BLS Manual Updates At-A-Glance: 2020 to 2025

Dispatchers should provide chest compression-only CPR instructions to callers for adults with suspected out-of-hospital cardiac arrest (OHCA)

Bystanders should perform chest compressions for all patients in cardiac arrest

Bystanders who are trained, able, and willing to give rescue breaths and chest compressions should do so for all adult patients in cardiac arrest

Bystanders should provide CPR with ventilation for infants and children less than 18 years of age with OHCA

Bystanders who cannot provide rescue breaths as part of CPR for infants and children less than 18 years of age with OHCA, should at least provide chest compressions

EMS dispatchers should offer dispatcher-assisted CPR instructions for presumed pediatric cardiac arrest

EMS dispatchers should offer dispatcher-assisted CPR instructions for pediatric cardiac arrest when no bystander CPR is in progress

For EMS systems, a reasonable alternative to conventional CPR for witnessed shockable OHCA is minimally interrupted cardiac resuscitation

Before placement of an advanced airway (supraglottic airway or tracheal tube), EMS providers should perform CPR with cycles of 30 compressions and 2 breaths

EMS providers should perform CPR with 30 compressions to 2 ventilations or continuous chest compressions with positive-pressure ventilation (PPV) without pausing chest compressions until a tracheal tube or supraglottic device is placed

Whenever an advanced airway (tracheal tube or supraglottic device) is inserted during CPR, it may be reasonable for providers to perform continuous compressions with PPV delivered without pausing chest compressions

After placement of an advanced airway in adults, it may be reasonable for the provider to deliver 1 breath every 6 seconds (10 breaths per minute) while continuous chest compressions are being performed

For infants and children receiving CPR with an advanced airway or who have a pulse but are undergoing rescue breathing, the recommended respiratory rate has been increased to 20 to 30 breaths per minute (1 breath every 2 to 3 seconds). Previously 1 breath every 6 to 8 seconds with advanced airway or 3 to 5 seconds during CPR without advanced airway

For pediatric patients with cardiac arrest due to pulseless electrical activity or asystole, the initial dose of epinephrine should be given as soon as possible during CPR to improve the chance of survival

For pediatric patients with suspected opioid overdose, naloxone administration is reasonable in addition to BLS/PALS; however, resuscitative measures for cardiac arrest (e.g., high quality CPR) should take priority over naloxone administration

The Suspected Opioid Poisoning algorithm has been updated (Figure 16)