The 2025 update to the Adult Cardiac Arrest Algorithm keeps the familiar overall layout but tightens priorities around high-quality CPR, early defibrillation, IV-first access, and selective use of advanced interventions. This page focuses only on what is new or clarified in 2025 compared with the prior ACLS guideline cycle.
Key 2025 themes for cardiac arrest
In the 2025 AHA Guidelines for CPR and ECC, there were no major changes to interventions within the cardiac arrest algorithm. Adult cardiac arrest care is framed even more explicitly around compressions and shocks as the highest-value actions, with everything else built around minimizing interruptions. The Adult Advanced Life Support recommendations stress clear sequencing of CPR, defibrillation, drug delivery, and advanced procedures to keep pauses as short as possible.
- Emphasis on high-quality, minimally interrupted chest compressions throughout resuscitation.
- Clear priority on early defibrillation for shockable rhythms and rapid rhythm reassessment every 2 minutes.
- Preference for IV over IO access when feasible, with IO as a backup if IV cannot be established quickly.
- More cautious stance on “extra” drugs and non-standard defibrillation strategies, which are not part of routine ACLS.
High-quality CPR and defibrillation
The 2025 algorithm reinforces that high-quality CPR and rapid defibrillation remain the core of successful cardiac arrest management. The text and visuals emphasize minimizing peri-shock pauses and avoiding unnecessary breaks for airway placement or other procedures.
- Reinforced targets for chest compressions: rate 100–120/min, depth at least 2 inches but not more than 2.4 inches, full chest recoil, and minimal interruptions.
- Strong reminder to use a one-shock strategy (no stacked shocks) with immediate resumption of compressions after each shock, without pausing to check rhythm or pulse right away.
- Ongoing preference for biphasic defibrillators when available, with continued allowance for monophasic devices where systems still use them.
- Rhythm checks remain brief and occur every 2 minutes; prolonged pulse checks are discouraged.
Drug strategy: timing and restraint
The 2025 Adult Advanced Life Support recommendations keep epinephrine and amiodarone/lidocaine in the algorithm but sharpen guidance on access route, timing, and avoidance of unhelpful routine medications. The overall tone is to use a streamlined set of medications with clear indications rather than adding more drugs to the arrest sequence.
- IV first: The guidelines explicitly prioritize IV access for drug delivery; IO access is reasonable when IV cannot be obtained quickly without delaying key interventions.
- Vasopressors: Epinephrine remains the standard and only vasopressor used in the cardiac arrest algorithm.
- Antiarrhythmics: Amiodarone and lidocaine remain acceptable options for refractory VF/pVT, and 2025 discussions present them as reasonable alternatives rather than clearly favoring one.
- Non-routine “extras”: Routine administration of sodium bicarbonate, calcium, magnesium, or steroids during undifferentiated cardiac arrest is not recommended unless there is a specific indication, such as hyperkalemia, known hypomagnesemia, or toxicologic arrest.
Advanced and non-routine interventions
For advanced or controversial techniques, the 2025 guidelines lean toward cautious, selective use rather than routine incorporation into the core algorithm. These options are treated as special considerations for particular systems or research settings, not standard ACLS steps.
- Mechanical CPR devices: Routine use in adult cardiac arrest is not recommended; they may be considered when high-quality manual CPR is not possible or safe, such as during prolonged transport.
- Vector-change and dual-sequence defibrillation: Interest in these strategies for refractory VF is acknowledged, but they are not recommended for routine use and may be considered only in specific systems or research contexts.
- Electrical pacing: Pacing is not useful for established adult cardiac arrest and should not be used as a resuscitation strategy in this context.
Algorithm structure and systems of care
Visually, the Adult Cardiac Arrest Algorithm still shows the familiar loop of high-quality CPR, 2-minute rhythm checks, shockable versus nonshockable branches, drug administration, and search for reversible causes. The 2025 materials more explicitly place that loop within an integrated Chain of Survival and post–cardiac arrest care framework.
- Integration with a unified Chain of Survival that now spans all ages and settings and explicitly includes recovery as a link.
- Stronger encouragement to use feedback-capable devices and structured debriefing to improve CPR quality and team performance.
- Clear linkage from the arrest algorithm into updated Post–Cardiac Arrest Care recommendations for hemodynamics, oxygenation, temperature management, and neurologic assessment.
This summary reflects the Adult Advanced Life Support recommendations from the 2025 American Heart Association Guidelines for CPR and ECC and the 2025 Adult Cardiac Arrest Algorithm. For full algorithm graphics and wording, refer to the official AHA materials and the 2025 ACLS Provider Manual.