Interpretation of the updated 2025 American Heart Association and American Academy of Pediatrics guidelines for neonatal resuscitation, pediatric basic life support and pediatric advanced life support_West China Medical Journal

Authors：

LI Yuyao ^1,2 ,  LI Xihong ^2,3

1. Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, P. R. China;
3. Department of Emergency Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LI Xihong, Email: hilixihong@163.com

Keywords：

American Heart Association; basic life support; advanced life support; guidelines; children; newborns

DOI：

10.7507/1002-0179.202510277

Video：

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Abstract Full text Figures/Tables Video References Cited by

In October 2025, the American Heart Association and American Academy of Pediatrics released the “2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care”, which systematically revised the 2025 version guideline based on evidence-based medicine, comprehensively updated the recommended content, class (strength) of recommendation, and level (quality) of evidence, and provided the latest recommendations aimed at improving survival rates and neurological outcomes after cardiac arrest. Since 2020, the Cardiology Committee of American Heart Association has strengthened its collaboration with the American Academy of Pediatrics to jointly publish and cochair the writing groups for neonatal resuscitation, pediatric basic life support, and pediatric advanced life support. This article mainly interprets the recommended content for updating neonatal resuscitation, pediatric basic life support, and pediatric advanced life support, in order to better guide emergency personnel and improve the quality of cardiopulmonary resuscitation and cardiovascular emergency care.

Citation： LI Yuyao, LI Xihong. Interpretation of the updated 2025 American Heart Association and American Academy of Pediatrics guidelines for neonatal resuscitation, pediatric basic life support and pediatric advanced life support. West China Medical Journal, 2025, 40(11): 1738-1746. doi: 10.7507/1002-0179.202510277 Copy

1.	Lee HC, Strand ML, Finan E, et al. Part 5: neonatal resuscitation: 2025 American Heart Association and American Academy of Pediatrics guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2025, 152(16_suppl_2): S385-S423.
2.	Joyner BL Jr, Dewan M, Bavare A, et al. Part 6: pediatric basic life support: 2025 American Heart Association and American Academy of Pediatrics guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2025, 152(16_suppl_2): S424-S447.
3.	Lasa JJ, Dhillon GS, Duff JP, et al. Part 8: Pediatric advanced life support: 2025 American Heart Association and American Academy of Pediatrics guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2025, 152(16_suppl_2): S479-S537.
4.	Bjorland PA, ?ymar K, Ersdal HL, et al. Incidence of newborn resuscitative interventions at birth and short-term outcomes: a regional population-based study. BMJ Paediatr Open, 2019, 3(1): e000592.
5.	Rashwan A, Eldaly A, El-Harty A, et al. Delayed versus early umbilical cord clamping for near-term infants born to preeclamptic mothers; a randomized controlled trial. BMC Pregnancy Childbirth, 2022, 22(1): 515.
6.	Katheria AC, Clark E, Yoder B, et al. Umbilical cord milking in nonvigorous infants: a cluster-randomized crossover trial. Am J Obstet Gynecol, 2023, 228(2): 217. e1-217. e14.
7.	Lu J, Yue G, Wang Q, et al. A review on development of placental transfusion in term and preterm infants. Front Pediatr, 2022, 10: 890988.
8.	Laptook AR, Bell EF, Shankaran S, et al. Admission temperature and associated mortality and morbidity among moderately and extremely preterm infants. J Pediatr, 2018, 192: 53-59. e2.
9.	Fawke J, Wyllie J, Udaeta E, et al. Suctioning of clear amniotic fluid at birth: a systematic review. Resusc Plus, 2022, 12: 100298.
10.	Kapadia VS, Kawakami MD, Strand ML, et al. Fast and accurate newborn heart rate monitoring at birth: a systematic review. Resusc Plus, 2024, 19: 100668.
11.	Mian Q, Cheung PY, O’Reilly M, et al. Impact of delivered tidal volume on the occurrence of intraventricular haemorrhage in preterm infants during positive pressure ventilation in the delivery room. Arch Dis Child Fetal Neonatal Ed, 2019, 104(1): F57-F62.
12.	Kapadia VS, Urlesberger B, Soraisham A, et al. Sustained lung inflations during neonatal resuscitation at birth: a meta-analysis. Pediatrics, 2021, 147(1): e2020021204.
13.	Madar J, Roehr CC, Ainsworth S, et al. European resuscitation council guidelines 2021: newborn resuscitation and support of transition of infants at birth. Resuscitation, 2021, 161: 291-326.
14.	Diggikar S, Krishnegowda R, Nagesh KN, et al. Laryngeal mask airway versus face mask ventilation or intubation for neonatal resuscitation in low-and-middle-income countries: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed, 2023, 108(2): 156-163.
15.	Trevisanuto D, Roehr CC, Davis PG, et al. Devices for administering ventilation at birth: a systematic review. Pediatrics, 2021, 148(1): e2021050174.
16.	Schm?lzer GM, Kumar M, Pichler G, et al. Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis. BMJ, 2013, 347: f5980.
17.	Sotiropoulos JX, Oei JL, Schm?lzer GM, et al. Initial oxygen concentration for the resuscitation of infants born at less than 32 weeks’ gestation: a systematic review and individual participant data network meta-analysis. JAMA Pediatr, 2024, 178(8): 774-783.
18.	Ramachandran S, Bruckner M, Wyckoff MH, et al. Chest compressions in newborn infants: a scoping review. Arch Dis Child Fetal Neonatal Ed, 2023, 108(5): 442-450.
19.	Berg KM, Bray JE, Ng KC, et al. 2023 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces. Circulation, 2024, 195: 109992.
20.	Committee on fetus and newborn; Papile LA, Baley JE, et al. Hypothermia and neonatal encephalopathy. Pediatrics, 2014, 133(6): 1146-1150.
21.	Sutton RM, Reeder RW, Landis WP, et al. Ventilation rates and pediatric in-hospital cardiac arrest survival outcomes. Crit Care Med, 2019, 47(11): 1627-1636.
22.	Kinoshita K, Azuhata T, Kawano D, et al. Relationships between pre-hospital characteristics and outcome in victims of foreign body airway obstruction during meals. Resuscitation, 2015, 88: 63-67.
23.	Katzenschlager S, Kelpanides IK, Ristau P, et al. Out-of-hospital cardiac arrest in children: an epidemiological study based on the German Resuscitation Registry identifying modifiable factors for return of spontaneous circulation. Crit Care, 2023, 27(1): 349.
24.	O’Connell KJ, Sandler A, Dutta A, et al. The effect of hand position on chest compression quality during CPR in young children: findings from the videography in pediatric resuscitation (VIPER) collaborative. Resuscitation, 2023, 185: 109741.
25.	Okubo M, Komukai S, Izawa J, et al. Prehospital advanced airway management for paediatric patients with out-of-hospital cardiac arrest: a nationwide cohort study. Resuscitation, 2019, 145: 175-184.
26.	Niemann JT, Stratton SJ. Endotracheal versus intravenous epinephrine and atropine in out-of-hospital “primary” and postcountershock asystole. Crit Care Med, 2000, 28(6): 1815-1819.
27.	Ohshimo S, Wang CH, Couto TB, et al. Pediatric timing of epinephrine doses: a systematic review. Resuscitation, 2021, 160: 106-117.
28.	Niles DE, Duval-Arnould J, Skellett S, et al. Characterization of pediatric in-hospital cardiopulmonary resuscitation quality metrics across an international resuscitation collaborative. Pediatr Crit Care Med, 2018, 19(5): 421-432.
29.	Farhat A, Ling RR, Jenks CL, et al. Outcomes of pediatric extracorporeal cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care Med, 2021, 49(4): 682-692.
30.	Arrich J, Herkner H, Mullner D, et al. Targeted temperature management after cardiac arrest. A systematic review and meta-analysis of animal studies. Resuscitation, 2021, 162: 47-55.
31.	Laverriere EK, Polansky M, French B, et al. Association of duration of hypotension with survival after pediatric cardiac arrest. Pediatr Crit Care Med, 2020, 21(2): 143-149.
32.	Meert K, Telford R, Holubkov R, et al. Paediatric in-hospital cardiac arrest: factors associated with survival and neurobehavioural outcome one year later. Resuscitation, 2018, 124: 96-105.
33.	Parizad R, Hatwal J, Javanshir E, et al. Artificial intelligence in cardiopulmonary resuscitation: revolutionizing resuscitation through precision and prediction - a narrative review. Vasc Health Risk Manag, 2025, 21: 847-857.
34.	Donnino MW, Miller J, Goyal N, et al. Effective lactate clearance is associated with improved outcome in post-cardiac arrest patients. Resuscitation, 2007, 75(2): 229-234.
35.	Bourgoin P, Barrault V, Joram N, et al. The prognostic value of early amplitude-integrated electroencephalography monitoring after pediatric cardiac arrest. Pediatr Crit Care Med, 2020, 21(3): 248-255.
36.	Fink EL, Wisnowski J, Clark R, et al. Brain MR imaging and spectroscopy for outcome prognostication after pediatric cardiac arrest. Resuscitation, 2020, 157: 185-194.
37.	Topjian AA, Scholefield BR, Pinto NP, et al. P-COSCA (pediatric core outcome set for cardiac arrest) in children: an advisory statement from the international liaison committee on resuscitation. Resuscitation, 2021, 162: 351-364.
38.	Ong ME, Stiell I, Osmond MH, et al. Etiology of pediatric out-of-hospital cardiac arrest by coroner's diagnosis. Resuscitation, 2006, 68(3): 335-342.
39.	Topjian AA, Raymond TT, Atkins D, et al. Part 4: pediatric basic and advanced life support: 2020 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2020, 142(16_suppl_2): S469-S523.
40.	Campbell M, Buitrago SR. BET 2: ice water immersion, other vagal manoeuvres or adenosine for SVT in children. Emerg Med J, 2017, 34(1): 58-60.
41.	Coughtrie AL, Behr ER, Layton D, et al. Drugs and life-threatening ventricular arrhythmia risk: results from the DARE study cohort. BMJ Open, 2017, 7(10): e016627.
42.	Gutierrez ME, Anders M, Guffey D, et al. Extracorporeal membrane oxygenation cannulation timing in the pediatric myocarditis population: an exploratory analysis from the extracorporeal life support organization registry. Crit Care Explor, 2022, 5(1): e0826.
43.	Marino BS, Tibby SM, Hoffman GM. Resuscitation of the patient with the functionally univentricular heart. Curr Pediatr Rev, 2013, 9(2): 148-157.
44.	Olsson KM, Halank M, Egenlauf B, et al. Decompensated right heart failure, intensive care and perioperative management in patients with pulmonary hypertension: updated recommendations from the cologne consensus conference 2018. Int J Cardiol, 2018, 272S: 46-52.

1. Lee HC, Strand ML, Finan E, et al. Part 5: neonatal resuscitation: 2025 American Heart Association and American Academy of Pediatrics guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2025, 152(16_suppl_2): S385-S423.
2. Joyner BL Jr, Dewan M, Bavare A, et al. Part 6: pediatric basic life support: 2025 American Heart Association and American Academy of Pediatrics guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2025, 152(16_suppl_2): S424-S447.
3. Lasa JJ, Dhillon GS, Duff JP, et al. Part 8: Pediatric advanced life support: 2025 American Heart Association and American Academy of Pediatrics guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2025, 152(16_suppl_2): S479-S537.
4. Bjorland PA, ?ymar K, Ersdal HL, et al. Incidence of newborn resuscitative interventions at birth and short-term outcomes: a regional population-based study. BMJ Paediatr Open, 2019, 3(1): e000592.
5. Rashwan A, Eldaly A, El-Harty A, et al. Delayed versus early umbilical cord clamping for near-term infants born to preeclamptic mothers; a randomized controlled trial. BMC Pregnancy Childbirth, 2022, 22(1): 515.
6. Katheria AC, Clark E, Yoder B, et al. Umbilical cord milking in nonvigorous infants: a cluster-randomized crossover trial. Am J Obstet Gynecol, 2023, 228(2): 217. e1-217. e14.
7. Lu J, Yue G, Wang Q, et al. A review on development of placental transfusion in term and preterm infants. Front Pediatr, 2022, 10: 890988.
8. Laptook AR, Bell EF, Shankaran S, et al. Admission temperature and associated mortality and morbidity among moderately and extremely preterm infants. J Pediatr, 2018, 192: 53-59. e2.
9. Fawke J, Wyllie J, Udaeta E, et al. Suctioning of clear amniotic fluid at birth: a systematic review. Resusc Plus, 2022, 12: 100298.
10. Kapadia VS, Kawakami MD, Strand ML, et al. Fast and accurate newborn heart rate monitoring at birth: a systematic review. Resusc Plus, 2024, 19: 100668.
11. Mian Q, Cheung PY, O’Reilly M, et al. Impact of delivered tidal volume on the occurrence of intraventricular haemorrhage in preterm infants during positive pressure ventilation in the delivery room. Arch Dis Child Fetal Neonatal Ed, 2019, 104(1): F57-F62.
12. Kapadia VS, Urlesberger B, Soraisham A, et al. Sustained lung inflations during neonatal resuscitation at birth: a meta-analysis. Pediatrics, 2021, 147(1): e2020021204.
13. Madar J, Roehr CC, Ainsworth S, et al. European resuscitation council guidelines 2021: newborn resuscitation and support of transition of infants at birth. Resuscitation, 2021, 161: 291-326.
14. Diggikar S, Krishnegowda R, Nagesh KN, et al. Laryngeal mask airway versus face mask ventilation or intubation for neonatal resuscitation in low-and-middle-income countries: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed, 2023, 108(2): 156-163.
15. Trevisanuto D, Roehr CC, Davis PG, et al. Devices for administering ventilation at birth: a systematic review. Pediatrics, 2021, 148(1): e2021050174.
16. Schm?lzer GM, Kumar M, Pichler G, et al. Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis. BMJ, 2013, 347: f5980.
17. Sotiropoulos JX, Oei JL, Schm?lzer GM, et al. Initial oxygen concentration for the resuscitation of infants born at less than 32 weeks’ gestation: a systematic review and individual participant data network meta-analysis. JAMA Pediatr, 2024, 178(8): 774-783.
18. Ramachandran S, Bruckner M, Wyckoff MH, et al. Chest compressions in newborn infants: a scoping review. Arch Dis Child Fetal Neonatal Ed, 2023, 108(5): 442-450.
19. Berg KM, Bray JE, Ng KC, et al. 2023 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces. Circulation, 2024, 195: 109992.
20. Committee on fetus and newborn; Papile LA, Baley JE, et al. Hypothermia and neonatal encephalopathy. Pediatrics, 2014, 133(6): 1146-1150.
21. Sutton RM, Reeder RW, Landis WP, et al. Ventilation rates and pediatric in-hospital cardiac arrest survival outcomes. Crit Care Med, 2019, 47(11): 1627-1636.
22. Kinoshita K, Azuhata T, Kawano D, et al. Relationships between pre-hospital characteristics and outcome in victims of foreign body airway obstruction during meals. Resuscitation, 2015, 88: 63-67.
23. Katzenschlager S, Kelpanides IK, Ristau P, et al. Out-of-hospital cardiac arrest in children: an epidemiological study based on the German Resuscitation Registry identifying modifiable factors for return of spontaneous circulation. Crit Care, 2023, 27(1): 349.
24. O’Connell KJ, Sandler A, Dutta A, et al. The effect of hand position on chest compression quality during CPR in young children: findings from the videography in pediatric resuscitation (VIPER) collaborative. Resuscitation, 2023, 185: 109741.
25. Okubo M, Komukai S, Izawa J, et al. Prehospital advanced airway management for paediatric patients with out-of-hospital cardiac arrest: a nationwide cohort study. Resuscitation, 2019, 145: 175-184.
26. Niemann JT, Stratton SJ. Endotracheal versus intravenous epinephrine and atropine in out-of-hospital “primary” and postcountershock asystole. Crit Care Med, 2000, 28(6): 1815-1819.
27. Ohshimo S, Wang CH, Couto TB, et al. Pediatric timing of epinephrine doses: a systematic review. Resuscitation, 2021, 160: 106-117.
28. Niles DE, Duval-Arnould J, Skellett S, et al. Characterization of pediatric in-hospital cardiopulmonary resuscitation quality metrics across an international resuscitation collaborative. Pediatr Crit Care Med, 2018, 19(5): 421-432.
29. Farhat A, Ling RR, Jenks CL, et al. Outcomes of pediatric extracorporeal cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care Med, 2021, 49(4): 682-692.
30. Arrich J, Herkner H, Mullner D, et al. Targeted temperature management after cardiac arrest. A systematic review and meta-analysis of animal studies. Resuscitation, 2021, 162: 47-55.
31. Laverriere EK, Polansky M, French B, et al. Association of duration of hypotension with survival after pediatric cardiac arrest. Pediatr Crit Care Med, 2020, 21(2): 143-149.
32. Meert K, Telford R, Holubkov R, et al. Paediatric in-hospital cardiac arrest: factors associated with survival and neurobehavioural outcome one year later. Resuscitation, 2018, 124: 96-105.
33. Parizad R, Hatwal J, Javanshir E, et al. Artificial intelligence in cardiopulmonary resuscitation: revolutionizing resuscitation through precision and prediction - a narrative review. Vasc Health Risk Manag, 2025, 21: 847-857.
34. Donnino MW, Miller J, Goyal N, et al. Effective lactate clearance is associated with improved outcome in post-cardiac arrest patients. Resuscitation, 2007, 75(2): 229-234.
35. Bourgoin P, Barrault V, Joram N, et al. The prognostic value of early amplitude-integrated electroencephalography monitoring after pediatric cardiac arrest. Pediatr Crit Care Med, 2020, 21(3): 248-255.
36. Fink EL, Wisnowski J, Clark R, et al. Brain MR imaging and spectroscopy for outcome prognostication after pediatric cardiac arrest. Resuscitation, 2020, 157: 185-194.
37. Topjian AA, Scholefield BR, Pinto NP, et al. P-COSCA (pediatric core outcome set for cardiac arrest) in children: an advisory statement from the international liaison committee on resuscitation. Resuscitation, 2021, 162: 351-364.
38. Ong ME, Stiell I, Osmond MH, et al. Etiology of pediatric out-of-hospital cardiac arrest by coroner's diagnosis. Resuscitation, 2006, 68(3): 335-342.
39. Topjian AA, Raymond TT, Atkins D, et al. Part 4: pediatric basic and advanced life support: 2020 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2020, 142(16_suppl_2): S469-S523.
40. Campbell M, Buitrago SR. BET 2: ice water immersion, other vagal manoeuvres or adenosine for SVT in children. Emerg Med J, 2017, 34(1): 58-60.
41. Coughtrie AL, Behr ER, Layton D, et al. Drugs and life-threatening ventricular arrhythmia risk: results from the DARE study cohort. BMJ Open, 2017, 7(10): e016627.
42. Gutierrez ME, Anders M, Guffey D, et al. Extracorporeal membrane oxygenation cannulation timing in the pediatric myocarditis population: an exploratory analysis from the extracorporeal life support organization registry. Crit Care Explor, 2022, 5(1): e0826.
43. Marino BS, Tibby SM, Hoffman GM. Resuscitation of the patient with the functionally univentricular heart. Curr Pediatr Rev, 2013, 9(2): 148-157.
44. Olsson KM, Halank M, Egenlauf B, et al. Decompensated right heart failure, intensive care and perioperative management in patients with pulmonary hypertension: updated recommendations from the cologne consensus conference 2018. Int J Cardiol, 2018, 272S: 46-52.

West China Medical Journal

Interpretation of the updated 2025 American Heart Association and American Academy of Pediatrics guidelines for neonatal resuscitation, pediatric basic life support and pediatric advanced life support

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