CPR Update Reflect Opioid Problem

Source: Houston Parks Department / Houston Swim Waves/Coach CPR

The “2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC),” published today in the Association’s flagship journal, Circulation, marks the first full revision of lifesaving resuscitation guidance since 2020. Among the updates are expanded recommendations for managing choking and suspected opioid overdose, in addition to other lifesaving interventions.

Each year, approximately 350,000 people in the U.S. experience an out-of-hospital cardiac arrest – when the heart suddenly stops beating – which results in death 90% of the time, according to the Association’s statistics.[1] The 2025 CPR guidelines provide an extensive review of the latest science, translating it into clear, lifesaving recommendations that empower people to act when every second counts.

Out-of-hospital cardiac arrests caused by respiratory emergencies or asphyxia occur in more than 9% of adults and 39% of children in the U.S.[2] New guidance on choking recommends alternating five back blows followed by five abdominal thrusts for conscious children and adults, until the foreign object is expelled or the person becomes unresponsive. Choking guidance for adults was not included in the previous guidelines,

and earlier guidance for children called for performing abdominal thrusts only. For infants, rescuers should alternate between five back blows and five chest thrusts using the heel of one hand, until the foreign object is expelled or the infant becomes unresponsive. Abdominal thrusts are not recommended for infants, due to the risk of injury.

The guidelines also provide updated recommendations for treating people experiencing a suspected opioid overdose, which is the cause of 80% of all drug overdose deaths worldwide.[3] According to the World Health Organization (WHO), opioid use can lead to death because opioids affect the part of the brain that regulates breathing. Signs of an opioid overdose include:

Slow, shallow or no breathing
Choking or gurgling sounds
Drowsiness or loss of consciousness
Small, constricted pupils
Blue or grey coloring of the skin, lips or nail beds

Guideline Highlights:

New guidance on choking in conscious children and adults recommends alternating five back blows followed by five abdominal thrusts, until the object is expelled or the person becomes unresponsive.
Guidance for choking in infants has been updated to alternate between five back blows and five chest thrusts using the heel of one hand, until the foreign object is expelled or the infant becomes unresponsive.
The guidelines provide a new algorithm for treating individuals with suspected opioid overdose, including public access guidance on naloxone use.
The systems of care volunteer writing group elected to revert to a single chain of survival for all forms of cardiac arrest, whether adult or pediatric, in- or out-of-hospital.
Evidence shows that children 12 years old or older can be taught effective CPR and defibrillation.
To improve lay-rescuer response to out-of-hospital cardiac arrests, the guidelines recommend support for media campaigns, instructor-led training and community training.