What's new in the latest CPR guidelines?

If you see someone choke or suddenly collapse, swift action can be lifesaving. The latest cardiopulmonary resuscitation (CPR) guidelines from the American Heart Association (AHA) provide recommendations for recognizing and responding to several types of emergencies, including choking, suspected opioid overdose, and cardiac arrest (when the heart suddenly stops beating).

"The new guidelines reflect a broader trend in medicine to focus more on empowering lay people to take action, which I think is really important," says Dr. Scott Goldberg, assistant professor of emergency medicine at Harvard Medical School and medical director of emergency preparedness at Brigham and Women's Hospital. In general, the advice geared toward the general public is simpler and more streamlined than it used to be, which can help people feel less overwhelmed and potentially more likely to help, he adds. "People need to understand that even if what they do isn't perfect, they can still make a difference."

Currently, only about 42% of adults who have a cardiac arrest outside a hospital receive CPR from a person nearby. Most of these cardiac arrests stem from heart-related problems, but some result from breathing issues. In 2024, about 9% were caused by asphyxiation (lack of oxygen), often due to choking. About 5% resulted from drug overdoses.

What to do if someone is choking

The 2025 CPR guidelines are the first ever to include advice about responding to choking in adults. Choking often occurs when food "goes down the wrong way" - that is, into the breathing tube (windpipe) rather than the swallowing tube (esophagus). As long as air is still moving into the lungs, that's a good sign. "But if a person becomes unable to cough, speak, or breathe, it's time to act," says Dr. Goldberg. Don't wait until their face turns blue or discolored - call 911 right away. Then follow these steps:

1. Bend the person over at the waist, tilting toward the ground.
2. Using the heel of your hand, give up to five sharp blows between their shoulder blades.
3. If that doesn't dislodge the object, try abdominal thrusts (commonly called the Heimlich maneuver). Stand behind the person and wrap your arms around their waist. Place one fist, covered by your other hand, just above their belly button. Quickly pull inward and upward. Repeat up to five times.
4. Alternate between back blows and abdominal thrusts until the object is dislodged or the person becomes unresponsive.

Responding to a possible opioid overdose

Opioids - which include heroin, fentanyl, and prescription drugs such as morphine, hydrocodone, and oxycodone - are to blame for 80% of overdose deaths worldwide. These powerful pain relievers affect the part of the brain that regulates breathing, so an overdose can be fatal. Signs of an overdose include slow, shallow, or no breathing; choking or gurgling sounds; drowsiness or loss of consciousness; small, constricted pupils; and blue or grey coloring of the skin, lips, or nail beds.

For the first time, the CPR guidelines include instructions for the general public about when to use naloxone, a drug available as an easy-to-administer nasal spray that can temporarily reverse an opioid overdose.

Cardiac arrest updates

The guidance for performing what professionals call "bystander CPR" has gotten progressively simpler over time - and it's easier than ever to learn the basics. Created in 1960, the original CPR instructions included checking a person's pulse, followed by mouth-to-mouth (rescue) breathing along with chest compressions. The CPR guidelines released in 2000 removed the recommendation to check a person's pulse. "It's challenging for the average person to detect a pulse even under normal, non-urgent circumstances, and people tend to second-guess themselves," says Dr. Goldberg. It's better to just start chest compressions. If you do CPR on someone who's conscious, they'll let you know, he adds.

In 2008, the AHA introduced Hands-Only CPR, after multiple studies showed that chest compressions alone can be lifesaving in the first few minutes of a sudden cardiac arrest. Finally, the 2025 guidelines emphasize speed and correct placement of the pads used with an automated external defibrillator (AED). That includes adjusting, pushing aside, or cutting off a bra rather than removing it entirely, which some bystanders did not feel comfortable doing.

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