Check for signs of severe FBAO: Weak or absence of cough, Unable to cry, Change in color (cyanosis), Altered mental status, Apnea.
Absent: Encourage cough. Continue to check for signs of severe FBAO.
Present: Activate emergency response system.
Is the infant responsive?
Yes: Start repeated cycles of 5 back blows (slaps), followed by 5 chest thrusts. Repeat until object is expelled or the infant becomes unresponsive. If object is expelled, continue to monitor until advanced care arrives.
No: Start CPR until advanced care arrives; refer to pediatric BLS algorithm. Start with compressions. Check for visible object in mouth before giving breaths.

Knowledge Check

What are the links in the updated Chain of Survival?

Recognition and emergency activation, high-quality CPR, defibrillation, advanced resuscitation, post-cardiac arrest care, and recovery and survivorship (Correct)

Knowledge Check

Which of the following is true of providing CPR for adults with obesity who are in cardiac arrest?

There is no difference in technique based on the patient’s weight (Correct)

Education Updates

Use of Feedback Devices During CPR Training

2025 (Updated): Feedback devices are recommended for use during CPR training for health care professionals.

2025 (Updated): Feedback devices are recommended for use during CPR training for lay rescuers.

Teamwork and Leadership Training

2025 (Updated): It is recommended that life support training for health care professionals includes a specific emphasis on teamwork competencies.

Scripted Debriefing

2025 (New): It may be reasonable for an instructor to use a debriefing script during resuscitation education.

Why: Scripted debriefing involves a written plan for debriefing students during or after life support training. Standardized debriefing helps to maintain consistency in debriefings across training centers and resuscitation programs. Six studies with varying outcomes were identified.

Use of Cognitive Aids

BLS BASIC LIFE SUPPORT PROVIDER MANUAL

2025 (New): It may be reasonable for health care professionals to use cognitive aids during resuscitation.

2025 (New): It is not recommended for lay rescuers to use cognitive aids during resuscitation.

Why: Cognitive aids provide prompts aimed at encouraging recall of information. They increase the likelihood of correct performance and behaviors. Published simulation data suggest that cognitive aid use by health care professionals may improve resuscitation performance. In lay rescuers, cognitive aid use was associated with significant delays in starting CPR, leading to a recommendation against their use for lay rescuers. (p. 36)

Course Updates

Course Agendas

Agendas
- There are 3 agendas for the BLS instructor-led courses:
  - BLS Course Agenda
  - BLS Renewal Course Agenda
  - HeartCode® BLS Instructor-Led and Virtual Instructor-Led Hands-On Skills Session Agenda
  - Found in Part 3 of your 2025 BLS Instructor Manual
- Important change
  - All agendas should be followed as written.
- Contents
  - The BLS and BLS Renewal Course Agendas include video lessons, class discussion, and skills practice and testing
  - The HeartCode BLS Instructor-Led and Virtual Instructor-Led Hands-On Skills Session Agenda includes video lessons, hands-on skills practice, class discussions, and a testing session with an instructor (p. 40)

Lesson Plans

Lesson Plans
- There are lesson plans for the BLS instructor-led courses:
  - BLS Course Lesson Plans
  - BLS Renewal Course Lesson Plans
  - HeartCode BLS Lesson Plans
  - Found in Parts 6, 6A, and 7 of your 2025 BLS Instructor Manual
Important
- All lesson plans should be followed as written
Contents
- There are 3 required instructor-led student practice activities:
  - AED
  - 2-rescuer adult BLS with AED
  - High-performance teams
- Instructor-led discussions have been added throughout lessons
- Play the practice-while-watching videos through once before students practice

BLS Video Updates

Course video updates include
- 2025 Guidelines updates
- Live-action scenarios
- An adult female patient in cardiac arrest

Course Tracks

Course tracks (Selected)
- 2 main course tracks for the BLS audience
- In-hospital track: For anyone who works or volunteers inside the hospital
- Out-of-hospital track: For anyone who works or volunteers outside of the hospital
Tailored content (Selected)
- Both tracks
  - Include the same course content
  - Present scenarios tailored to the audience

Skill Updates

Infant BLS
- No longer teaching 2-finger chest compressions
- Instead, use the heel-of-1-hand or the 2 thumb–encircling hands technique
Adult and child choking
- Administer sets of 5 back blows followed by 5 abdominal thrusts
- Alternate between the 2 until the object is dislodged or the person becomes unresponsive
Infant choking
- Administer sets of 5 back blows followed by 5 chest thrusts
- Use the heel of 1 hand in the middle of the chest for chest thrusts
- No longer teaching 2-finger technique for chest thrusts

Knowledge Check

Your class is made up of 3 respiratory therapists, an environmental services worker, 5 nurses, 2 physical therapists, a social worker, and a child life specialist. Which BLS course track would be most appropriate?

(✓) In-hospital
- That’s correct! The BLS course track that is most appropriate for this audience is the in-hospital track.

Knowledge Check

Which technique is no longer recommended for infant compressions?

(✓) The 2-finger technique
- That’s correct! The 2-finger technique is no longer recommended for infant compressions.

Team Dynamics: Debriefing Update

Awareness
- The BLS course update acknowledges that resuscitations can be traumatic, even for experienced health care professionals
- Be prepared for students to express concerns
Professional help
- The 2025 BLS course advises seeking professional help if experiencing post-traumatic stress reactions, such as:
  - Replaying events or questioning one’s role in the resuscitation
  - Feeling sad, angry, or not sleeping
  - Immediate help from a professional to process emotions is encouraged

Instructor Renewal Updates

Requirements
- The BLS instructor renewal requirements were updated for 2025
- You are required to earn 4 credits during the 2 years of your instructor recognition
Community CPR classes
- Beginning with the 2025 update, you can now receive a maximum of 2 credits by facilitating any of the following community CPR classes:
  - Family & Friends®
  - CPR in Schools® With First Aid
  - CPR & First Aid in Youth Sports®
  - CPR Anywhere
Credits
- Each class you facilitate counts as 1 credit
- You can count a maximum of 2 credits by facilitating any of these classes
- You must submit a course roster to obtain your credit

Conclusion

This concludes the 2025 BLS Instructor Update Course. The information is based on the 2025 Guidelines.

Resources: eccguidelines.heart.org | cpr.heart.org | atlas.heart.org

Heartsaver® Instructor Update and Product and Course Orientation Bundle

Welcome to the Heartsaver® Instructor Update and Product and Course Orientation (PCO) Bundle!

NOTE: All United States (US) Palm Desert Resuscitation Education LLC (PDRE) AHA Instructors must complete their required science update by 11:59 p.m. February 28, 2026, to continue teaching AHA courses. The P&CO provides different and separate updates from the 2025 AHA Guidelines Instructor Update Course for Heartsaver. Completion of the P&CO is optional for current Heartsaver/BLS Instructors.

Heartsaver® Product and Course Orientation

The Heartsaver Product and Course Orientation (P&CO) is designed to help Heartsaver Instructors understand the new, 2025 Heartsaver Course design and teaching strategies, and to quickly get up to speed on the latest and most important updates to the Heartsaver Course materials.
Quick Facts:
- Online Instructions
- Possible CEH
- 0.5 Hour Online Course
- KJ-1926 Course code

Heartsaver® Instructor Update

The 2025 AHA Guidelines Heartsaver Instructor Update Course provides AHA Instructors updates on new science and key changes published in the 2025 AHA Guidelines for CPR and ECC. It also delivers Interim Training Materials and guidance on how to use these materials to incorporate 2025 science and education updates. All US AHA Instructors must complete their required science update by 11:59 p.m. February 28, 2026, to continue teaching AHA courses.
Quick Facts:
- Online Instructions
- Possible CEH
- 1 Hour Online Course
- 25-1636 Course code

Heartsaver 2025 Instructor Update

2025 GUIDELINES AMERICAN HEART ASSOCIATION FOR CPR AND ECC

The American Heart Association (AHA) recently released new science and education recommendations that are documented in the 2024 AHA and American Red Cross Guidelines for First Aid and the 2025 AHA Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC).

Learning Objectives

At the end of this course, you’ll be able to:

Describe the 2025 Heartsaver science updates and their rationale
Describe the 2025 Heartsaver education updates and their rationale
Describe the 2025 Heartsaver course updates, their rationale, and their application to Heartsaver training

Science Updates

Opioid Overdose

2024 (New): It is beneficial for first aid providers to receive training in responding to opioid overdose, including the administration of naloxone.

2024 (New): A first aid provider who encounters a person with suspected opioid overdose who is unresponsive and not breathing or not breathing normally should activate the emergency response system, provide CPR (ie, compressions plus breaths), and administer naloxone.

Why: Opioid overdose is a major cause of preventable death in the United States, Canada, and elsewhere. Opioid overdose is currently addressed in adult and pediatric basic and advanced life support training. But earlier first aid recommendations did not include first aid for opioid overdose. Naloxone reverses the effect of opioid overdose, restoring consciousness and breathing, and often preventing cardiac arrest. Naloxone nasal spray is available in the United States and Canada without a prescription. Many studies show the benefit of naloxone administration by community members, and rates of naloxone administration increase when community members receive training. Adding opioid overdose treatment, including naloxone administration, to first aid training multiplies the number of community members willing and able to perform this lifesaving skill.

Act Now. Save a Life.

Unresponsive:
- Follow these steps to take action. No breathing, abnormal breathing (eg, gasping). Activate emergency response. Start CPR. Press hard. Press fast in the center of the chest. Get AED. Apply AED pads. Follow AED prompts. Resume CPR for 2 minutes. If suspected opioid overdose, give a dose of naloxone (if available). Resume CPR.

Recognition of Stroke in Children

2024 (New): If pediatric stroke is suspected, EMS should be activated, and the person should be transported to an emergency department.

2024 (New): It is reasonable to consider stroke when common pediatric symptoms are present in association with other neurological signs and symptoms.

2024 (New): Adult stroke scores are not validated in the pediatric population and should not solely be used to identify the broad presentation of stroke in children.

Why: While previous first aid guidelines have included recognition of stroke in adults, approximately 40,000 children worldwide experience stroke each year. The initial signs and symptoms of stroke in children are often missed. This results in delayed diagnosis and potentially the missed opportunity to intervene. Although pediatric stroke can present in similar ways to adult stroke, it can also present in nonspecific ways and mimic other childhood diseases.

SPOT A STROKE™ F.A.S.T.

FACE Drooping
ARM Weakness
SPEECH Difficulty
TIME to Call 911

Recognition of Stroke in Adults

2024 (New): If stroke is suspected, the EMS system should be activated immediately.

2024 (New): It is reasonable for first aid providers to measure capillary blood glucose in adults with suspected stroke if it is available and does not delay activating EMS.

SPOT A STROKE™
- F.A.S.T.
  - FACE Drooping
  - ARM Weakness
  - SPEECH Difficulty
  - TIME to Call 911
- Learn more at stroke.org

Bee, Wasp, and Hornet Stings

2024 (New): If a person experiences a severe allergic reaction due to a bee, wasp, or hornet sting and an epinephrine autoinjector is available, the person should self-administer the autoinjector.

2024 (New): A first aid provider should help someone experiencing a severe allergic reaction use the autoinjector, if assistance is required.

2024 (New): If a person experiences a severe allergic reaction due to a bee, wasp, or hornet sting, the emergency response system should be activated.

2024 (New): Stings to the eye should be evaluated by a trained medical professional.

2024 (New): Removal of a stinger remaining in the skin, as soon as possible, by plucking or scraping, can be beneficial.

2024 (New): Over-the-counter oral antihistamines can be used to alleviate local itching.

2024 (New): Topical anti-inflammatory medications can be used to alleviate local itching.

2024 (New): It is reasonable to wash the area of a bee, wasp, or hornet sting with soap and water.

Tick Bites

2024 (New): Tick bites occurring in regions with high prevalence of Lyme disease should receive prompt consultation with a health care professional within 72 hours after removal of an engorged tick.

2024 (New): We recommend removing a tick as soon as possible.

2024 (New): To remove a tick, we recommend grasping the head of the tick as close to the skin as possible with tweezers or a commercial tick removal device and pulling upward with steady, even pressure.

Why: At least 48,000 people are diagnosed with tick-borne illness in the United States annually. More than 100,000 seek treatment in emergency departments for tick bite exposure. The incidence of tick-borne illness and range of the Ixodes tick are increasing. Early removal of the tick (generally within 24-48 hours of attachment) can prevent Lyme disease transmission. But the tick has to be removed properly to successfully extract its mouth parts and minimize the risk of infection.

Spider Bites and Scorpion Stings

2024 (New): Emergency services should be called if a person bitten by a spider or stung by a scorpion develops symptoms throughout the body, such as difficulty breathing, muscle rigidity, dizziness, or confusion.

2024 (New): A person bitten by a spider or stung by a scorpion should seek medical care if pain extends beyond the site of the bite or sting, becomes severe, and is not controlled by over-the-counter pain medications; if an open wound develops; or if the person experiences symptoms throughout the body.

2024 (New): Over-the-counter acetaminophen and nonsteroidal anti-inflammatory agents can be used to alleviate local pain from scorpion stings.

2024 (New): If the skin is intact, topical lidocaine can be useful to relieve local pain from scorpion stings.

2024 (New): Ice can be useful for local pain relief from scorpion stings.

Why: Bites from black widow and related spiders (found throughout the United States (except Alaska) and in southern Canada) cause severe muscle pain, cramping, and rigidity, along with excessive sweating and hypertension. Although a rash is sometimes observed around the bite site, black widow spider bites do not cause local tissue injury. Bites from brown recluse and related spiders (found in the southern half of the United States) cause painful ulcerated wounds that progress over days to weeks. Bark scorpion (found in the desert Southwest) stings cause severe localized pain and muscle cramping that may impair breathing in children. The effects of spider and scorpion bites and stings vary widely around the world. The 2024 Guidelines for First Aid equip first aid providers to manage spider bites and scorpion stings occurring in the United States and Canada.

Suspected Foreign Body in the Eye

2024 (New): A person who sustains a high-velocity eye injury (such as injuries from grinding, nailing, or machinery), penetrating eye injury from a sharp or metal object at a high speed, irregular pupil after trauma, eye bleeding after trauma, or loss of vision after trauma should seek immediate medical attention.

2024 (New): A person who has persistent foreign-body sensation in the eye should seek immediate medical attention.

2024 (New): A person who develops a foreign-body sensation in the eye associated with contact lens use should remove the contact lens, discontinue contact lens use, and seek medical attention.

2024 (New): A person with a foreign-body sensation in the eye should not rub their eye.

2024 (New): Taping a hard plastic shield, paper cup, or plastic cup over the eye can help prevent unintentional touching of the eye.

2024 (New): It is reasonable for a person with a foreign body in the eye from a low-energy mechanism (eg, dust, dirt, other object blown into the eye by wind; eyelash in the eye) to attempt to remove the foreign body by allowing natural tears to wash out the object or by flushing out the eye with tap water or a commercial eye wash solution.

2024 (New): It is reasonable to take over-the-counter oral acetaminophen or nonsteroidal anti-inflammatory drugs to treat residual discomfort after the removal of a foreign body in the eye.

Why: Eye injuries are a common reason people seek treatment in emergency departments. About half of these injuries are due to foreign bodies in the eye. A foreign-body sensation can be caused by a loose foreign body or a foreign body embedded on the surface of the cornea. It can also result from a scratch on the eye, ultraviolet radiation exposure, a penetrating eye injury, chemical injury, or infection. While many of these conditions require treatment by a health care professional, these injuries can often be safely managed in the first aid setting.

Nosebleed

2024 (New): A person experiencing a nosebleed should sit with their head slightly forward with their nostrils pinched for 10 to 15 minutes.

2024 (New): A person experiencing a nosebleed that does not stop after 15 minutes of continuous manual pressure or who becomes lightheaded from a nosebleed should seek medical attention.

2024 (New): A person with a nosebleed due to trauma should seek medical attention if they experience signs of brain injury, obvious nasal deformity, or signs of facial fracture.

2024 (New): It is reasonable for a person experiencing a nosebleed who is taking anticoagulant or antiplatelet medication or who has a blood-clotting disorder to seek care from a health care professional unless the bleeding has stopped.

2024 (New): The usefulness of cryotherapy (ie, ice) for managing a nosebleed in the first aid setting is unknown.

Why: Nosebleeds are responsible for 1 in every 313 emergency department visits in the United States. Most nosebleeds can be treated by pinching and holding the front of the nose for 10 to 15 minutes without medical care. However, a nosebleed can be a true medical emergency, particularly in older adults and people taking anticoagulant or antiplatelet medications.

Snakebite

2024 (Updated): Emergency services should be activated for any person bitten by a venomous or possibly venomous snake.

2024 (Updated): It is reasonable to rest and immobilize the bitten extremity and minimize exertion by the person who was bitten if it does not delay access to emergency medical care.

2024 (Updated): It is reasonable to remove rings and other constricting objects from the bitten extremity.

2024 (Updated): Application of ice to a snakebite wound is of unproven benefit and may be harmful in some situations.

2024 (Updated): The use of suction, tourniquets, and pressure immobilization bandaging, as well as the application of electric shock, to treat snakebites is potentially harmful.

Why: About 8,000 to 10,000 people are treated for snakebites in the United States each year. More than 95% of venomous bites in North America are caused by pit vipers. The definitive treatment for snakebites is antivenom, which can only be administered by a health care professional. Many first aid treatments have known risks and unclear benefits.

Use of Inhalers in Asthma

2024 (Updated): First aid providers should help a person with asthma who is having difficulty breathing use their own prescribed inhalers, as needed.

2024 (Updated): It is reasonable to use either an inhaler with a spacer or a nebulizer when helping a person with asthma use their own inhaler medication, in preference to using an inhaler alone.

2024 (Updated): If a commercially available spacer is not available, it is reasonable to use an improvised spacer when helping a person who is having an asthma attack use their own inhaler medication.

Why: The 2024 Guidelines for First Aid strengthen the recommendations to use spacers, including improvised spacers (eg, from a beverage bottle), when a commercial spacer is not available.

Seizures

2024 (Updated): First aid providers should activate EMS for the reasons listed below.

2024 (Updated): First aid providers should minimize the risk of injury by helping the person to the ground, placing them on their side in the recovery position, and clearing the area.

2024 (Updated): First aid providers should stay with the person having a seizure.

2024 (Updated): For children who have experienced a febrile seizure, antipyretics are not effective for stopping or preventing them.

2024 (Updated): The person having the seizure should not be restrained.

2024 (Updated): Nothing should be put in the mouth.

Reasons to Activate the Emergency Response System for Seizures:

First-time seizure
Seizure in an infant <6 months of age
Seizure lasting >5 minutes
Seizure in a person who is pregnant
More than 1 seizure that occurs without return to baseline mental status in between
Person does not return to baseline within 5-10 minutes after seizure has stopped
Seizure with traumatic injuries
Seizure with choking
Seizure with difficulty breathing
Seizure occurring in the water

Hypothermia

2024 (Updated): Protect from further heat loss by moving to a warm environment and using blankets.

2024 (Updated): For alert patients, provide high-calorie foods or drinks.

2024 (Updated): It is not beneficial to use body-to-body rewarming over other techniques like chemical heat packs.

2024 (Updated): Heat sources, rubbing, and massage should not be applied to extremities.

2024 (Updated): Warm showers or water immersion for moderate/severe hypothermia are potentially harmful.

Rewarming strategies by level:

Cold stress (35-37 °C, 95-98.6°F): Remove from cold environment; protect from further heat loss.
Mild hypothermia (32-35 °C, 89.6-98.6°F): Passive and active rewarming methods; seek additional care.
Moderate hypothermia (28-32 °C, 82.4°F): Medical emergency; employ all available rewarming methods; activate EMS.
Severe/Profound (<28 °C, 82.4°F): Handle gently; activate EMS.

Frostbite

2024 (Updated): The preferred method for warming frostbitten tissue is clean lukewarm water immersion at 37 to 40°C (99-104°F).

2024 (Updated): Rewarm at the earliest opportunity, as long as there is no risk of refreezing.

2024 (Updated): If water immersion is not feasible, allow spontaneous rewarming in room air or next to warm skin.

2024 (Updated): Seek prompt medical attention.

2024 (Updated): Remove jewelry or constricting materials.

2024 (Updated): Treat moderate to severe hypothermia (core rewarming) before treating frostbite.

2024 (Updated): Protect tissue from further injury; avoid walking on frozen feet.

2024 (Updated): Apply bulky, clean, dry gauze or sterile cotton dressings wrapped loosely.

2024 (Updated): Ibuprofen may be reasonable for pain and to prevent tissue damage.

2024 (Updated): Do not debride blisters.

Oral Rehydration of Exertional Dehydration

2024 (Updated): Assist or encourage individuals with exertional dehydration to orally rehydrate with any available drink or water.

2024 (Updated): It is reasonable to choose 4% to 9% carbohydrate-electrolyte drink over potable water or other options if readily available.

Why: This fluid is generally retained better than other options.

Jellyfish Stings

2024 (Updated): Observe for systemic reaction and call EMS for difficulty breathing, shock, or severe pain.

2024 (Updated): Remove tentacles by lifting or pulling; rinsing with seawater is an alternative. Mechanical removal (tweezers) is first-line.

2024 (Updated): Use nonscalding hot water immersion or irrigation for pain control.

2024 (Updated): Topical lidocaine cream/gel is reasonable if hot water is not available.

Why: Vinegar, baking soda, urine, and meat tenderizer showed no consistent positive data.

Care of Thermal Burns After Cooling

2024 (Updated): Seek prompt evaluation for full-thickness burns, or partial-thickness burns larger than the palm or involving face, hands, feet, or genitals.

2024 (Updated): Activate EMS for signs of smoke inhalation injury.

2024 (Updated): Remove jewelry and tight items.

2024 (Updated): Over-the-counter pain medications are reasonable.

2024 (Updated): For small partial-thickness burns at home, apply petroleum jelly, honey, or aloe vera and a clean nonadherent dressing.

Dental Avulsion

2024 (Updated): Rinse tooth briefly (<10 seconds) and attempt to replant in socket.

2024 (Updated): Seek immediate care. Bring the tooth if not replanted.

2024 (Updated): Do not store in tap water.

Storage Media Options (ranked):

First choice: Hanks Balanced Salt Solution, oral rehydration salt solutions, propolis solution, rice water, wrapping in cling film.
Second-line: Cow’s milk, person’s saliva.
Third-line: Another person’s saliva, probiotic media, egg white, almond milk.

Knowledge Check

Scenario: You encounter an unresponsive person with suspected opioid overdose who is not breathing or not breathing normally. What are the appropriate next steps?

(✓) Correct Step: Activate the emergency response system, provide CPR, and administer naloxone (for an unresponsive person with suspected opioid overdose, not breathing normally)
- For someone who encounters an unresponsive person with suspected opioid overdose who is not breathing or not breathing normally, the appropriate first aid steps are to activate the emergency response system, provide CPR, and administer naloxone.

Knowledge Check

Scenario: When are first aid provider is caring for someone with a bee sting who begins to show signs of a severe allergic reaction, which of the following are appropriate measures to take before emergency responders arrive? (Caring for someone with a bee sting showing signs of a severe allergic reaction)

Correct Step: Administer an epinephrine autoinjector.
- When caring for a person with signs and symptoms of a severe allergic reaction after a bee, wasp, or hornet sting, use of epinephrine and activation of emergency response is appropriate.

Public Access to Naloxone

NALOXONE OVERDOSE EMERGENCY KIT

2025 (New): Public policies should allow for possession, use, and immunity for good-faith administration by lay rescuers.
2025 (New): Naloxone distribution programs can be beneficial to increase naloxone availability among lay rescuers and decrease mortality from opioid-related overdose.

Toxicology: Opioid Overdose

Give naloxone and continue to monitor responsiveness and breathing

2025 (New): For lay and trained rescuers, administering an opioid antagonist (eg, naloxone) may be reasonable for adults and children in cardiac arrest with suspected opioid overdose, provided that opioid antagonist administration does not interfere with the delivery of standard resuscitation, including CPR with breaths
2025 (New): Adults and children who are treated for opioid overdose should receive an opioid antagonist and instruction on how to use it at the time of discharge from a health care setting.

Why: Opioid antagonists restore protective airway reflexes and reverse respiratory arrest from opioid overdose in adults and children.; Opioid antagonists should be administered whenever opioid overdose is suspected. No clinical trials have evaluated the role of opioid antagonists in adults or children with cardiac arrest. There is conflicting evidence about efficacy of naloxone administration in animal studies and adult observational studies for undifferentiated cardiac arrest or cardiac arrest with suspected opioid overdose. However, there is no known harm from administering naloxone to someone in cardiac arrest, as long as it does not interfere with standard resuscitation. People who survive an opioid overdose are at high risk of a subsequent overdose. In addition to brief psychosocial interventions and referral to evidence-based treatment programs, providing “take-home” or “leave-behind” doses of opioid antagonists may prevent future fatal overdoses.

Community Initiatives to Improve Lay Rescuer Response to Out-of-Hospital Cardiac Arrest

2025 (Updated): Implementing a bundle of community initiatives is a reasonable strategy to improve lay rescuer response to an out-of-hospital cardiac arrest (OHCA).
2025 (New): Increasing the availability of instructor-led training in communities can be effective to improve lay rescuer response to OHCA.
2025 (New): Mass media campaigns may be considered to promote learning of CPR skills in all populations.
2025 (New): ): It may be reasonable for communities to implement policies that require CPR certification in the general public.

Why: Improving lay rescuer response requires a multifaceted approach. Existing evidence supports numerous interventions as being effective.

Components of CPR

2025 (New): For infants and children in cardiac arrest, interruptions in CPR should be minimized; pauses in compressions should be less than 10 seconds.

Why: Evidence demonstrated that increased frequency and duration of pauses in CPR were significantly associated with a lower probability of achieving return of spontaneous circulation.

Sequence of Resuscitation

2025 (Updated): For infants, rescuers should compress the breastbone with the heel of 1 hand or use the 2 thumb-encircling hands technique. If the rescuer cannot physically encircle the chest, it is recommended to compress the breastbone with the heel of 1 hand.

Why: Systematic reviews and meta-analyses from simulation studies suggest that the 2 thumb-encircling hands technique is superior for giving compressions to infants when compared with the 2-finger technique, particularly for achieving adequate depth. In a multicenter prospective observational registry study, the single-hand technique resulted in greater compression depth than the 2 thumb-encircling hands technique with infants. Additionally, there was no difference in chest compression rate between hand positions. The 2-finger technique was used rarely in this study, but when used, no chest compression segments were compliant with AHA guidelines. Given this, the heel-of-1-hand or 2 thumb-encircling hands technique is recommended for infants. The long-used 2-finger technique for infant CPR is no longer recommended.

Foreign-Body Airway Obstruction: Infants

2025 (Updated):For infants with severe foreign-body airway obstruction (FBAO), repeated cycles of 5 back blows alternating with 5 chest thrusts should be performed until the object is expelled or the infant becomes unresponsive. Rescuers should activate the emergency response system.

Why: Abdominal thrusts are not recommended for infants, given the potential to cause abdominal organ injury. The heel-of-1-hand technique for chest thrusts is now recommended for infants with severe FBAO. While the heel-of-1-hand technique for chest thrusts resembles chest compressions that are used as part of CPR, there is no focus on the other components of high-quality CPR chest compressions (eg, rate, recoil). For that reason, the term chest compression is not used. If infants and children develop severe FBAO, EMS should be promptly activated because these patients can rapidly deteriorate into cardiac arrest.

Foreign-Body Airway Obstruction: Children

2025 (Updated): For children with severe FBAO, repeated cycles of 5 back blows alternating with 5 abdominal thrusts should be performed until the object is expelled or the child becomes unresponsive. Rescuers should activate the emergency response system.

Why: Many FBAOs are relieved by allowing the patient to cough or, if severe, by lay rescuers using chest or abdominal thrusts. A recent observational study of adult and pediatric FBAOs suggests improved clearance of a foreign body with the use of back blows over abdominal thrusts. For consistency in teaching, and in the absence of inferiority from pediatric data, managing severe FBAO in children now starts with a series of back blows instead of abdominal thrusts. Repeated cycles of 5 back blows followed by 5 abdominal thrusts are performed until the obstruction is cleared or the child becomes unresponsive.

Ventilation

2025 (Updated):When a rescuer is providing ventilation (ie, breaths) for an adult patient in cardiac arrest, it is reasonable for them to give enough tidal volume to produce visible chest rise. Rescuers should avoid hypoventilation (ie, too few breaths or too little volume) or hyperventilation (ie, too many breaths or too large a volume).

Why: Recent studies have shown that rescuers often fail to give breaths that meet guidelines. In these studies, CPR with both effective breaths and chest compressions was associated with improved outcomes.

Defibrillation Pads

2025 (New): It might be reasonable for a rescuer to adjust the position of a person’s bra instead of removing it when they are placing pads for defibrillation on an adult in cardiac arrest.

Why: Women experience significantly lower rates of public-access defibrillation compared with men. The need to apply pads or paddles directly to the bare chest may be a contributing factor. The option to adjust rather than remove a bra could reduce a rescuer’s discomfort with exposing a woman’s chest.

CPR for Adults With Obesity

2025 (New): Use the same techniques as for patients without obesity.

Knowledge Check

Which method is recommended for relieving choking in an infant?

Cycles of 5 back blows followed by 5 chest thrusts.
- To relieve choking in an infant, perform repeated cycles of 5 back blows followed by 5 chest thrusts. Select Next to continue.

Which of the following is true of providing CPR for adults with obesity who are in cardiac arrest?

There is no difference in technique based on the patient’s weight
- To relieve choking in an infant, perform repeated cycles of 5 back blows followed by 5 chest thrusts. Select Next to continue.

Education Updates

Use of Feedback Devices During CPR Training

2025 (Updated): Recommended for use during training for both health care professionals and lay rescuers.

2025 (Updated): Feedback devices are recommended for use during CPR training for lay rescuers.

Why: A meta-analysis of several new randomized controlled trials conducted with health care professionals demonstrated that CPR feedback devices had a moderate to large effect on all CPR quality metrics. Three trials with lay rescuers demonstrated that feedback devices were effective in increasing mean CPR quality metrics.

Opioid Overdose Training for Lay Rescuers

2025 (Updated): Recommended that lay rescuers receive education on recognition and initial treatment steps.

2025 (Updated): The optimal training method for lay rescuers in recognizing and intervening in opioid overdose has not been established.

Why: Three recent systematic reviews of over 140 studies summarized the impact of lay rescuer training in opioid overdose recognition and treatment. They found that this training increased knowledge, improved willingness to respond, and increased likelihood of naloxone use.

Disparities in Education

2025 (Updated): It is recommended to focus and tailor lay rescuer CPR training to specific racial and ethnic populations as well as neighborhoods with high densities of these populations and incorporate awareness efforts in these areas.

2025 (Updated): It is recommended to address barriers to performing lay rescuer CPR on women through educational training and public awareness efforts.

2025 (Updated): It is recommended to focus on low socioeconomic status populations and neighborhoods for lay rescuer CPR training and awareness efforts.

2025 (Updated): It is reasonable to address barriers to linguistically isolated communities by increasing availability and access to CPR training materials in diverse languages.

2025 (Updated): It is reasonable to consider cost-effective methods for CPR training and to promote safe access to CPR training for low socioeconomic status populations and settings.

Why: There are known disparities due to social factors in both people who receive CPR outside the hospital and availability of CPR training. Targeting specific racial, ethnic, and socioeconomic populations for CPR education and modifying education to address sex and gender differences could eliminate disparities in CPR training and lay rescuer CPR. This would potentially enhance cardiac arrest outcomes in these populations. Specific recommendations have been made for cost-effective CPR training methods in low-income neighborhoods and linguistically isolated communities.

Course Updates

Survivor Stories

Put students in shoes of real lay rescuers
Showcase real-life emergencies
Develop emotional connection
Promote critical thinking and motivation

Course Delivery Methods

Instructor-led training: Video-based “practice-while-watching” technique.
Blended learning: Online eLearning followed by in-person skills assessment.
Self-directed (Heartsaver Direct): Independent online portion and skills assessment using specialized manikin station.
Virtual: Training kit and app combined with virtual hands-on skills session with an instructor.

Course Overview & Paths

5 Course Paths: Heartsaver Total First Aid CPR AED, Heartsaver Basic First Aid CPR AED, Heartsaver CPR AED, Heartsaver First Aid, Heartsaver Pediatric First Aid CPR AED (p. 1).
Instruction: Ensure students take the correct course path. Refer to Part 4 of the 2025 Heartsaver Instructor Manual

New Topics for 2025

For the 2025 course, two new topics were identified based on workplace feedback and OSHA priorities:

Preventing repetitive stress injuries and overexertion: Focuses on reducing risks through practical strategies
Recognizing signs of mental health crisis in the workplace: Addresses suicide as a leading cause of death and the impact of workplace violence

Notable Updates & Practice

Course Updates: Learning objectives were updated. Tested skills for first aid now include responding to a first aid emergency (formerly “finding the problem”) and controlling bleeding and bandaging
Hands-on Practice: Includes removing gloves, using an epinephrine autoinjector, and splinting
Videos:
- Abridged versions of child and infant videos eliminate content duplication
- New practice-while-watching video for CPR combines compressions and breaths
- Drowning topics updated based on 2025 Guidelines
- New demonstration video for administering naloxone
Video Formats: Available via DVD, USB, and downloadable streaming (for offline use on up to 3 devices). Menus have been reformatted for ease of use

Skill Updates

Infant Compressions: No longer teaching the 2-finger chest compression technique. Use the heel-of-1-hand or the 2 thumb-encircling hands technique
Adult and Child Choking: Administer sets of 5 back blows followed by 5 abdominal thrusts until the object is dislodged or the person is unresponsive
Infant Choking: Administer sets of 5 back blows followed by 5 chest thrusts using the heel of one hand. The 2-finger technique for chest thrusts is no longer taught

Manuals & Resources

Instructor Manual: Adult and pediatric manuals have been combined. New “Guiding Questions” and discussion prompts are included to maximize active learning and engagement
Student Workbook: Adult and pediatric topics are combined in one book. It features alphabetized topics and a one-page reference guide available on Atlas (
Key Resource Links:
- 2025 AHA Guidelines: eccguidelines.heart.org
- Resuscitation Resources: cpr.heart.org
- Interim Materials: atlas.heart.org

American Heart Association

This concludes the 2025 Heartsaver Instructor Update. The information in this course is based on updated science and education recommendations in the 2025 Guidelines; key issues and changes are summarized in the Highlights document of the 2025 Guidelines.
For more information, please refer to these resources.

2025 AHA Guidelines (full chapters) and AHA Highlights of the 2025 Guidelines: eccguidelines.heart.org
Resuscitation education resources: cpr.heart.org
Interim training materials: atlas.heart.org
Next, you’ll take the posttest to complete the course.

Post-Course Q&A Summary

Naloxone: Administration should not interfere with CPR
Defibrillation (Females): Rescuers may adjust a bra rather than remove it to increase public access defibrillation rates
Feedback Devices: Recommended because they increase mean CPR quality metrics
Survivor Stories: Included to help students develop an emotional connection to the content

Would you like me to clarify any of the specific skill changes for 2025?

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2025 ACLS Instructor Update

Quick Facts:

The American Heart Association (AHA) recently released new science and education recommendations for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) that are documented in the 2025 AHA Guidelines for CPR and ECC.

Learning Objectives

2025 ACLS Science Updates

2025 ACLS Education Updates

2025 ACLS Course Updates

ACLS High-Quality BLS Learning and Testing Station

2025 ACLS Product & Course Orientation

Quick Facts:

PALS Instructor Update

Quick Facts:

PALS Product & Course Orientation

Quick Facts:

2025 PALS Science Updates

Education Updates

2025 PALS Course Updates

2025 PEARS Instructor Update

Quick Facts:

BLS Product & Course Orientation

Quick Facts:

2025 BLS Instructor Update

Quick Facts:

BLS 2025 Instructor Update

Learning Objectives

Science Updates

Education Updates

Course Updates

Heartsaver® Product and Course Orientation

Quick Facts:

Heartsaver® Instructor Update

Quick Facts:

Heartsaver 2025 Instructor Update

Science Updates

Education Updates

Course Updates

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