2025 ILCOR Guidelines: CPR, ECC, and Life Support
In 2025, the International Liaison Committee on Resuscitation published its most comprehensive evidence update since 2020, introducing meaningful changes to resuscitation science across every major certification area. The updates affect anyone who holds or is working toward ACLS, BLS, PALS, CPR, or Neonatal Resuscitation certification, and the changes are already reflected in AMC's course content.
The 2025 update spans six task forces and addresses resuscitation science across both in-hospital and out-of-hospital cardiac arrest scenarios, covering Basic Life Support, Advanced Life Support (ALS), Pediatric Life Support, Neonatal Life Support, Education and Teams, and First Aid. For most health care professionals, the headline changes are immediately practical:
- The Chain of Survival is now unified across adults, children, and infants.
- The two-finger infant compression technique has been removed.
- The 30:2 compression-to-ventilation ratio is the preferred approach for trained rescuers.
- The choking protocol now calls for back blows before abdominal thrusts.
The guidelines also address post-resuscitation recovery, pregnancy-related cardiac arrest, and the mental health of rescuers after a resuscitation event.
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How ILCOR Guidelines Work in 2025
ILCOR is the International Liaison Committee on Resuscitation, a global scientific body formed in 1992 with a single mission: create worldwide consensus on evidence-based resuscitation and emergency cardiovascular care. Its member organizations include the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Australia and New Zealand Committee on Resuscitation, and several other regional councils joining to represent the global resuscitation community.
ILCOR's core work is the Consensus on Science with Treatment Recommendations, or CoSTR. Six task forces review the resuscitation literature across their domains, evaluate the evidence using GRADE methodology, and publish updated recommendations. Those recommendations flow outward as national and regional councils adapt them into country-specific guidelines, and certification programs build their curricula from those guidelines. AMC's courses are built directly on ILCOR's CoSTR, reflecting the same global evidence base that informs all nationally recognized resuscitation training.
The shift to continuous evidence evaluation
Before 2015, ILCOR updated its guidelines on a strict five-year cycle. Since then, the process has become continuous, with ILCOR now reviewing evidence as it emerges and publishing CoSTR updates on an ongoing basis. The 2025 CoSTR represents the most significant consolidated update since 2020, incorporating five years of systematic reviews, scoping reviews, and evidence updates across all six task forces.
For health care professionals, this means resuscitation science no longer waits for an arbitrary calendar date. When meaningful new evidence emerges, guidelines can reflect it. Choosing a certification provider that stays current with ILCOR's ongoing process ensures your training reflects the most up to date science.
2025 Basic Life Support (BLS) Changes
The 2025 International Liaison Committee on Resuscitation update brings several meaningful changes to Basic Life Support that affect both lay rescuers and health care professionals. AMC's BLS certification course reflects all of the updates below.
Unified Chain of Survival
One of the most structurally significant changes in the 2025 guidelines is the consolidation of the Chain of Survival into a single six-link framework covering adults, children, and infants. The separate pediatric chain has been retired.
The unified chain now runs: prevention, early recognition and activation of emergency response, high-quality CPR, defibrillation, advanced resuscitation, and recovery. The addition of recovery as a formal sixth link reflects growing evidence that cardiac arrest survival extends well beyond hospital discharge. Patients need structured assessment and support for physical, cognitive, and psychosocial needs in the weeks and months following a cardiac arrest event. Debriefing is also now recognized as beneficial for lay rescuers, EMS providers, and hospital-based health care workers following a resuscitation event.
Infant Compressions: Two-Thumb-Encircling Technique Only
The two-finger compression technique for infant CPR has been removed from the 2025 guidelines. The two-thumb-encircling technique is now the standard for infant chest compressions in all settings.
For two-rescuer scenarios, the two-thumb-encircling technique with hands wrapped around the infant's chest remains the preferred method. For single-rescuer scenarios where the encircling technique is not feasible, one-hand compressions may be used. The change reflects evidence that the two-thumb-encircling technique produces more consistent compression depth and superior hemodynamic outcomes compared to the two-finger approach.
Compression-to-Ventilation Ratio: 30:2 Preferred
The 2025 guidelines reaffirm 30:2 as the preferred compression-to-ventilation ratio for trained rescuers, including health care providers. Continuous chest compressions without ventilation remain an acceptable approach for untrained lay rescuers, but 30:2 is now explicitly preferred when rescue breaths can be delivered effectively.
The evidence supports that ventilation remains a critical component of high-quality cardiopulmonary resuscitation, particularly in arrests with a respiratory etiology. The 30:2 ratio balances adequate compression delivery with effective oxygenation, and it is the standard reflected in AMC's BLS and CPR course content.
CPR Feedback Devices and Simulation Training
The 2025 ILCOR Education, Implementation, and Teams task force issued a strong recommendation supporting the use of CPR feedback devices during resuscitation training for both health care professionals and lay providers. The evidence shows that real-time feedback improves compression depth, rate, and chest recoil during training, and that these improvements translate to better CPR performance in clinical settings.
2025 Advanced Cardiac Life Support (ACLS) Changes
The most clinically significant ACLS updates in 2025 address vascular access priority and epinephrine use during cardiac arrest. AMC's ACLS certification course reflects both changes.
IV-First Vascular Access
Intravenous access remains the preferred route for drug and fluid administration during cardiac arrest, and the 2025 guidelines sharpen that priority. The previous qualifier allowing IO access after two unsuccessful IV attempts has been removed. The guidance is now straightforward: attempt IV first, and if IV access cannot be obtained, move to IO. Endotracheal drug administration is not recommended due to poor absorption and unknown optimal dosing.
Previous guidance included a qualifier allowing IO access after two unsuccessful IV attempts but that qualifier has been removed. The current guidance does not define a number of attempts before escalating to IO. If IV access cannot be established, IO is the appropriate next step without a defined trial period.
Epinephrine: Timing and Role in Cardiac Arrest
Epinephrine remains the standard pharmacological treatment for cardiac arrest since the evidence consistently shows it improves the likelihood of return of spontaneous circulation and short-term survival. For non-shockable rhythms including PEA and asystole, epinephrine should be administered as soon as IV or IO access is available. For shockable rhythms, it is given after the third shock and repeated every 3 to 5 minutes.
2025 Pediatric Advanced Life Support (PALS) Changes
The 2025 ILCOR update introduces several refinements to pediatric resuscitation, covering compression technique, vascular access, medication options, and epinephrine timing.
Infant Compressions: Two-Thumb-Encircling Technique Only
The two-finger compression technique for infant CPR has been removed. The two-thumb-encircling technique is now the standard across all rescuer scenarios. For full detail on this change and its clinical rationale, see the BLS section above.
IV-First Hierarchy in the Bradycardia Pathway
Consistent with the broader 2025 vascular access guidance, IV access is the preferred route in the pediatric bradycardia pathway. If bradycardia with poor perfusion persists despite oxygenation and ventilation support, epinephrine is administered at 0.01 mg/kg IV or IO every 3 to 5 minutes. Atropine at 0.02 mg/kg may be considered for bradycardia caused by increased vagal tone or primary atrioventricular block. If medications are ineffective, transcutaneous pacing is indicated. IO access remains the appropriate alternative when IV access cannot be established as endotracheal administration is not recommended.
Sotalol Added for SVT Management
For pediatric supraventricular tachycardia, the 2025 guidelines expand the pharmacological options to include amiodarone, procainamide, or sotalol. This is a meaningful addition for SVT management specifically. It is important to note that sotalol is not indicated for ventricular fibrillation or pulseless ventricular tachycardia, and that its addition applies to the SVT pathway only.
Early Epinephrine for Non-Shockable Rhythms
For PEA and asystole, epinephrine should be administered as soon as IV or IO access is available. Providers should not delay administration until the end of the first CPR cycle. Early epinephrine in non-shockable rhythms is associated with improved likelihood of return of spontaneous circulation, and the 2025 guidelines make this timing expectation explicit.
2025 Choking & First Aid Change: Back Blows First
The 2025 ILCOR guidelines update the choking response sequence for adults and children older than one year. Back blows are now the first intervention for severe airway obstruction, followed by abdominal thrusts if back blows are unsuccessful.
The sequence for a responsive adult or child with severe choking is: deliver 5 firm back blows between the shoulder blades using the heel of one hand, then perform 5 abdominal thrusts. Alternate between the two until the obstruction is cleared or the person becomes unresponsive. If the person loses consciousness, begin CPR.
For infants under one year, the protocol remains back blows and chest thrusts. Abdominal thrusts are not used in infants.
This change brings the U.S. guidelines into alignment with international consensus. The previous approach, which began with abdominal thrusts, has been updated based on evidence that back blows are effective as a first-line intervention and that an escalating strategy combining both techniques improves the likelihood of clearing the obstruction.
Key Highlights: What the 2025 Updates Mean for EMS Providers, Clinicians, and Your Certification
If your certification was earned before 2025, your training may not reflect the current science. Several of the changes outlined in this article represent direct protocol changes that affect how you assess, intervene, and escalate during a resuscitation event. The unified Chain of Survival, the removal of the two-finger infant compression technique, the updated choking sequence, revised vascular access hierarchy, and clarified epinephrine timing all have immediate clinical implications.
For health care professionals whose certifications are due for renewal, this is the right time to update. For those whose cards are current but were issued under previous guidelines, it is worth reviewing the changes relevant to your practice area and confirming that your training reflects the 2025 CoSTR.
The 2025 guidelines also place greater emphasis on simulation training and CPR feedback devices as tools for building and maintaining resuscitation competence, reflecting evidence that realistic practice environments improve skills retention and clinical performance.
AMC's ACLS, BLS, PALS, and CPR courses have been clinically reviewed and updated to reflect the 2025 ILCOR standards covered in this article. All courses are 100% online, completable in under an hour, and include continuing education credit through the joint providership with the Postgraduate Institute for Medicine at no additional cost.
Frequently Asked Questions About ILCOR Guideline Updates
What are the new CPR guidelines for 2025?
The 2025 ILCOR guidelines introduce several meaningful changes to CPR practice. The Chain of Survival is now unified across adults, children, and infants into a single six-step framework. The two-finger infant compression technique has been removed in favor of the two-thumb-encircling technique. The 30:2 compression-to-ventilation ratio is explicitly preferred for trained rescuers. The choking response now begins with back blows before abdominal thrusts. And for cardiac arrest during pregnancy, the focus is on maternal resuscitation with early preparation for perimortem cesarean delivery if needed.
What is the ACLS 2025 protocol?
The core ACLS algorithm remains structured around early recognition, high-quality CPR, rhythm assessment, defibrillation for shockable rhythms, and identification of reversible causes. The 2025 update clarifies two key points. First, IV access is the preferred route for drug administration, and the previous qualifier allowing IO access only after two unsuccessful IV attempts has been removed. If IV access cannot be obtained, move directly to IO. Second, for non-shockable rhythms including PEA and asystole, epinephrine should be administered as soon as IV or IO access is available rather than waiting until the end of the first CPR cycle. Endotracheal drug administration is not recommended in either pathway.
What is the recommended BLS sequence for the 2025 ILCOR guidelines?
For trained rescuers responding to an unresponsive adult, the BLS sequence is: confirm scene safety, assess responsiveness, activate emergency services and retrieve an AED, check for breathing, begin CPR at 30 compressions to 2 breaths, and use the AED as soon as it is available. Compressions should be delivered at 100 to 120 per minute to a depth of 2 to 2.4 inches for adults, with full chest recoil between compressions and interruptions kept under 10 seconds. For pediatric patients, compression depth is approximately one-third the chest diameter, and the two-provider ratio for children is 15:2. The 2025 guidelines also recommend the use of CPR feedback devices when available to optimize compression rate, depth, and recoil.
What are the 4 C's of CPR?
The 4 C's of CPR are Compressions, Circulation, Cervical spine protection, and Clear. Compressions form the foundation of CPR, circulating blood to the brain and vital organs when the heart cannot do so on its own. Circulation is maintained through consistent, high-quality compressions at the correct rate and depth. Cervical spine protection is observed when a traumatic cause of cardiac arrest is suspected, using a jaw thrust rather than head-tilt/chin-lift to open the airway. Clear refers to the instruction given before AED shock delivery to ensure no one is in contact with the patient at the moment of defibrillation.
How often are ILCOR guidelines updated?
ILCOR moved away from fixed five-year update cycles in 2015 and now operates on a continuous evidence evaluation model. Each of ILCOR's six task forces reviews new resuscitation research as it is published and updates the Consensus on Science with Treatment Recommendations on an ongoing basis.
Keeping Your Skills Aligned with the Latest Science
Resuscitation science does not stand still, and neither should your training. The 2025 ILCOR consensus on science represents the most comprehensive update to resuscitation guidelines in five years, with meaningful changes across every major certification area.
AMC's ACLS, BLS, PALS, and CPR courses have been clinically reviewed and updated to reflect the 2025 standards. Built directly on current ILCOR science, accredited through the Postgraduate Institute for Medicine, and accepted by more than 98% of health care employers nationwide, AMC certifications give you the most current training available in a format that works around your schedule.