The American Heart Association's 2025 Adult Basic Life Support Guidelines build upon prior versions with updated recommendations for assessment and management of persons with cardiac arrest, as well as respiratory arrest and foreign-body airway obstruction. The chapter addresses the important elements of adult basic life support including initial recognition of cardiac arrest, activation of emergency response, provision of high-quality cardiopulmonary resuscitation, and use of an automated external defibrillator. In addition, there are updated recommendations on the treatment of foreign-body airway obstruction. The use of opioid antagonists (eg, naloxone) during respiratory or cardiac arrest is incorporated into the adult basic life support algorithms, with more detailed information provided in "Part 10: Adult and Pediatric Special Circumstances of Resuscitation."

The guidelines in this document from the American Heart Association and the American Academy of Pediatrics focus upon optimal care of the newborn infant, including those who are proceeding to a normal transition from the fluid-filled uterine environment to birth. Newborn infants who are proceeding to normal transition can benefit from deferred cord clamping for at least 60 seconds in most instances, skin-to-skin with their parent soon after birth, and appropriate assistance with thermoregulation. Some newborn infants require assistance during transition, with interventions ranging from warming and tactile stimulation to advanced airway management, assisted ventilation, oxygen therapy, intravascular access, epinephrine, and volume expansion. In this context, individuals, teams, and health care settings that care for newborn infants should be prepared and have access to appropriate training and resources for neonatal resuscitation. The newborn chain of care provides guidance on considerations that may lead to optimal outcomes for newborn infants starting from prenatal care to recovery and follow-up.

Improving survival and quality of life after cardiac arrest requires integrated systems of people, protocols, policies, and resources along with ongoing data acquisition and review. Such systems of care, which are highly influenced by the environment in which they operate, produce efficiency and effectiveness in responding to cardiac arrest. Part 4 of the 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care focuses on systems of care, emphasizing elements that are relevant to a broad range of resuscitation situations. The chapter follows the Chain of Survival, beginning with prevention and preparedness to resuscitate, proceeding to early identification of cardiac arrest, and moving to effective resuscitation through to post-cardiac arrest care, survivorship, and recovery. This Part provides cardiac arrest systems of care guidelines on how to train specific personnel, protocols that have been demonstrated to be effective, as well as the incorporation of nonhuman resources to optimize cardiac arrest care with ongoing debriefing and quality improvement strategies. Specific to out-of-hospital cardiac arrest, included are recommendations about emergency medical services team composition and transport recommendations, community initiatives to promote lay rescuer response, public access defibrillation and naloxone, and an enhanced role for emergency telecommunicators. Germane to in-hospital cardiac arrest are recommendations about cardiac arrest prevention and code team composition. Specific recommendations about extracorporeal membrane oxygenation cardiopulmonary resuscitation, transport to specialized cardiac arrest centers, organ donation, survivorship systems, and performance measurement across the continuum of resuscitation situations are also included.

The American Heart Association and the American Academy of Pediatrics provide these pediatric advanced life support guidelines focusing on resuscitation during cardiopulmonary resuscitation and emergency cardiovascular care. These guidelines are intended to be a resource for health care professionals to identify and treat infants and children up to 18 years of age (excluding newborn infants) in the prearrest, intra-arrest, and post-cardiac arrest states as well as select other emergency care situations. These guidelines apply to infants and children in various settings, including the community, prehospital environments, and hospital environments. Topics presented include ventilation and advanced airway strategies during cardiopulmonary resuscitation; drug administration and weight-based dosing of medications during cardiopulmonary resuscitation; energy doses for defibrillation; measuring cardiopulmonary resuscitation physiology and quality; extracorporeal cardiopulmonary resuscitation; post-cardiac arrest care related to management of core temperature, blood pressure, oxygenation/ventilation, neurologic monitoring, and seizures; neurological prognostication post-cardiac arrest; post-cardiac arrest survivorship; family presence during cardiopulmonary resuscitation; evaluation of sudden unexplained cardiac arrest; management of shock types; airway/intubation management; arrhythmia management including bradycardia and tachycardia (narrow and wide complex); treatment of myocarditis/cardiomyopathies; resuscitation of patients with single ventricle congenital heart disease; management of pulmonary hypertension; and management of traumatic cardiac arrest. Lastly, important gaps in resuscitation science knowledge are identified, aiming to encourage further scientific inquiry and provide additional evidence for future pediatric advanced life support guidelines.

In these 2025 Advanced Life Support Guidelines, the American Heart Association provides comprehensive recommendations for the resuscitation and management of adults experiencing cardiac arrest, respiratory arrest, and life-threatening cardiovascular emergencies. Based on structured evidence reviews and the latest clinical research, these guidelines offer evidence-based strategies to optimize survival and patient outcomes. The 2025 guidelines provide guidance for the treatment of cardiac arrest, including ventricular fibrillation, pulseless ventricular tachycardia, asystole, and pulseless electrical activity, as well as peri-arrest conditions such as atrial fibrillation and flutter with rapid ventricular response. Recommendations are made for defibrillation, electrical cardioversion, advanced airway management, drug therapies, and intravenous access. Additionally, guidelines are provided for the use of double sequential defibrillation, head-up cardiopulmonary resuscitation, and point-of-care ultrasound in the advanced life support setting. Termination of resuscitation rules have been refined to guide decision-making based on the emergency medical services professional's scope of practice. Finally, these guidelines also underscore the importance of identifying causative versus secondary arrhythmias to inform the appropriate timing of therapeutic strategies.

Blood pressure (BP) management in older adults is complex because of age-related physiological changes and uncertainty around ideal systolic BP (SBP) targets. Heart stress (HS), defined by age-adjusted elevation in NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, may improve cardiovascular disease (CVD) risk stratification and support more individualized BP management.

The long-term benefits of bailout intracranial angioplasty or stenting (BAOS) after thrombectomy in patients with acute large vessel occlusion remain unclear. This study compared BAOS with standard therapy in patients with large vessel occlusion with unsuccessful recanalization (expanded Thrombolysis In Cerebral Infarction score 0-2a) or >70% residual stenosis after thrombectomy.

The International Liaison Committee on Resuscitation continually reviews new, peer-reviewed cardiopulmonary resuscitation science and publishes comprehensive reviews every 5 years. The Neonatal Life Support chapter of the 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations addresses all published resuscitation evidence reviewed by the Neonatal Life Support Task Force science experts since 2020. This summary addresses 40 questions on population, intervention, comparator, and outcomes, addressing all parts of the Neonatal Resuscitation Algorithm. The summary includes 4 new systematic reviews, 2 new scoping reviews, and evidence updates for other topics. Members of the Neonatal Life Support Task Force have assessed, discussed, and debated the quality of the evidence on the basis of Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task force are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task force lists priority knowledge gaps for further research.

The International Liaison Committee on Resuscitation conducts continuous review of new, peer-reviewed published cardiopulmonary resuscitation science, and publishes more comprehensive reviews every 5 years. The Basic Life Support Task Force chapter of the 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations addressed all published resuscitation evidence reviewed by the Basic Life Support Task Force science experts since 2020. Topics addressed by systematic reviews in the last year include chest compression-only cardiopulmonary resuscitation, starting cardiopulmonary resuscitation with compressions or airway and breathing, chest compression and ventilation ratios, durations of cardiopulmonary resuscitation cycles, hand positioning during compressions, head-up cardiopulmonary resuscitation, ventilation feedback devices, and pad and paddle size and placement. Members from the Basic Life Support Task Force have assessed, discussed, and debated the quality of the evidence, based on Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task force are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task force lists priority knowledge gaps for further research.

The International Liaison Committee on Resuscitation conducts continuous review of new peer-reviewed published cardiopulmonary resuscitation science and publishes annual summaries. More comprehensive reviews are published every 5 years. The Pediatric Life Support Task Force chapter of the 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations addresses all published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Pediatric Life Support Task Force members in the past year, as well as brief summaries of topics reviewed since 2020, to provide a more comprehensive update. In total, 39 questions related to pre-arrest, intra-arrest, and postarrest resuscitation phases of pediatric cardiac arrest are included, including systematic reviews, scoping reviews, and evidence updates. Members of the task force assessed, discussed, and debated the quality of evidence, based on Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into deliberations of the task force are provided in the Justification and Evidence-to-Decision Framework Highlights sections. The task force has also listed priority knowledge gaps for further research.

The International Liaison Committee on Resuscitation conducts continuous reviews of new, peer-reviewed published cardiopulmonary resuscitation science and publishes more comprehensive reviews every 5 years. The Advanced Life Support Task Force chapter of the 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations addresses all resuscitation evidence reviewed by the task force in the past year, as well as brief summaries of topics reviewed since 2020, to provide a comprehensive update. Newly updated topics this year include defibrillator pad placement, mechanical cardiopulmonary resuscitation devices, mechanical circulatory support after return of spontaneous circulation, intravenous versus intraosseous access, vasopressor choice and hemodynamic targets after return of spontaneous circulation, treatment of cardiac arrest related to hyperkalemia and opioid toxicity, and neuroprotective drugs, among others. Task Force members have assessed, discussed, and debated the certainty of the evidence based on Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task force are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task force lists priority knowledge gaps for further research.

The International Liaison Committee on Resuscitation conducts continuous reviews of new, peer-reviewed, published first aid and cardiopulmonary resuscitation science and publishes more comprehensive reviews every 5 years. The First Aid chapter of the 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations addresses all published evidence reviewed by the First Aid Task Force science experts since 2020. This summary includes new systematic reviews on manual uterine massage for postpartum hemorrhage, unintentional injury from chest compressions in noncardiac arrests, and treatment of jellyfish stings. There are also new scoping reviews on the topics of first aid interventions to prevent adverse consequences of postpartum hemorrhage, spinal motion restriction, and preservation of an amputated body part. Summaries of systematic and scoping reviews included in the 2021 to 2024 annual summaries are also included to provide a more comprehensive reference for the reader. Members of the First Aid Task Force have assessed, discussed, and debated the certainty of the evidence, on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task force are provided in the Justification and Evidence-to-Decision Framework Highlights sections. The task force also lists priority knowledge gaps for further research.

The International Liaison Committee on Resuscitation conducts continuous reviews of new, peer-reviewed, published cardiopulmonary resuscitation science and publishes more comprehensive reviews every 5 years. The Education, Implementation, and Teams chapter of the 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations describes all published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation's Education, Implementation, and Teams Task Force science experts since 2020. This summary addresses the evidence in 4 subchapters: (1) training populations, (2) faculty development, (3) knowledge translation and implementation, and (4) instructional design. Members from the Education, Implementation, and Teams Task Force have assessed, discussed, and debated the quality of the evidence, based on Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task force are provided in the Justification and Evidence-to-Decision Framework Highlights sections. Priority knowledge gaps for further research are listed.

Equitable, timely, and evidence-based care remains a central goal across health care ecosystems, yet significant quality gaps, care variability, and health disparities persist. Professional societies, including the American Heart Association, have long developed clinical practice guidelines to provide standardized, evidence-based recommendations across the cardiovascular care continuum. These guidelines are operationalized into quality measures to monitor care, identify gaps, and guide improvement. Professional societies, agencies, and health systems have applied implementation science strategies, such as education, data sharing, and evaluation, to improve care quality and achieve quality measures defined in the clinical practice guidelines. American Heart Association's Get With The Guidelines programs target inpatient quality measures for stroke, heart failure, atrial fibrillation, resuscitation, and coronary artery disease, complemented by ambulatory quality improvement programs to support seamless care transitions. Decades of Get With The Guidelines implementation have enabled American Heart Association teams and volunteers to refine these programs, improving guideline adherence at local, regional, and national levels. Lessons learned informed the development of the Observe, Uncover, Trial, Personalize, Accelerate, Check, Expand Framework, designed to guide successful quality improvement initiatives. While existing quality improvement frameworks provide structured approaches, many are costly, slow, or siloed, limiting rapid-cycle, data-driven innovation across diverse health systems. The Observe, Uncover, Trial, Personalize, Accelerate, Check, Expand framework addresses these limitations as an adaptable model, applicable across care settings, disease areas, patient populations, system size, budgets, and target end points. Here, we illustrate the Observe, Uncover, Trial, Personalize, Accelerate, Check, Expand framework through 2 recent American Heart Association programs: Target: Aortic Stenosis and the IMPLEMENT-HF initiative, demonstrating its utility in guiding effective, scalable quality improvement.

A domain of CMYA5 (RID) is a novel RYR2 regulator. RID overexpression reduced arrhythmias in CPVT disease models.