The American Academy of Pediatrics and American Heart Association have published updated guidelines for cardiopulmonary resuscitation and emergency cardiovascular care for newborn and pediatric populations. The "2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" represent a comprehensive update to pediatric basic and advanced life support and neonatal resuscitation guidelines since 2020.
These guidelines address a critical public health need, as more than 7,000 out-of-hospital cardiac arrests and approximately 20,000 in-hospital cardiac arrests occur in infants and children annually in the United States. Dr. Javier Lasa, associate professor in critical care and cardiology at Children's Health in Dallas and volunteer co-chair of the 2025 Pediatric Advanced Life Support Writing Group, emphasized that "children are not little adults, and these guidelines offer specific recommendations that reflect the unique needs of children."
The updated pediatric guidelines introduce several significant changes to emergency care protocols. A single chain of survival now applies to both adult and pediatric in- and out-of-hospital cardiac arrest, acknowledging that prevention and preparedness before cardiac arrest can both avoid and optimize resuscitation. The guidelines maintain emphasis on early recognition of cardiac arrest in infants and children, early activation of emergency medical services, and initiation of high-quality CPR beginning with chest compressions.
Notable changes include revised protocols for choking emergencies. For infants with severe foreign body airway obstruction, repeated cycles of 5 back blows alternating with 5 chest thrusts are now recommended, with abdominal thrusts specifically not recommended. For children with severe choking, repeated cycles of 5 back blows alternating with 5 abdominal thrusts replace earlier guidance that called for performing abdominal thrusts only. Infant compression techniques have been updated to include either the one-hand technique or two thumbs-encircling hands technique, while eliminating the use of two fingers along the sternum due to ineffectiveness in achieving proper depth.
The neonatal guidelines introduce a separate newborn chain of care that starts with prenatal care and extends to recovery and appropriate follow-up in the postnatal period. Dr. Henry Lee, professor of pediatrics and neonatologist from the University of California San Diego and American Heart Association volunteer co-chair of the 2025 Neonatal Writing Group, highlighted that "one out of every 10-20 newborns each year needs help transitioning from the fluid-filled environment of the womb to the air-filled room."
Key neonatal updates include extended deferred cord clamping recommendations from at least 30 seconds to 60 seconds or more, allowing most newborn infants to maintain skin-to-skin contact with a parent after birth. Ventilation rates for newborn infants have been expanded to 30-60 inflations per minute from the previous 40-60 range, while maintaining effective lung ventilation as the priority in resuscitation. The guidelines stress that newborn resuscitation requires anticipation and preparation by healthcare professionals who train individually and as teams.
The updated guidelines and CPR training materials are available in U.S. and international English, with many additional translated languages planned. Healthcare professionals, first responders, and other learners can access educational materials at Pediatric Advanced Life Support and the Neonatal Resuscitation Program, 9th Edition. These evidence-based updates represent the latest scientific consensus on pediatric and neonatal resuscitation, potentially improving survival rates and neurological outcomes for thousands of children experiencing cardiac emergencies annually.
