Basic and advanced cardiopulmonary resuscitation in adults – 2025 guidelines

In 2025, the European Resuscitation Council (ERC) released updated Adult Advanced Life Support (ALS) guidelines, marking a paradigm shift from rigid algorithms to a dynamic “Physiologically-focused CPR” concept. Simultaneously, American Heart Association/American College of Cardiology (AHA/ ACC) guidelines have been updated, allowing for a comparative analysis of key directions in global resuscitation science. Key European updates include a move towards maintaining target physiological parameters (EtCO2, blood pressure) during CPR, refined timing of adrenaline administration for shockable rhythms, a recommendation to use the maximum available energy for defibrillation, and a post-resuscitation care shift from targeted hypothermia management (TTM 32-34°C) to active fever prevention (≤37.5°C) [3]. The American guidelines, in turn, place significant emphasis on CPR quality, minimizing interruptions, more precise determination of when to terminate resuscitation, and the abandonment of outdated procedures [2]. This review details these innovations in a comparative manner, integrating them into a structured clinical context for practitioners.

1. A.N. Kuzovlev, V.A. Boboshko, E.A. Boeva, E.V. Grigoriev, P.A. Davydov, L.A. Davydova, L. I. Dezhurny, I. B. Zabolotskikh, A. A. Kolodkin, A. A. Krylov, V. V. Kuzkov, A. V. Kulikov, R.E. Lakhin, K.M. Lebedinsky, I.P. Minnullin, V.V. Moroz, T.S. Musayeva, M.V. Petrova, V. Yu., Pikovsky, D.M. Prasol, A.V. Pyregov, D.O. Starostin, V.M. Teplov, N.I. Usoltseva, E.M. Shifman, S.V. Tsarenko. Cardiac arrest (adult patients). Clinical guidelines. General resuscitation. 2025; 21 (3): 5–78. https://doi.org/10.15360/1813‑9779‑2025‑4‑2589

2. 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care [Electronic resource] / J. M. G. Berg, M.W. Donnino, K. M. D.B.G. et al. // Circulation. 2025. Mode of access: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001372.– Date of access: 01.11.2025.

3. European Resuscitation Council (ERC). European Resuscitation Council Guidelines 2025: Adult Advanced Life Support [Electronicresource]. 2025. Mode of access: https://www.erc.edu/science-research/guidelines/guidelines-2025/guidelines-2025-english/. Date of access: 01.11.2025.

4. Smida T., et al. A retrospective ‘target trial emulation’ comparing amiodarone and lidocaine for adult out-of-hospital cardiac arrest resuscitation. Resuscitation. 2025; 208: 110515. https://doi.org/10.1016/j.resuscitation.2025.110515

5. Kudenchuk P.J., Brown S.P., Daya M., Rea T., Nichol G., Morrison L.J. et al. Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. New England Journal of Medicine. 2016; 374 (18): 1711–1722. DOI: 10.1056/NEJMoa1514204

6. Smida T., Salcido D.D., Menegazzi J.J., Schmidbauer S., Salciccioli J.D., Rittenberger J.C. et al. A retrospective ‘target trial emulation’ comparing amiodarone and lidocaine for adult out-of-hospital cardiac arrest resuscitation. Resuscitation. 2025; 208: 110515. DOI: 10.1016/j.resuscitation.2025.110515

7. American Heart Association. 2025 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations: Systematic Reviews [Electronic resource]. 2025. (Входит в состав Suppl. materials к официальным рекомендациям AHA).

8. Kudenchuk P.J., Cobb L.A., Copass M.K., Cummins R.O., Doherty A.M., Fahrenbruch C.E. et al. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. New England Journal of Medicine. 1999; 341 (12): 871–878. DOI: 10.1056/NEJM199909163411203

9. Kudenchuk P.J., Brown S.P., Daya M., Rea T., Nichol G., Morrison L.J. et al. Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. New England Journal of Medicine. 2016; 374 (18): 1711–1722. DOI: 10.1056/NEJMoa1514204

10. Berg K.M., Bray J.E., Ng K.C., Bhanji F., Bierens J.J.L.M., Bourdon E. et al. Antiarrhythmic drugs for cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2025 (Входит в состав Suppl. materials к официальным рекомендациям ERC)

11. Wigginton J.G., Agarwal S., Bartos J.A., et al. Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency CardiovascularCare. Circulation.2025; 152 (16suppl2): S538S577. DOI: 10.1161/CIR.0000000000001376