In October 2025, the American Heart Association released its first full refresh of the CPR and Emergency Cardiovascular Care Guidelines since 2020. If you certified or recertified before October 22, 2025, the protocols you trained on are already a guideline cycle behind — and many hospitals and EMS agencies are quietly updating their internal policies right now to match.
The good news: the 2025 update isn’t a rewrite. The familiar algorithms, the H’s and T’s, the compression rate of 100–120/min, the 30:2 ratio for single-rescuer adult CPR — all still hold. What changed is how the AHA wants teams to think, communicate, and act during a code, plus a handful of clinically important tweaks to BLS, ACLS, and PALS protocols.
Here is what’s new, what stayed the same, and what it means for your next recertification.
The five changes you’ll actually be tested on:
- One unified Chain of Survival now covers adults and pediatrics, in-hospital and out-of-hospital arrests.
- Naloxone is now explicit in the BLS algorithm for suspected opioid-associated emergencies.
- Updated choking guidance: cycles of 5 back blows followed by 5 abdominal thrusts in adults and children, until the obstruction clears or the patient becomes unresponsive.
- Tightened thresholds for stable vs. unstable bradycardia and tachycardia, to reduce hesitation on when to escalate.
- Greater emphasis on team performance: closed-loop communication, real-time CPR feedback, and integrated systems of care are now woven through every algorithm.
1. A Single Chain of Survival
Previously, the AHA published separate Chains of Survival for adult vs. pediatric and in-hospital vs. out-of-hospital arrests. The 2025 guidelines collapse these into one unified Chain that applies to every patient population and every setting.
Why it matters: it gives clinicians, dispatchers, and lay rescuers one shared mental model. For test purposes, expect questions that ask you to apply the same Chain across scenarios — a 4-year-old with a witnessed arrest in an ED and a 70-year-old with an unwitnessed arrest at home now follow the same conceptual framework, even though the specific interventions differ.
2. Naloxone now lives inside the BLS algorithm
In prior guidelines, naloxone was discussed in opioid-emergency content but wasn’t formally integrated into the BLS flow. The 2025 BLS algorithm now explicitly shows where naloxone fits for a patient with suspected opioid overdose who has respiratory or cardiac arrest.
Practical implications:
- High-quality CPR remains the priority — naloxone does not replace compressions or rescue breaths in cardiac arrest.
- For respiratory arrest with a pulse and suspected opioid involvement, naloxone is given alongside ventilations.
- Lay-rescuer guidance now includes naloxone administration when available, reflecting the public-health reality of the opioid crisis.
If you work in an ED, urgent care, or EMS setting, expect this update to also appear in your facility’s policy refresh in 2026.
3. New choking guidance: 5 back blows + 5 abdominal thrusts
For severe airway obstruction in a responsive adult or child, the AHA now recommends alternating cycles of 5 back blows and 5 abdominal thrusts until the object clears or the patient becomes unresponsive. This replaces the older “abdominal thrusts only” guidance for adults that many of us learned and brings adult care closer to the back-blows-then-thrusts pattern long used in infants.
Once the patient becomes unresponsive, the algorithm shifts to standard CPR with attention to checking the mouth before each ventilation.
4. Cleaner thresholds for unstable rhythms
The Bradycardia and Tachycardia algorithms keep their familiar layouts, but the 2025 update sharpens the clinical thresholds that distinguish stable from unstable patients. The intent is to reduce hesitation in the gray zone — the place where a code team most often loses time.
You’ll still look for hypotension, altered mental status, signs of shock, ischemic chest discomfort, and acute heart failure. What’s new is more precise language about how to weigh borderline findings and when to move from observation to atropine, transcutaneous pacing, synchronized cardioversion, or adenosine.
5. Team performance is now a first-class topic
This is the change most likely to feel new on test day. The 2025 guidelines elevate the human factors of resuscitation:
- Closed-loop communication: every order is verbally confirmed; every action is verbally announced (“amiodarone 300 mg IV in” / “amiodarone 300 mg IV given”).
- Real-time CPR performance feedback: where available, teams should use feedback devices for compression depth, rate, and recoil.
- Integrated systems of care: smoother handoffs between dispatch, EMS, ED, cath lab, ICU, and post-arrest care.
Megacode scenarios in 2026 recertification courses are increasingly designed around these team behaviors, not just the drug doses.
What’s not changing
Here’s what carried over unchanged from the 2020 guidelines:
- Compression rate: 100–120 per minute
- Compression depth: at least 2 inches for adults; about 2 inches for children; about 1.5 inches for infants
- Compression-to-ventilation ratio: 30:2 for single rescuer; 15:2 for two rescuers in pediatrics
- Defibrillation energy doses for monophasic and biphasic devices
- Core ACLS drugs: epinephrine 1 mg every 3–5 minutes; amiodarone 300 mg → 150 mg; lidocaine alternative
- The H’s and T’s reversible causes framework
If you trained on the 2020 guidelines and you’re due to renew, the bulk of what you know is still correct. You’re updating, not re-learning.
What this means for your recertification
If your card expires in 2026, your next renewal must be against the 2025 guidelines. A few things to look for when choosing where to recertify:
- Curriculum alignment: confirm the course is updated to the 2025 ILCOR/AHA guidelines, not just labeled as “current.”
- Algorithm coverage: the new unified Chain of Survival, naloxone in BLS, and updated choking guidance should all appear.
- Megacode design: scenarios should reflect closed-loop communication and team-based performance, not just memorized drug sequences.
- Employer acceptance: if you have any uncertainty, our 2025 Guide to Online ACLS Accreditation walks through how to verify acceptance with your hospital or agency.
At ACI, our ACLS, BLS, and PALS courses are fully aligned with the 2025 ILCOR/ECC/AHA Guidelines, completable in about an hour, and accepted by the vast majority of healthcare employers nationwide. If you want to renew today, you can start your recertification here.
FAQ
Do I need to re-test if I just renewed in 2024 or early 2025? No. Your existing certification is valid through its expiration date. You’ll certify against the 2025 guidelines at your next renewal.
Are the 2025 changes going to show up on my next ACLS exam? Yes. Any course updated for 2025 ILCOR/AHA alignment will reflect the unified Chain of Survival, naloxone in BLS, the new choking guidance, and updated bradycardia/tachycardia language.
Is online ACLS still accepted under the 2025 guidelines? Yes. The guideline update is a clinical content refresh, not a delivery-format change. Online courses that adhere to ILCOR/AHA guidelines remain accepted by the vast majority of employers — confirm with your specific facility if in doubt.
When should I renew if I’m close to expiration? Don’t let your card lapse for more than 30 days. Renewing early (within 60 days of expiration) carries no penalty and gives you a buffer.
Where can I see the official 2025 algorithms? The AHA publishes them at cpr.heart.org/algorithms. We’ll be publishing detailed walkthroughs of each algorithm — Adult Cardiac Arrest, Bradycardia, Tachycardia, ACS, Stroke, and the pediatric algorithms — over the next several weeks.
Ready to recertify against the 2025 guidelines? Start your online ACLS, BLS, or PALS course at ACI — finish in about an hour, no skills test, instant digital provider card.
