Historical collection · First published Oct 22, 2025; added to EM Weekly Oct 27, 2026. This retrospective summary may be superseded by later evidence or guidance.
← All articlesPart 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Summary
The 2025 adult ALS guideline recommends attempting IV access first during adult cardiac arrest; IO is reasonable when IV access fails or is infeasible. Head-up CPR is not recommended outside clinical trials. POCUS for reversible causes or prognostication remains insufficiently established.
Why it matters
Keep local arrest protocols centered on high-quality CPR, early indicated defibrillation and established therapies. Avoid letting an ultrasound examination interrupt compressions or determine prognosis in isolation.
Study at a glance
- Design
- Guideline
- Population
- Adults with cardiac arrest, peri-arrest arrhythmias and life-threatening cardiovascular emergencies.
- Sample size
- Not applicable
- Intervention
- Evidence-graded adult advanced life support.
- Comparator
- Prior AHA ALS guidance.
- Primary endpoint
- Resuscitation and peri-arrest recommendations.
Main findings
- IV-first access: Class 1, Level A; IO after unsuccessful/infeasible IV: Class 2a, Level A.
- Head-up CPR outside trials: Class 3, No Benefit, Level C-LD.
Limitations
Recommendation strength differs substantially across interventions; limited evidence for adjuncts should not be confused with proven harm. This article covers adult ALS, not the entire pediatric, special-circumstances or post-arrest guideline set.
Recommendation strength
Individual COR/LOE assignments apply; POCUS for reversible causes and prognostication is Class 2b, Level C-LD.
Read the primary source
Full text: Open-access full text available.
Original sourceDOI: 10.1161/CIR.0000000000001376
PMID: 41122884
Material reviewed: full text.
Source retrieved Oct 27, 2026. Historical backfill. Official AHA full-text HTML at https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/adult-advanced-life-support reviewed, including access/adjunct recommendation tables. Journal endpoint returned 403; no access controls bypassed. First electronic publication October 22, 2025 confirmed by PubMed and AHA release; print labeling October 21 was not used.
Corrections & review history
No corrections recorded. Human review: not yet human-reviewed.