31/10/2025
The 2025 CPR updates
The emphasis is on high-quality CPR, effective team dynamics, and comprehensive post-arrest care.
Key Takeaways
1. Infant BLS: A Significant Practical Change
· Update: The two-finger technique is officially no longer recommended.
· New Standard: Use the heel of one hand or the two-thumb–encircling hands technique.
· Why it Matters: This simplifies training and aligns with evidence showing that the heel-of-one-hand technique can produce better compression depth and is less fatiguing for the rescuer than the two-finger method.
2. Adult BLS: Clarifications and Reaffirmations
· Airway Management: Clear guidance that even with suspected trauma, the head tilt–chin lift takes precedence if the jaw thrust fails. The priority is a patent airway.
· Choking Care: Standardizing the sequence to 5 back blows followed by 5 abdominal thrusts (or chest thrusts for special populations) provides a simple, repeatable algorithm.
· Mechanical CPR: The recommendation against routine use reinforces that manual CPR is the gold standard, but acknowledges the value of devices in specific, challenging situations (e.g., prolonged CPR, in a moving ambulance, in a confined space).
3. Adult ALS: Streamlining and Strengthening the Process
· Drug Access: The "IV first, then IO" guidance is a practical, step-wise approach to avoid delays.
· Adrenaline Timing: The distinction between shockable and non-shockable rhythms is crucial. For non-shockable rhythms (PEA/Asystole), where outcomes are generally poorer, giving epinephrine early is emphasized as a key intervention.
· Team Focus: The explicit call for safety huddles, clear roles, and structured debriefs. Recognizes that resuscitation is a team sport, and system-level improvements significantly impact outcomes.
4. Post–Cardiac Arrest Care: A Focus on the Details
· Hemodynamics: A clear MAP goal of ≥65 mmHg provides a concrete target.
· Temperature Control: The range is broader (32°C - 37.5°C), moving away from strict, universal hypothermia to a more personalized approach of targeted temperature management.
· Gas Management: The guidelines stress avoiding extremes—no hyperoxia, no hypo-/hypercapnia. This "normoxia" and "normocapnia" approach is key to protecting the vulnerable post-arrest brain.
· Diagnostics: Encouraging broader use of imaging (CT head to pelvis) and point-of-care ultrasound (POCUS) helps identify the cause of the arrest and any complications from CPR.
Summary of Critical Changes
Category Old Thinking 2025 Guideline Update
Infant Compressions Two-finger technique was an option. Two-finger technique is NOT recommended. Use heel of one hand or two-thumb.
Airway (Trauma) Hesitancy to use head tilt-chin lift. If jaw thrust fails, use head tilt-chin lift to open the airway.
Choking Sequence varied. Standardized: 5 back blows, then 5 abdominal thrusts.
IV/IO Access Often taught concurrently. Establish IV first. Use IO if IV access fails.
Post-Arrest Temp Often 32°C-36°C (therapeutic hypothermia). Targeted Temperature Management (32°C-37.5°C) for at least 36 hours.
Post-Arrest Imaging Focused on head CT. Consider CT from head to pelvis to find cause/complications.
Team Performance Implied importance. Emphasized: Safety huddles, role clarity, and structured debriefs.
