2025 CPR & ECC Guidelines

～ Guidelines ～
- Adult Advanced Life Support
- Pediatric Advanced Life Support (PALS) Updates
- Sience Overview Basic Life Support
- Training Implementation
- 2026 AHA Guidelines Launch
- 2025 Heartcode Basic Life Support (BLS)

	Adult Advanced Life Support

	■ALS Hot Topics/Controversies

	■ALS Top 10 A rapid assessment of clinical stability is essential to direct the appropriate advanced life support (ALS) treatment, and these guidelines go into greater depth to describe how poor organ perfusion manifests as instability. Higher first-shock energy settings (≥200J) are preferable to lower settings for cardioversion of atrial fibrillation and atrial flutter. Updated termination of resuscitation (TOR) guidelines emphasize rule application based on emergency medical services (EMS) scope of practice (basic life support [BLS], ALS, or universal TOR rule [UTOR]), and that end-tidal carbon dioxide (ETCO2) should not be used in isolation to end resuscitative efforts. Vector change (VC) and double sequential defibrillation (DSD) may be considered as therapies for shock-refractory ventricular fibrillation (VF); however, further investigation of the technique, patient candidacy and the development of new technology to optimize shock delivery are necessary. Head-up cardiopulmonary resuscitation (CPR) use is discouraged outside of the setting of rigorous clinical trials with appropriate subject protections. Recommendations regarding outdated or extraordinary procedures that have been replaced by modern equivalents with better efficacy (eg, administration of intra-arrest medications via an in-place endotracheal tube) have been removed. Use of point-of-care ultrasonography (POCUS) by experienced professionals during cardiac arrest may be considered to diagnose reversible causes if it can be done without interrupting resuscitative efforts (ie, CPR). Pulseless ventricular tachycardia (pVT) is always unstable and should be treated immediately with defibrillation, because delays in shock delivery worsen outcomes. Intravenous (IV) access remains the first-line choice for drug administration during cardiac arrest; however, intraosseous (IO) access is a reasonable alternative if IV access is not feasible or delayed. Arrhythmias can be both the cause of and a manifestation of clinical instability. Evaluating the proximal cause of that instability will direct professionals to the most judicious use of these guidelines.

■ALS Top 10

A rapid assessment of clinical stability is essential to direct the appropriate advanced life support (ALS) treatment, and these guidelines go into greater depth to describe how poor organ perfusion manifests as instability.

Higher first-shock energy settings (≥200J) are preferable to lower settings for cardioversion of atrial fibrillation and atrial flutter.

Updated termination of resuscitation (TOR) guidelines emphasize rule application based on emergency medical services (EMS) scope of practice (basic life support [BLS], ALS, or universal TOR rule [UTOR]), and that end-tidal carbon dioxide (ETCO2) should not be used in isolation to end resuscitative efforts.

Vector change (VC) and double sequential defibrillation (DSD) may be considered as therapies for shock-refractory ventricular fibrillation (VF); however, further investigation of the technique, patient candidacy and the development of new technology to optimize shock delivery are necessary.

Head-up cardiopulmonary resuscitation (CPR) use is discouraged outside of the setting of rigorous clinical trials with appropriate subject protections.

Recommendations regarding outdated or extraordinary procedures that have been replaced by modern equivalents with better efficacy (eg, administration of intra-arrest medications via an in-place endotracheal tube) have been removed.

Use of point-of-care ultrasonography (POCUS) by experienced professionals during cardiac arrest may be considered to diagnose reversible causes if it can be done without interrupting resuscitative efforts (ie, CPR).

Pulseless ventricular tachycardia (pVT) is always unstable and should be treated immediately with defibrillation, because delays in shock delivery worsen outcomes.

Intravenous (IV) access remains the first-line choice for drug administration during cardiac arrest; however, intraosseous (IO) access is a reasonable alternative if IV access is not feasible or delayed.

Arrhythmias can be both the cause of and a manifestation of clinical instability. Evaluating the proximal cause of that instability will direct professionals to the most judicious use of these guidelines.

	■Significant Changes Vector Change & Double Sequential Defibrillation NEW The usefulness of vector change defibrillation for adults in cardiac arrest with persisting ventricular fibrillation/pulseless ventricular tachycardia after 3 or more consecutive shocks has not been established. UPDATED The usefulness of double sequential defibrillation for adults in cardiac arrest with persisting ventricular fibrillation/pulseless ventricular tachycardia after 3 or more consecutive shocks has not been established.

■Significant Changes
Vector Change & Double Sequential Defibrillation

NEW The usefulness of vector change defibrillation for adults in cardiac arrest with persisting ventricular fibrillation/pulseless ventricular tachycardia after 3 or more consecutive shocks has not been established.
UPDATED The usefulness of double sequential defibrillation for adults in cardiac arrest with persisting ventricular fibrillation/pulseless ventricular tachycardia after 3 or more consecutive shocks has not been established.

	■Evidence to Recommendation - Vector Change and DSD DOSE-VF - compared standard defibrillation, VC, and DSD in VF that persisted after 3 standard shocks. High cross-over - Improvement in survival seen with VC and DSD by intention-to-treat, but not when trial findings were analyzed by the treatment strategy patients actually received. The interval between each sequential "double" shock required for successfully terminating VF has also been shown experimentally and demonstrated in DOSE-VF itself to require a level of precision (separated by milliseconds) unlikely to be consistently achievable by manual activation of two defibrillators. Based on its review, ILCOR's 2023 International Consensus on CPR and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) judged the overall supportive evidence as relatively weak when issuing "may be considered" recommendations for VC and DSD. Further investigation of the technique, patient candidacy and the development of new technology to optimize shock delivery are necessary.

■Evidence to Recommendation - Vector Change and DSD

DOSE-VF - compared standard defibrillation, VC, and DSD in VF that persisted after 3 standard shocks.
High cross-over - Improvement in survival seen with VC and DSD by intention-to-treat, but not when trial findings were analyzed by the treatment strategy patients actually received.
The interval between each sequential "double" shock required for successfully terminating VF has also been shown experimentally and demonstrated in DOSE-VF itself to require a level of precision (separated by milliseconds) unlikely to be consistently achievable by manual activation of two defibrillators.
Based on its review, ILCOR's 2023 International Consensus on CPR and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) judged the overall supportive evidence as relatively weak when issuing "may be considered" recommendations for VC and DSD.
Further investigation of the technique, patient candidacy and the development of new technology to optimize shock delivery are necessary.

Recommendations for Vector Change and Double Sequential Defibrillation

	■Significant Changes Initial Vascular Access UPDATED It is recommended that health care professionals first attempt establishing IV access for drug administration in adult patients in cardiac arrest. UPDATED Intraosseous (IO) access is reasonable if initial attempts at IV access are unsuccessful or not feasible for adult patients in cardiac arrest.

	■Evidence to Recommendation – IV vs IO Access The peripheral IV route for vascular access has traditionally been preferred for emergency drug and fluid administration during adult resuscitation. The pharmacokinetic properties, acute effects, and clinical efficacy of emergency drugs have primarily been described for IV administration. There has been a significant increase in the use of IO access in adult OHCA. Three recent large RCTs evaluated the clinical effectiveness of initial IO access compared with initial IV access in adult OHCA and found no differences in clinical outcomes. Each RCT used a superiority design. An ILCOR systematic review found that the use of IO access compared with IV access did not result in a statistically significant improvement in outcomes. Patient, EMS professional, or circumstantial characteristics may limit successful IV access or make IV access infeasible. The optimal anatomical location for IO access (ie, tibial or humeral) remains a knowledge gap.

■Evidence to Recommendation – IV vs IO Access

The peripheral IV route for vascular access has traditionally been preferred for emergency drug and fluid administration during adult resuscitation. The pharmacokinetic properties, acute effects, and clinical efficacy of emergency drugs have primarily been described for IV administration.
There has been a significant increase in the use of IO access in adult OHCA.
Three recent large RCTs evaluated the clinical effectiveness of initial IO access compared with initial IV access in adult OHCA and found no differences in clinical outcomes.
Each RCT used a superiority design.
An ILCOR systematic review found that the use of IO access compared with IV access did not result in a statistically significant improvement in outcomes.
Patient, EMS professional, or circumstantial characteristics may limit successful IV access or make IV access infeasible.
The optimal anatomical location for IO access (ie, tibial or humeral) remains a knowledge gap.

Recommendations for Vascular Access in Cardiac Arrest Management

	■Significant Changes Vasopressor Medications UPDATED In consideration of timing, for adult patients in cardiac arrest with a shockable rhythm, it is reasonable to administer epinephrine after initial defibrillation attempts have failed. UPDATED Vasopressin alone or vasopressin in combination with epinephrine offers no advantage as a substitute for epinephrine for adult patients in cardiac arrest.

■Significant Changes
Vasopressor Medications

UPDATED In consideration of timing, for adult patients in cardiac arrest with a shockable rhythm, it is reasonable to administer epinephrine after initial defibrillation attempts have failed.
UPDATED Vasopressin alone or vasopressin in combination with epinephrine offers no advantage as a substitute for epinephrine for adult patients in cardiac arrest.

	■Significant Changes Adjuncts to CPR NEW Head-up CPR in adults with cardiac arrest is not recommended except in the setting of clinical trials.

	■Evidence to Recommendation – Heads Up CPR Pre-clinical work done in porcine models with conflicting evidence of efficacy. A recent ILCOR systematic review identified no randomized controlled trials and only 3 observational studies, each with significant methodological limitations. Evidence on heads up CPR was considered very low-certainty and downgraded for serious risk of bias. Implementation of this approach requires specialized equipment (automated positioning device, mechanical CPR device, an impedance threshold device) and significant training. Based on this, there is currently insufficient evidence for its use outside of well-designed clinical trials, although future work is needed to evaluate this adjunct.

■Evidence to Recommendation – Heads Up CPR

Pre-clinical work done in porcine models with conflicting evidence of efficacy.
A recent ILCOR systematic review identified no randomized controlled trials and only 3 observational studies, each with significant methodological limitations.
Evidence on heads up CPR was considered very low-certainty and downgraded for serious risk of bias.
Implementation of this approach requires specialized equipment (automated positioning device, mechanical CPR device, an impedance threshold device) and significant training.
Based on this, there is currently insufficient evidence for its use outside of well-designed clinical trials, although future work is needed to evaluate this adjunct.

	■Significant Changes Termination of Resuscitation Measures UPDATED In a tiered EMS system with both ALS and BLS professionals, it is reasonable to use the universal termination of resuscitation rule for adult patients with OHCA.

	■Significant Changes Wide-Complex Tachycardia UPDATED Synchronized cardioversion is recommended for acute treatment of adult patients with hemodynamically unstable wide-complex tachycardia. UPDATED Synchronized cardioversion is recommended for acute treatment of adult patients with hemodynamically stable wide-complex tachycardia when vagal maneuvers and pharmacological therapy is ineffective or contraindicated.

■Significant Changes
Wide-Complex Tachycardia

UPDATED Synchronized cardioversion is recommended for acute treatment of adult patients with hemodynamically unstable wide-complex tachycardia.
UPDATED Synchronized cardioversion is recommended for acute treatment of adult patients with hemodynamically stable wide-complex tachycardia when vagal maneuvers and pharmacological therapy is ineffective or contraindicated.

	■Significant Changes Initial Management of Bradycardia NEW In adult patients with persistent hemodynamically unstable bradycardia refractory to medical therapy, temporary transvenous pacing is reasonable to increase heart rate and improve symptoms.

	■Significant Changes Atrial Fibrillation of Flutter with Rapid Ventricular Response UPDATED For synchronized cardioversion of AF in adults using any currently US-approved biphasic waveform defibrillator, an initial energy setting of at least 200 J is reasonable and incremented in the event of shock failure, depending on the biphasic defibrillator used. NEW The usefulness of double synchronized cardioversion of AF in adults as an initial treatment strategy is uncertain. Based on currently available data and considering the high success of optimal synchronized cardioversion using biphasic waveforms, the incremental benefit from double synchronized cardioversion appears modest. UPDATED For synchronized cardioversion of atrial flutter in adults, an initial energy setting of 200 J may be reasonable and incremented in the event of shock failure, depending on the biphasic defibrillator used. Recent studies support the likelihood of greater efficacy, efficiency, and simplicity, without safety concerns, when a starting energy of 200 J with any currently US-marketed biphasic defibrillator is used for flutter cardioversion and incremented in the event of shock failure, depending on the defibrillator's features.

■Significant Changes
Atrial Fibrillation of Flutter with Rapid Ventricular Response

UPDATED For synchronized cardioversion of AF in adults using any currently US-approved biphasic waveform defibrillator, an initial energy setting of at least 200 J is reasonable and incremented in the event of shock failure, depending on the biphasic defibrillator used.
NEW The usefulness of double synchronized cardioversion of AF in adults as an initial treatment strategy is uncertain.
Based on currently available data and considering the high success of optimal synchronized cardioversion using biphasic waveforms, the incremental benefit from double synchronized cardioversion appears modest.
UPDATED For synchronized cardioversion of atrial flutter in adults, an initial energy setting of 200 J may be reasonable and incremented in the event of shock failure, depending on the biphasic defibrillator used.
Recent studies support the likelihood of greater efficacy, efficiency, and simplicity, without safety concerns, when a starting energy of 200 J with any currently US-marketed biphasic defibrillator is used for flutter cardioversion and incremented in the event of shock failure, depending on the defibrillator's features.

	■Adult Cardiac Arrest(VF/pVT/Asystole/PEA)

	■Adult Cardiac Arrest Circular

	■Adult Bradycardia with a Pulse

	■Adult Tachyarrhythmia with a Pulse

	■Termination of Resuscitation Algorithms

	■Electrical Cardioversion Algorithm

	Thank You!

	Pediatric Advanced Life Support (PALS) Updates

■Disclosures
Volunteer: American Heart Association, American Academy of Pediatrics

AAP/AHA 2025 PALS Guidelines	Co-Chair, Co-author (AAP representative)
AHA 2020 PALS/PBLS Writing Group	Member, Co-author
AHA GWTG®-Resuscitation: Pediatric Research Task Force	Member (2016-2025)
AHA "Strive to Revive" Conferences	Speaker (no fees)

	Universal Chain of Survival

	■PALS Top 10 High-quality cardiopulmonary resuscitation (CPR) is the foundation of pediatric advanced life support (PALS) resuscitation for health care professionals. We reaffirm the key components of high-quality CPR: providing adequate chest compression rate and depth, minimizing interruptions in CPR, allowing full chest recoil between compressions, and providing sufficient ventilation for the pediatric patient population while avoiding excessive ventilation. For initial nonshockable rhythms, administering epinephrine as soon as possible is associated with favorable outcomes for infants and children in cardiac arrest. Rapid defibrillation remains the priority for cardiac arrest with initial shockable rhythms. Administer epinephrine if defibrillation is not immediately possible. For infants and children with continuous invasive arterial blood pressure monitoring in place during CPR, diastolic blood pressure targets of:≥25 mm Hg in infants≥30 mm Hg in children (at least 1 year of age)...are now included as hemodynamic goals of high-quality cardiopulmonary resuscitation. End-Tidal Carbon Dioxide (ETCO₂)End-tidal carbon dioxide (ETCO₂) can be an indicator of CPR quality, although the use of specific ETCO₂ cutoff values to guide termination of resuscitation in infants and children are not advised. Preventing HyperthermiaPreventing hyperthermia is a critical component of post-cardiac arrest care and treatment. Avoiding central temperatures >37.5 °C can improve neurological outcomes in infants and children who remain comatose following cardiac arrest. For infants and children, new data support maintaining post-arrest systolic and mean arterial blood pressure greater than the 10th percentile for age and sex. Neuroprognostication after cardiac arrest in infants and children requires multiple modalities assessed at various timepoints throughout the post-arrest period. Single tests conducted in isolation carry a risk of inaccurately predicting neurologic outcomes. After discharge from the hospital, cardiac arrest survivors often have ongoing physical, cognitive, and behavioral challenges and require evaluation for appropriate therapies and interventions. New data support the use of IV sotalol as an anti-arrhythmic to treat infants and children with supraventricular tachycardia (SVT) and cardiopulmonary compromise that is unresponsive to vagal maneuvers, IV adenosine, and electrical synchronized cardioversion when expert consultation is not available.

■PALS Top 10

High-quality cardiopulmonary resuscitation (CPR) is the foundation of pediatric advanced life support (PALS) resuscitation for health care professionals. We reaffirm the key components of high-quality CPR: providing adequate chest compression rate and depth, minimizing interruptions in CPR, allowing full chest recoil between compressions, and providing sufficient ventilation for the pediatric patient population while avoiding excessive ventilation.
For initial nonshockable rhythms, administering epinephrine as soon as possible is associated with favorable outcomes for infants and children in cardiac arrest.
Rapid defibrillation remains the priority for cardiac arrest with initial shockable rhythms. Administer epinephrine if defibrillation is not immediately possible.
For infants and children with continuous invasive arterial blood pressure monitoring in place during CPR, diastolic blood pressure targets of:≥25 mm Hg in infants≥30 mm Hg in children (at least 1 year of age)...are now included as hemodynamic goals of high-quality cardiopulmonary resuscitation.
End-Tidal Carbon Dioxide (ETCO₂)End-tidal carbon dioxide (ETCO₂) can be an indicator of CPR quality, although the use of specific ETCO₂ cutoff values to guide termination of resuscitation in infants and children are not advised.
Preventing HyperthermiaPreventing hyperthermia is a critical component of post-cardiac arrest care and treatment. Avoiding central temperatures >37.5 °C can improve neurological outcomes in infants and children who remain comatose following cardiac arrest.
For infants and children, new data support maintaining post-arrest systolic and mean arterial blood pressure greater than the 10th percentile for age and sex.
Neuroprognostication after cardiac arrest in infants and children requires multiple modalities assessed at various timepoints throughout the post-arrest period. Single tests conducted in isolation carry a risk of inaccurately predicting neurologic outcomes.
After discharge from the hospital, cardiac arrest survivors often have ongoing physical, cognitive, and behavioral challenges and require evaluation for appropriate therapies and interventions.
New data support the use of IV sotalol as an anti-arrhythmic to treat infants and children with supraventricular tachycardia (SVT) and cardiopulmonary compromise that is unresponsive to vagal maneuvers, IV adenosine, and electrical synchronized cardioversion when expert consultation is not available.

■Significant Changes
Drug Administration During Cardiac Arrest

2020	2025
For pediatric patients in any setting, it is reasonable to administer the initial dose of epinephrine within 5 minutes from the start of chest compressions.	For infants and children in cardiac arrest with an initial non-shockable rhythm, it is reasonable to administer the initial dose of epinephrine as early as possible.

A recent meta-analysis of retrospective observational studies showed that shorter time to administration of epinephrine during pediatric cardiac arrest with initial nonshockable rhythm was associated with favorable outcomes.
URL

■Significant Changes
Measuring Physiology During CPR

2020	2025
ETCO₂ monitoring may be considered to assess the quality of chest compressions, but specific values to guide therapy have not been established in children.	A specific ETCO₂ cutoff value alone should not be used as an indication to end resuscitative efforts in infants and children.

When considering termination of resuscitative efforts, it is vital to avoid using a specific ETCO₂ cutoff value alone as survival has been noted in patients with average ETCO₂ < 20mmHg.

■Significant Changes
Measuring Physiology During CPR

2020	2025
For patients with continuous invasive arterial blood pressure monitoring in place at the time of cardiac arrest, it is reasonable for providers to use diastolic blood pressure to assess CPR quality.	For infants and children with continuous invasive arterial blood pressure monitoring in place during CPR, it may be reasonable for healthcare professionals to target a diastolic BP ≥ 25mmHg in infants and ≥ 30mmHg in children ≥ 1 year of age.

A new study revealed improved rates of survival w/favorable neurologic outcome if the diastolic BP was ≥ 25mmHg in infants and ≥ 30mmHg in children during CPR.
URL

■Significant Changes
Post-Cardiac Arrest Management

2020	2025
After ROSC, we recommend that parenteral fluids and/or vasoactive drugs be used to maintain a systolic blood pressure greater than the fifth percentile for age.	After cardiac arrest in infants and children, it is recommended to maintain systolic and mean arterial blood pressure > 10th percentile for age.

New evidence supports maintaining post-ROSC systolic and mean blood pressures > 10th percentile (as compared to > 5th percentile in 2020).
URL

	■Significant Changes Prognostication Following Cardiac Arrest It is recommended that health care professionals consider multiple modalities when predicting neurological outcomes (favorable or unfavorable after resuscitation from cardiac arrest in infants and children). Avoid single tests conducted in isolation and use multiple modalities at various timepoints throughout the post-cardiac arrest period for prognostication. New recommendations for prognostication: Clinical Examination (e.g. cough, gag reflexes, Glasgow Coma Scale, pupillary light reflexes) Biomarkers (e.g. lactate, pH, neuronal biomarkers) Electrophysiology (e.g. electroencephalography, EEG)

■Significant Changes
Prognostication Following Cardiac Arrest
It is recommended that health care professionals consider multiple modalities when predicting neurological outcomes (favorable or unfavorable after resuscitation from cardiac arrest in infants and children).

Avoid single tests conducted in isolation and use multiple modalities at various timepoints throughout the post-cardiac arrest period for prognostication.

New recommendations for prognostication:

Clinical Examination (e.g. cough, gag reflexes, Glasgow Coma Scale, pupillary light reflexes)
Biomarkers (e.g. lactate, pH, neuronal biomarkers)
Electrophysiology (e.g. electroencephalography, EEG)

	■Neuroprognostication

■Significant Changes
Post-Cardiac Arrest Survivorship

2020	2025
It is reasonable to refer pediatric cardiac arrest survivors for ongoing neurological evaluation for at least the first year after cardiac arrest.	It is reasonable that infants and children who survive cardiac arrest be evaluated for physical, cognitive, and emotional needs to guide follow-up care within the first year following cardiac arrest.

Post-arrest morbidities should be measured objectively and addressed through multi-disciplinary rehabilitation services.

	■Updated Algorithms Cardiac Arrest

	■Updated Algorithms Tachyarrhythmia With A Pulse

	■Updated Algorithms Bradycardia With A Pulse

	■Updated Checklist Post-Cardiac Arrest Care Checklist

	Thank You!

	Sience Overview Basic Life Support ■Development of the Guidelines Class (Strength) of Recommendation CLASS 1 (STRONG) Benefit >>> Risk CLASS 2a (MODERATE) Benefit >> Risk CLASS 2b (WEAK) Benefit ≥ Risk CLASS 3: No Benefit (MODERATE) Benefit = Risk CLASS 3: Harm (STRONG) Risk > Benefit Level (Quality) of Evidence LEVEL A High-quality evidence from more than 1 RCT Meta-analyses of high-quality RCTs One or more RCTs corroborated by high-quality registry studies. LEVEL B-R (Randomized) Moderate-quality evidence from 1 or more RCTs Meta-analyses of moderate-quality RCTs. LEVEL B-NR (Nonrandomized) LEVEL C-LD (Limited Data) LEVEL C-EO (Expert Opinion)

Sience Overview
Basic Life Support
■Development of the Guidelines

Class (Strength) of Recommendation

CLASS 1 (STRONG) Benefit >>> Risk
CLASS 2a (MODERATE) Benefit >> Risk
CLASS 2b (WEAK) Benefit ≥ Risk
CLASS 3: No Benefit (MODERATE) Benefit = Risk
CLASS 3: Harm (STRONG) Risk > Benefit

Level (Quality) of Evidence LEVEL A

High-quality evidence from more than 1 RCT
Meta-analyses of high-quality RCTs
One or more RCTs corroborated by high-quality registry studies.

LEVEL B-R (Randomized)

Moderate-quality evidence from 1 or more RCTs
Meta-analyses of moderate-quality RCTs.

LEVEL B-NR (Nonrandomized)
LEVEL C-LD (Limited Data)
LEVEL C-EO (Expert Opinion)
■Development of the Guidelines

	Systems Of Care

	■Significant Changes Chain of Survival MAJOR CHANGE – The 4 Chains of Survival have been consolidated into one Universal Chain of Survival to include adult and peds, and IHCA/OHCA.

	Pediatric Basic Life Support

	■PBLS Top 10 Immediate recognition of cardiac arrest is vital to improving outcomes. For infants and children who are unresponsive with abnormal breathing including gasping, rescuers should activate emergency medical services (EMS) and initiate high-quality cardiopulmonary resuscitation (CPR) beginning with chest compressions. High-quality CPR is the foundation of resuscitation. The key components of high-quality CPR include providing adequate chest compression rate and depth, minimizing interruptions in CPR, allowing full chest recoil between compressions, and avoiding excessive ventilation. For out-of-hospital cardiac arrest in infants and children, providing breaths in addition to chest compressions improves survival; thus, lay rescuers are encouraged to provide breaths if able and willing. A respiratory rate of 20 to 30 breaths/minute is recommended for infants and children who are (a) receiving CPR with an advanced airway in place or (b) receiving breaths and have a pulse. For infants, the recommended compression techniques include using either 1-hand technique or the 2-thumbs-encircling-hands technique. If the rescuer cannot physically encircle the chest, it is recommended to compress the chest with the heel of 1-hand technique. The use of 2 fingers along the sternum was eliminated due to ineffectiveness in achieving proper depth. For out-of-hospital cardiac arrest in infants and children, providing breaths in addition to chest compressions improves survival. For infants and children in cardiac arrest, an automated external defibrillator (AED) should be attached as soon as possible using a pediatric attenuator and pediatric pads if available. Prompt defibrillation for ventricular fibrillation and pulseless ventricular tachycardia (VF/pVT) is critical, with minimization of peri-shock pauses. For infants with severe body airway obstruction (FBAO), repeated cycles of 5 back blows alternating with 5 chest thrusts is recommended. Abdominal thrusts are not recommended in infants. In children with severe FBAO, guidance is the same as for infants, with repeated cycles of 5 back blows alternating with 5 abdominal thrusts, as opposed to solely abdominal thrusts.

■PBLS Top 10
Immediate recognition of cardiac arrest is vital to improving outcomes. For infants and children who are unresponsive with abnormal breathing including gasping, rescuers should activate emergency medical services (EMS) and initiate high-quality cardiopulmonary resuscitation (CPR) beginning with chest compressions.
High-quality CPR is the foundation of resuscitation. The key components of high-quality CPR include providing adequate chest compression rate and depth, minimizing interruptions in CPR, allowing full chest recoil between compressions, and avoiding excessive ventilation.
For out-of-hospital cardiac arrest in infants and children, providing breaths in addition to chest compressions improves survival; thus, lay rescuers are encouraged to provide breaths if able and willing.
A respiratory rate of 20 to 30 breaths/minute is recommended for infants and children who are (a) receiving CPR with an advanced airway in place or (b) receiving breaths and have a pulse.
For infants, the recommended compression techniques include using either 1-hand technique or the 2-thumbs-encircling-hands technique. If the rescuer cannot physically encircle the chest, it is recommended to compress the chest with the heel of 1-hand technique. The use of 2 fingers along the sternum was eliminated due to ineffectiveness in achieving proper depth.
For out-of-hospital cardiac arrest in infants and children, providing breaths in addition to chest compressions improves survival.
For infants and children in cardiac arrest, an automated external defibrillator (AED) should be attached as soon as possible using a pediatric attenuator and pediatric pads if available.
Prompt defibrillation for ventricular fibrillation and pulseless ventricular tachycardia (VF/pVT) is critical, with minimization of peri-shock pauses.
For infants with severe body airway obstruction (FBAO), repeated cycles of 5 back blows alternating with 5 chest thrusts is recommended. Abdominal thrusts are not recommended in infants.
In children with severe FBAO, guidance is the same as for infants, with repeated cycles of 5 back blows alternating with 5 abdominal thrusts, as opposed to solely abdominal thrusts.
■PBLS Top 10

	■Significant Changes New Child FBAO Algorithm

	■Significant Changes New Infant FBAO

	■Significant Changes Infant Choking Video

■Significant Changes
Compression Technique
For infants, the recommended compression techniques include using either 1-hand technique or the 2 thumb—encircling hands technique.
If the rescuer cannot physically encircle the chest, it is recommended to compress the chest with the heel of 1-hand technique. The use of 2 fingers along the sternum no longer recommended due to ineffectiveness in achieving proper depth.
■Significant Changes

	■Significant Changes Infant Compressions

	■Significant Changes Pediatric BLS Algorithm (Infants to Puberty) for Healthcare Professionals – Single Rescuer

	■Significant Changes Pediatric BLS Algorithm (Infants to Puberty) for Healthcare Professionals – 2 or More Rescuers

	Adult Basic Life Support

■PBLS Top 10
In adult cardiac arrest, resuscitation should generally be conducted where the patient is found, as long as high-quality cardiopulmonary resuscitation (CPR) can be administered safely and effectively.
After identifying an adult in cardiac arrest, a lone responder should activate the emergency response system first, then immediately begin CPR.
In adult cardiac arrest, rescuers should perform chest compressions with the patient's torso at approximately the level of the rescuer's knees.
It is reasonable for health care professionals to perform chest compressions and ventilations for all adult patients in cardiac arrest from either a cardiac or noncardiac cause.
When ventilating adult patients in cardiac arrest, it is reasonable to give enough tidal volume to produce visible chest rise while avoiding hypo- and hyperventilation.
The routine use of mechanical CPR devices is not recommended for adults in cardiac arrest.
For adult patients who are not breathing normally but have a pulse, it is reasonable for rescuers to provide 1 breath every 6 seconds (10 breaths per minute).
CPR for adult cardiac arrest patients with obesity should be provided by using the same techniques as for the average weight patient.
For adults with severe foreign-body airway obstruction (FBAO), rescuers should perform cycles of 5 back blows followed by 5 abdominal thrusts until the object is expelled or the patient becomes unresponsive.
During adult cardiac arrest, it is reasonable for rescuers to use personal protective equipment (PPE) while performing CPR.
■PBLS Top 10

	■Anterolateral Pad Placement Standardized Visuals and Verbiage for 2025

	■Adult BLS Algorithm Adult BLS Algorithm for Healthcare Professionals Major Changes: No separate algorithm for opioid-associated emergency. Naloxone integrated into the BLS algorithm.

	■Adult Foreign Body Airway Obstruction New Recommendations: Rescuers should perform repeated cycles of alternating 5 back blows followed by 5 abdominal thrusts. Blind finger sweeps should not be performed for adults with FBAO.

	Thank You!

Training Implementation
■International: Precourse Self-Assessment (PSA) and Video Prework ACLS AND PALS ONLY

PSA print PDF available on Atlas 22 October
PSA and Video Prework Online Availability in International English coming shortly. Stay tuned for communication to International Training Network
The Precourse Self-Assessment is required for all ACLS and PALS courses
Video Prework is only required depending which agenda is chosen
Single certificate upon bundle completion for Precourse Self-Assessment and Video Prework

■International Instructor Updates and Product & Course Orientations (P&CO)

Instructor Updates are free and will be available in English for Heartsaver, BLS, ACLS, PALS, PEARS on October 22.
Instructor Update are available on ShopCPR, eLearning, and LLP, and are assignable through Training Central when purchased through ShopCPR.
Instructor Updates in additional languages will be provided later according to the plan.
P&COs are available on Atlas as PDFs now. And additional language will be provided later.
Stay tuned for future communication from AHA.

	■Interim materials Interim materials are available on Atlas Course Information page.

	■Atlas Platform Updates INTERNATIONAL USERS

	■International Exams FIND ON SHOPCPR: Print options available on Atlas Online Exams available soon Online Exams are Exclusive to the Training Center Coordinator with Training Center Security Code For proctored classroom use only

	■Creating Classes on Atlas COURSE NAMES ALIGN WITH AGENDAS ACLS Course ACLS Update Course PALS Course with Video Prework BLS Renewal Course ACLS Course Card and BLS Card with Video Prework PALS Course and BLS Card with Video Prework

	■Updated Universal Chain of Survival The 2025 Systems of Care Guidelines has a new Chain of Survival, which is intended to apply to all forms of cardiac arrest regardless of age (pediatric versus adult) or location (out-of-hospital or in-hospital).

■Significant Change
For infants, the recommended compression techniques include using either 1-hand technique or the 2 thumb-encircling hands technique. If the rescuer cannot physically encircle the chest, it is recommended to compress the chest with the heel of 1-hand technique. The use of 2 fingers along the sternum was eliminated due to ineffectiveness in achieving proper depth.

This is a major change from 2020 where the use of 2 fingers was still a recommended technique. The removal of this recommendation also removes differences in compression technique between single and two-rescuer CPR in infants. Previously it was recommended that a single rescuer use the 2 finger technique and two-rescuers use the two-thumb technique. Now for single or two-rescuer, either two-thumbs or the heel of one hand is recommended, whichever can achieve the best depth.

■Foreign Body Airway Obstruction

NEW Recommendations for adults with FBAO
For adults with severe foreign-body airway obstruction (FBAO), rescuers should perform cycles of 5 back blows followed by 5 abdominal thrusts until the object is expelled or the patient becomes unresponsive.
If the rescuer is unable to encircle the person's abdomen (Includes obesity, pregnancy, people in wheelchairs), repeated cycles of 5 back blows (slaps) followed by 5 chest thrusts should be used for adults with severe FBAO until the object is expelled or the person becomes unresponsive.
For children with severe FBAO, repeated cycles of 5 back blows alternating with 5 abdominal thrusts should be performed until the object is expelled or the child becomes unresponsive.
This is a major change from 2020, where the intervention was abdominal thrusts only until the object was expelled or the child became unresponsive.
For infants with severe body airway obstruction (FBAO), repeated cycles of 5 back blows alternating with 5 chest thrusts is recommended. Abdominal thrusts are not recommended in infants.

	■Science Updates EXPANDED FIRST AID GUIDANCE Opioid associated emergencies Expanded first aid actions Recognition of stroke Recovery position

■Streamlined Course Paths
Core Offerings

Heartsaver First Aid CPR AED
◎Heartsaver Total
◎Heartsaver Basic
Heartsaver CPR AED
Heartsaver First Aid
Heartsaver Pediatric First Aid CPR AED

Updates

Eliminated course paths (Educator, Office)
DVD, USB, and streaming updates are more succinct
More tailored to help instructors (Child and infant CPR AED stand alone)

■Practice & Skills Testing
Required First Aid Skills

Responding to First Aid Emergency (replaces Finding the Problem)
Controlling Bleeding and Bandaging

Required Practice Skills (Not Tested)

Remove Gloves
Using Epinephrine Autoinjector

Optional Practice

Splinting

Skills Exam Sheets Updated
■Practice & Skills Testing

■Combined Instructor Manual
2-in-1 Resource

Covers both Heartsaver First Aid CPR AED and Pediatric First Aid CPR AED.

Enhanced Features

Guided questions and discussion prompts
Expanded practice opportunities
Revised FA module order
Comprehensive instructor FAQ
Course paths

■Combined Student Workbook
4-in-1 Comprehensive Resource

All Heartsaver course support in one student workbook

Redesigned Layout

Less transition text and redundancy
Topics in alphabetical order
Compact size to keep with first aid kit
Digital reference guides available with eBook
No more Reminder Cards
Easier inventory management

	■Heartsaver Instructor Resources

■eLearning
Dynamic and engaging

Completely refreshed
Students practice their skills virtually through robust activities.
The courses effectively prepare students for in-person skills testing.

Interactions and features

Creative interactions to enhance engagement.
Light and dark mode options.
Mobile-friendly application.

	BLS

■BLS Update
COURSE TRACKS
BLS Provider Course is designed for health care professionals and trained first responders who provide care to patients in a wide variety of settings, as well as individuals enrolled in a health care training program.
There are still 2 main course tracks for the BLS audience: in-hospital and out-of-hospital. Both tracks include the same course content, but the scenarios presented are tailored to the audience taking the BLS course.
■BLS Update

	■Basic Life Support SKILLS TESTING CHECKLIST Infant CPR Skills Testing Checklist Updated hand placement for infant compressions to the heel of one hand technique. Removed 2-finger technique for infant chest compressions.

■Basic Life Support
STUDENT PRACTICE ACTIVITIES
Instructor-led student activities within lesson plans

AED
2-Rescuer BLS with AED
Team Activity
◎It is recommended that life support training for health care professionals include a specific emphasis on teamwork competencies.
◎Activity now required for the BLS Course and BLS Renewal Course.
◎A minimum of 3 students is highly recommended to support team dynamics course objectives.

	■Basic Life Support LESSON PLAN Discontinued Lesson Plans The continuous compressions lesson plan has been discontinued in the BLS course.

	■Basic Life Support Update Interim materials available on Atlas Course Information page. International HeartCode Standardization for BLS provider course, Instructor training will not change.

	ACLS

■Revised Course Agenda Titles
ACLS agenda titles have been revised to align with the learner's chosen path—either completing the precourse self-assessment and video prework or just the precourse self-assessment alone.
Agendas:

ACLS Course
ACLS Course with Video Prework
ACLS Update Course
ACLS Update Course with Video Prework
Heartcode® ACLS Instructor-Led Hands-On Skills Session
ACLS Course Card and BLS Card With Video Prework
ACLS Update Course Card and BLS Card With Video Prework

	■High-Quality BLS Learning and Testing Stations Revised Continuous compressions reduced to 1 minute per student—Record how many compression performed in the 1 minute. This will reduce fatigue during the course.

	■Airway Management Skills Testing Checklist Record the exact number of average interval between breathes

	■Megacode Testing A minimum of 3 students must be present for each case scenario. Authentic team interaction: ACLS and PALS emphasize communication, leadership, and role assignment during resuscitation scenarios. These skills can only be accurately assessed when students interact as part of a functioning team, not when roles are simulated by instructors or non-rostered participants.

	■Updated Skills Testing Checklist

	■Roster Changes New column for CCF % Instructors will record the passing CCF (Chest Compression Fraction) for each student.

	PALS

■Lesson Plans
Revised to single set of plans chosen based on agenda

PALS Course With Video Prework
PALS Course (full, traditional course without video prework)
PALS Update Course (traditional update course without video prework; new option in 2025)
HeartCode® PALS Hands-On Skills Session

New agendas with BLS renewal

PALS Provider Course Card and BLS Card With Video Prework
PALS Update Course Card and BLS Card

	■Updated Skills Testing Checklist Updated skills descriptor regarding hand placement

■New 3 Minute Teams Dynamics Skill

Simulate real-life challenges of CPR by using 3-minute practice rounds
Help participants recognize their limits
Develop skills for optimal outcomes in pediatric cardiac arrest
Divide students into groups of 3 to 4
Assign a CPR Coach to each group to act as the Monitor/Defibrillator
Complete as many rounds as there are students
Ensure every student practices in the CPR Coach role
Compressor switch required at least once per round
Ideal to switch before the 2-minute pulse check, especially if fatigue affects compression quality
Challenge teams to minimize interruptions in chest compressions to less than 5 seconds

	Thank You!

	2026 AHA Guidelines Launch THE PROGRAM ADMINISTRATIVE MANUAL Marida Straccia American Heart Association International Program Administrator Manager

	■THE PAM CONTENTS ITC Organization ITC Policies and Procedures Instructor Alignment Boundaries and Recognition of Status Course Information Conflict of interest and Ethics policies Legal Aspects References and Resources

	International Training Network Structure

■International Training Center
Organization

■THE PAM: ITC ORGANIZATION
The Role of the ITC

Laws rules and Regulations
ITC Criteria
ITC Application Availability

International Regional Faculty

Criteria

ITC Staffing Roles

ITC Coordinator (TCC)
Training Center Faculty
Prerequisites
Renewal Criteria

Training Sites

Responsibilities
Management
Application Criteria for a TS to become an ITC

	■INTERNATIONAL TRAINING CENTER POLICIES AND PROCEDURES Managing ITC agreement ◎Renewal process ◎Administrative reviews/Course monitorings ◎Adding/deleting a discipline ◎Terminating ITC agreement Transferring ITC agreement ◎ITC acquisitions

■International Regional Faculty
Criteria

Must be an active AHA instructor for at least 4 years in the corresponding discipline
Must have TCF status for at least 2 years
Must be aligned with an AHA ITC

Scope of Capability

Can conduct administrative reviews as requested by AHA International
Conducts course monitoring on a routine basis and as requested by AHA International
May monitor, update, coach, and mentor TCF and instructors upon request of the assigned ITC
May conduct science and training updates in the region, as requested by AHA International
Oversees quality assurance and compliance at the regional level
Works closely with the AHA Regional Team, who are responsible for the management and supervision of their assignments locally

■ITC Staffing Roles
ITC Coordinator

Represents the ITC and is selected by the ITC
Has an understanding of ECC Programs
Handles the management and storage of ITC records
Is responsible for the security and distribution of course completion cards
Is responsible for the security and distribution of exams to instructors and TSs
Is responsible for all instructors and ensures that instructor profiles are kept up-to-date at all times
Identifies, appoints, and is responsible for the training and management of all TCF for the ITC
Ensures that instructors are current with information from the AHA, including science updates and Training Memos and Bulletins
The AHA recognizes only one (1) TCC for an ITC.

AHA Training Center Faculty (TCF)
Role

Conducts Instructor Essentials courses and monitors, updates, renews, instructors
Serves as quality assurance and educational leadership for the ITC
Ensures that the ITC can conduct quality Instructor Essentials courses, course monitoring, and instructor updates within the ITC

The recommended ratio is at least one (1) TCF per 8 instructors (in the same discipline) or at least one (1) TCF per TS if the instructor numbers are fewer than 12.

Renewal Criteria

TCF status must be renewed every 2 years.
AHA staff and RFs are responsible for TCF renewal.
TCF must maintain provider/instructor status.
TCF must teach one (1) instructor course in 2 years or have completed at least 4 instructor renewals in accordance with the AHA guidelines. At least one (1) of these activities should be supervised by either AHA Training Staff or an RF.

ICT Policies and Procedures
■Managing an ITC Agreement
The agreement will remain active until it expires and is not renewed or either party chooses to terminate the agreement under the terms of the ITC agreement.

To ensure that each ITC meets its contractual obligations, the AHA Regional Office will conduct periodic reviews.

All ITCs should adhere to the terms of the agreement and AHA guidelines outlined in this PAM.

The TCC should retain a copy of the current ITC Agreement on file at the ITC.
■Managing an ITC Agreement

■Managing an ITC Agreement
Adding a Discipline
ITCs that wish to add or reinstate a discipline need to contact the Regional Director who will provide the application to submit with the appropriate documentation.

Deleting a Discipline
The procedure for deleting a discipline is the same as for terminating an ITC Agreement. All instructors must be notified in writing by the TCC.

Liability Insurance for ITCs
■Managing an ITC Agreement

ITC Acquisitions
Any change of control of an ITC, including mergers, acquisitions, or ownership transfer, requires the submission of a new ITC Application, including updated insurance reflecting the new organization. The AHA will review the new organization to ensure compliance with all applicable criteria and policies. If approved, the new organization must execute a new ITC Agreement before conducting any AHA courses.

Until the new agreement is fully executed, the existing ITC Agreement cannot be assigned, transferred, or continued under new ownership.

Managing Records
Document Retention
ITCs must keep all required documents (either hard copy or electronic) for at least 3 years after the date of action; for example, maintain records for 3 years past the last day of the course.

ITC documents
Course Files
◎Provider courses
◎Instructor Essentials courses
◎TCF courses
◎Instructor and TCF records for all disciplines
◎Instructor records Transfer

Reporting
ITCs that are on Atlas are not required to submit training reports. Those countries not on Atlas must submit a midyear report and an end-of-year report. Failure to submit the required ITC Activity Report by the deadline is considered a breach of the ITC Agreement and cause for the AHA to terminate the ITC Agreement.

Course Fees The AHA does not set or receive fees for courses offered by ITCs or instructors. It is the responsibility of the ITC and/or instructor to determine what fees, if any, to charge for their courses and to ensure that their billing practices comply with applicable laws.
The following disclaimer must be printed on all ITC promotional brochures, announcements, agendas, or other materials distributed to students in courses for which fees are charged:

The American Heart Association (AHA) strongly promotes knowledge and proficiency in all AHA courses and has developed instructional materials for this purpose. Use of these materials in an educational course does not represent course sponsorship by the AHA. Any fees for an AHA course are set and charged solely by the applicable Training Center or Training Site and are not charged by the AHA.

■AHA Platforms
All ITCs should fully use the AHA Platforms for maintaining course records, managing instructors, and accessing course information and exams. Users have the following access, depending on their role:

TCC: One TCC account is created by the AHA for each ITC. The TCC can add, edit, and deactivate administrators, TS Coordinators (TSCs), TSAs, TCF, and instructors.
TCA: The TCA can add, edit, and deactivate TSCs, TSAs, TCF, and instructors.
TSC: One TSC account is created by the TCC or TCA. The TSC can add and deactivate instructors and manage rosters for their site, but they cannot access rosters and instructors that are not associated with their TS.
TSA: The TSA can add and deactivate instructors and manage rosters for their site, but they cannot access rosters and instructors that are not associated with their TS.
Instructors: Their access allows them to add or edit rosters for classes in which they are aligned as well as accessing course resources.
TCF: Can teach Instructor Essentials courses, renew instructors, and monitor instructor candidates.

Instructor Alignment
■Requirements for Instructor Alignment
An instructor candidate must complete all course and monitoring requirements and be accepted by and align with an approved primary AHA ITC that is authorized by the AHA to teach in that geographic territory before teaching a course other than the initial monitored course. Only instructors aligned with an ITC are authorized to teach courses and issue course completion cards through the TCC.
■Requirements for Instructor Alignment

■Instructor Status Revocation
Revocation of instructor status means the privilege of claiming instructor status, aligning with an ITC, and issuing AHA course completion cards is no longer allowed.
Reasons for Instructor Revocation
The following list includes some, but not all, instructor activities that could result in revocation:

Falsification of class records
Nonadherence to AHA guidelines and curricula
Producing or issuing non-AHA course completion cards
Continued instruction that is inconsistent with AHA standards for the course or program after remediation by the TCC, TCF, ECC staff, or IRF
Using non-AHA exams or breaching security of AHA exams
Inappropriate activities, language, harassment, or conduct during courses or directed toward other instructors, students, ECC staff, or volunteers

	Boundaries and Recognition of Status ■Training Boundaries ITC Agreement The ITCs (including all aligned instructors and TSs) may offer their AHA courses only in the geographic territory defined in their ITC Agreement.

■Training Boundaries
Training Outside of the ITC’s Authorized Territory
The AHA acknowledges that many AHA instructors and ITCs have ongoing relationships within the international medical and safety communities.

However, an ITC’s approval to deliver AHA training is strictly limited to the Territory defined in its ITC Agreement. Any training outside that Territory requires prior written approval from AHA through the process of obtaining permission to ensure the quality of international training.
■Training Boundaries

■Recognition of Status
The AHA ECC Programs recognizes the mobility of its providers and instructors and encourages them to remain active in the ECC Training Network wherever they move.
International TCs
The role of the ITC and US Training Center is the same. The AHA seeks consistency in training in all ITCs, both in the United States and globally.
AHA course completion cards issued by any AHA ITC should be considered equivalent, regardless of their country of origin.
■Recognition of Status

Course Information
■Course Information
General Information
For specific course information, please refer to the appropriate instructor manual.

The course must be taught according to the guidelines and core curriculum set forth in the current editions of the AHA course textbook(s) and instructor manual.
A course evaluation form must be used in each ECC course to obtain feedback from students on course content and instructors.

Written Exams and Skills Tests

Only current AHA written (including paper or online) exams and skills tests issued by the AHA are used to determine successful course completion.

Exam Security

To prevent possible compromise of exam contents, the AHA will issue an exam only to the TCC listed on AHA records when the class is created. TCCs are ultimately responsible for the security of the exams.

Validation

To validate students' completion certificates, eCards.heart.org/international

■Use of the Term Health Care Professional in Advanced Courses
The AHA uses the terminology of "any current, active health care professional" to be inclusive of any potential member of a resuscitation team.

Examples of "any current, active health care professional" include but are not limited to:

physicians,
nurses,
paramedics,
physician assistants,
nurse practitioners,
advanced practice nurses,
dentists,
respiratory therapists,
pharmacists,

and any other professional who may be part of a resuscitation team. Therefore, there is no limitation for current, active health care professionals to attend AHA advanced courses or to be considered instructors for AHA advanced courses.

■Instructor Candidates
The AHA requires that instructors be at least 18 years of age for Heartsaver Instructor Essentials. BLS, ACLS, PALS, and PEARS Instructors must be at least 18 years of age and be licensed or credentialed in a health care occupation in which the skills are within the provider's scope of practice. ITCs should ensure that they comply with local laws regarding the age of instructors and participants.

Conflict of Interest and Ethics Policy
■Conflict of Interest
The AHA has established a Conflict of Interest Policy that applies to all ECC leadership roles, including but not limited to International Regional Faculty (IRF), Training Center Coordinators (TCC), Training Center Faculty (TCF), and any other individuals designated by AHA as ECC leaders (ECC Leaders).
Conflict of Interest Policy
ECC Leaders shall avoid any conflict between their own respective personal, professional, or business interests and the interests of the AHA in any and all actions taken by them on behalf of the AHA in their respective capacities. ECC Leaders are expected to conduct themselves with impartiality while performing AHA ECC tasks.

Ethics and Code of Conduct
The AHA has established an Ethics Policy that applies to all AHA leaders, ITCs, and instructors. These positions hold a responsibility to exhibit a high standard of conduct.
■Conflict of Interest

Legal Aspects
■Trademarks
The AHA's stylized name and heart-and-torch logo are trademarks of the American Heart Association, Inc. and are registered with the US Patent and Trademark Office. Only the AHA may use these trademarks.

The AHA has an ITC seal logo (ITC Seal) that includes the heart-and-torch logo. ITCs may use this ITC Seal logo if their use of the ITC Seal meets the requirements outlined in the Authorized ITC Seal – Guidelines for Use for TCCs. This document and the ITC Seal logo application may be requested from the AHA Regional Office and ITCAgreementSupport@heart.org.
■Trademarks

■Using AHA Verbiage, Logos, and Marks
Instructors are not AHA employees; they operate under independent Training Centers that the Association licenses.

Listing "American Heart Association" or "AHA" as an employer or in their job title on business cards erroneously implies a formal employment relationship. Inaccurate representation of their role may lead students, clients, and regulatory bodies to believe the Association is directly responsible for training quality, logistics, or business practices of these individuals and exposes the Association to liability for their actions.

Instructors can use the following language on their CVs or business cards because it does not incorrectly assert or imply an employment relationship with the AHA:

"Instructor authorized to teach American Heart Association courses"
"Certified by an American Heart Association-licensed Training Center to teach Association courses"
"Certified to deliver American Heart Association curriculum through [Name of Licensed ITC]"

	References and Resources ■Resources on the ECC Training Network

	Thank You!

	2025 Heartcode Basic Life Support (BLS) Marida Straccia American Heart Association International Program Administrator Manager

	■Course Updates Updates to the BLS Course Materials: Videos and Graphics All course videos have been updated to reflect the 2025 AHA Guidelines updates to science and education, including scenarios, instructional, and Practice While Watching Live-action scenarios tailored to both course tracks New and revised illustrations Scenarios and illustrations depicting female cardiac arrest

	■Course Updates Updates to the BLS Course materials: Instructor Manual New Instructor-led discussions to reinforce learning Instructor-led student practice activities within lesson plans Lesson plans enhanced with correlating references to student manual ecommend Instructors to play practice-while-watching videos once through before practice Aligning lesson numbers for each course agenda

■Overview of HC BLS Course
Course Types:

◎HeartCode® (blended-learning)
◎Resuscitation Quality Improvement® (RQI®) (self-directed course)
Is an in-person skills session required for successful completion? Yes
Prerequisites? No
Course Card or Certificate of Completion?
　・Yes, upon successful completion of the course, students will receive a BLS Provider eCard, valid for 2 years
　・For HeartCode: After successfully passing HeartCode Online, students will receive a Certificate of Completion. Students must then attend an in-person skills testing session where they will receive a BLS Provider eCard upon successful completion, valid for 2 years

	■HeartCode Blended Learning The HeartCode Blended Learning program combines self-directed eLearning with Instructor-led hands-on practice and testing to provide consistency in resuscitation training and meets diverse learning needs.

	■HeartCode BLS

	■True Adaptive Learning in HeartCode Artificial intelligence provides a truly personalized learning at scale. Personalized algorithm adapts educational content in real time to the learner’s specific expertise. Learning algorithm continuously adapts content as the learner is progressing through the course.

■HeartCode BLS Course Topics

The steps of the Chains of Survival
How to perform high-quality CPR for an adult, a child and an infant
How to use an AED
Effective team dynamics in a multi-rescuer resuscitation
How to treat special considerations in basic life support
How to relieve foreign-body airway obstruction for an adult, a child and an infant
Four Computer Assisted Assessments that are interactive patient care scenarios where learners practice recognizing the signs of a cardiac arrest emergency, activate the response system and begin CPR in a virtual environment

	■Preparing to Take 2025 Heartcode BLS Choose your preferred language

	■Find your Provider Manual

	■Completing the Online Session

	■Now What?

	■Success The hand-on session it's mandatory for the student to receive a Provider eCard.

	Teaching a BLS HeartCode Course ■Preparing to Teach HeartCode

	■Instructor Materials For the HeartCode hands-on session, use the Instructor materials.

	■Hands-on Session and Skills Testing Students must demonstrate that they can successfully perform each skill as outlined in the skills testing checklists. The skills practice and testing must be conducted by an AHA Instructor for that discipline. For this session refer to the specific Lesson Plan.

	Instructor Development and Renewal ■Instructor Development The 5 core competencies for all instructor candidates: Skills Course delivery Testing Professionalism Program administration

■Instructor Essentials Course Prerequisites

Currently have or obtain a provider card in the discipline(s) the candidate is interested in teaching and be proficient in all skills.
Identify ITCs accepting new instructors before enrolling in an instructor program (the ITC hosting the course may not necessarily be the same as the primary designated ITC); Instructor Essentials courses/ITCs may be located at heart.org/cpr.
Complete an Instructor Candidate Application to be on file with the accepting primary ITC.
Successfully complete the appropriate discipline-specific online Instructor Essentials course with a certificate of completion brought to the classroom for a hands-on session conducted by TCF.
Successfully be monitored teaching within 6 months after successful completion of the appropriate Instructor Essentials course with a Course Monitor Form documented by TCF (ITCs may require additional monitoring, if needed).

■Instructor Renewal
Meet the following requirements:
✓ Be renewed by a TCF
✓ Maintain current provider status
✓ Earn 4 credits during each 2 years of instructor recognition by doing any combination of the following:

Conduct the hands-on skills session for a blended course. Each HeartCode® BLS hands-on session or Heartsaver hands-on session counts as 1 credit.
Teach an instructor-led Heartsaver® class. Each course counts as 1 credit.
Conduct a BLS and AED skills testing during a Pediatric Advanced Life Support (PALS); Pediatric Emergency Assessment, Recognition, and Stabilization (PEARS®); or Advanced Cardiovascular Life Support (ACLS) class. Only one of the 4 credits can be awarded via this method.
Attend updates as required within the previous 2 years.
Be monitored while teaching before instructor status expiration. The first monitoring after the Instructor Essentials Course does not satisfy this requirement.

	Thank You!

American Heart Associaton. 2025 CPR&ECC GUIDELINES