What changed recently

The 2025 edition replaces the four separate 2020 Chains of Survival with a single unified six-link chain spanning adult, paediatric and in-hospital arrest, and adds first-time guidance for choking in responsive adults using alternating back blows and abdominal thrusts. It also advises against routine mechanical CPR devices, reserving them for situations where manual compressions are unsafe or impractical, and extends delayed cord clamping in newborns to at least 60 seconds.

ATLS 11 shifts the primary survey to an xABCDE sequence that puts control of exsanguinating haemorrhage ahead of the airway, and moves to balanced resuscitation with early 1:1:1 blood component therapy rather than crystalloid-led volume replacement. Glasgow Coma Scale assessment changes from the 10th edition's single total score to combined component and trend scoring, with new emphasis on recognising herniation and preventing secondary brain injury from the primary survey onward.

The 2025 ERC guidelines supersede the 2021 edition, folding CPR-quality and technology guidance into the individual chapters instead of treating it separately and strengthening the message to call emergency services for any unresponsive person before assessing breathing. Advanced life support adds emphasis on effective ventilation and correct pad placement, positions extracorporeal CPR as an option in specialist centres when conventional CPR fails, and addresses sedation for CPR-induced consciousness.

The 2024 update to the 2017 ATS guideline adds conditional recommendations in favour of corticosteroids, venovenous ECMO in selected severe ARDS, and neuromuscular blockade in early severe ARDS, all of which the 2017 document had left unresolved. It also now favours higher PEEP without recruitment manoeuvres in moderate-to-severe ARDS and recommends strongly against prolonged recruitment manoeuvres, which meta-analysis suggested increase mortality.

The sixth edition condenses the guideline into 39 recommendations grouped behind key decision points along the bleeding patient's timeline, citing only the highest-quality evidence rather than an exhaustive literature review as earlier editions did. Clinically it takes an explicitly neutral position on prehospital blood product transfusion, advises against routine point-of-care platelet function testing, and retains restrictive volume replacement targeting a systolic pressure of 80-90 mmHg until bleeding is controlled.

This focused update replaces the toxicology section of the 2010 AHA CPR and ECC Guidelines, expanding narrow antidote advice into poison-specific pathways covering beta-blockers, calcium channel blockers, cyanide, digoxin, local anaesthetics, opioids, organophosphates, sodium channel blockers and sympathomimetics. It newly positions venoarterial ECMO for refractory poisoning-induced shock or arrest and clarifies that specific antidotes are most valuable before arrest occurs, being largely unproven once the patient arrests.