AHA/ILCOR Update 2025 — Part 2

By Marc Gosselin MD , SIRIUSMEDx

When we published our first article on the 2025 AHA/ILCOR guidelines, I deliberately focused on the main points: the unified chain of survival, the importance of technological feedback, the role of publicly available naloxone, and the increased emphasis on debriefing in training.

However, as is often the case with major updates, several more technical elements—which are nonetheless crucial to the quality of our teaching—needed to be clarified.However, as is often the case with major updates, several more technical elements—which are nonetheless crucial to the quality of our teaching—needed to be clarified.

That is the purpose of this article: to clarify what had not yet been addressed and to provide an overview of all the new recommendations that are useful for all our instructors.

To make it easier to read, I have divided the content into two sections:

1. What affects first aid in the field
2. Regarding structured teams and advanced care

🟧 1. New developments that directly affect first responders in the field

In basic training or in the field, simplicity and quality of movements are more important than anything else.

Here are the key points clarified by the new guidelines—and which we must absolutely incorporate:

🔹 Compression in infants

An important change: using the palm rather than two fingers is now the recommended technique when the infant's size allows it.   

This results in more stable, deeper compressions that are less physically demanding.

🔹 Transition in the event of airway obstruction in children

The actions remain the same, but the logic has changed:

If the child loses consciousness, immediately begin CPR without checking for a pulse or attempting to remove the object before the compression sequence.

🔹 The importance of AED electrode adhesion

This is one of the most practical additions: the electrodes must be securely attached. Sweat, sand, sunscreen, and moisture can significantly impact the effectiveness of the shock.

🔹 Hard surface for compressions

The recommendations are now explicit: if the victim is lying on a soft surface, the situation should be corrected quickly by sliding a rigid support underneath them or moving the person.

🔹 Rescuer fatigue

Rotation is no longer strictly limited to two minutes: data shows that quality often declines before then. We therefore recommend 1 to 2 minutes.

🔹 Recognition of the “gasp”

An important reminder: agonal breathing—the "gasp"—is considered cardiac arrest.

Even if the person "appears to be breathing."​

🔹 Naloxone as a first aid tool

Naloxone now joins the AED in the philosophy of accessible public tools.

Important: Never delay CPR to administer naloxone.

🟧 2. New features for professional teams and advanced support

Structured teams—professional, paramedical, or in isolated regions—are also seeing significant changes, especially in the way they work together.

🔹 Closed-loop communication becomes an official standard

A clear message from the AHA: team management requires structured communication.

The closed loop consists of three simple steps:

1. A clear instruction.​
2. A confirmatory repetition.​
3. An announcement once the task is complete.

It is no longer a "best practice." It is now a standard.

🔹 A clear definition of leadership

The team leader must be identified, assume their position, and verbally guide actions, especially in diverse teams or in austere environments.

🔹 Oxygen therapy for advanced settings

The targets are clarified:

94–99% after circulation return.

Avoid prolonged over-oxygenation.

🔹 Traumatic arrest and reversible causes (H & T)

A refinement of logic: in traumatic arrest, the focus is primarily on reversible causes, particularly in remote areas.

🔹 Structured debriefing

The AHA confirms that "hot" and "cold" debriefings are an integral part of the resuscitation process.

This fits perfectly with our SIRIUSMEDx culture of continuous improvement.

📘 Summary table — Consolidated version 2025

(This table presents the essentials, separated according to the two levels of intervention.)