2025 AHA Guideline Updates: Changes in CPR 2025-2030
The American Heart Association published its first comprehensive CPR and Emergency Cardiovascular Care update since 2020 on October 22, 2025, with 760 new recommendations in Circulation. On a vessel, there is a much bigger problem: the Cardiac Chain of Survival is broken. Advanced help can be hours to days away.
The Framework: Survival Is a Chain
The links are: Recognition, CPR, Defibrillation, Advanced Care, Post-Arrest Care, and Recovery. On a vessel, you own the first three. Recognition is tough, CPR is WAY easier said than done, Defibrillation is often unavailable.
Advanced care begins when the Coast Guard or medevac arrives — and even then, capabilities vary widely between different rural and municipal systems. Get the patient to the appropriate hospital. That is,most appropriate for your problem. Heart Attack= Hospital with cath lab.
Every link is brutally time-dependent. Your concern is what happens between collapse and that arrival.
How can I prevent Cardiac Arrest?
You can't. As a cynical ER doc once told me, cardiac arrest is "the only thing we have in common." Cue the flat line and the verbal beep. I'm more optimistic.
While you can't prevent the moment, you can prepare. USCG Boating Safety data is instructive: in 2023, there were 564 recreational boating fatalities — 75% drowning, 86% of whom were not wearing a PFD. Cardiac events are a smaller but significant subset, and unlike drowning, they strike regardless of seamanship skill or experience level. Your best move is knowing your crew before you leave the dock: the MMG Medical Declaration (Confidential) surfaces cardiac history, hypertension, medications, and anticoagulant use for each crew member, the MMG Crew Profile identifies who has medical training and CPR capability, and the Offshore Skills Matrix maps coverage across watches so you're never one person deep on resuscitation. Pair those with the MMG Emergency Medical Quick Guide and a properly stocked Marine First Aid Kit and you've done what the AHA guidelines assume someone else will do — you've built the system.
Key Updates
1. The New Choking Protocol
For a conscious adult with a complete airway obstruction (can’t speak, can’t cough, cyanotic — turning blue around the lips), the 2025 guidelines now recommend alternating five back blows with five abdominal thrusts until the obstruction clears or the person loses consciousness. Back blows generate expulsive pressure from a different angle than abdominal thrusts alone, and the evidence now supports using both.
For infants: five back blows, then five chest thrusts — no abdominal thrusts.
2. Breaths Matter, Especially in Prolonged Resuscitation
For trained rescuers who are willing and able, the 2025 guidelines recommend full CPR (30:2 — 30 compressions to 2 breaths), not compression-only. Compression-only is appropriate for untrained bystanders. For anyone who has taken a CPR class, the full protocol applies.
This is especially important for drowning victims, children, and any cardiac arrest that was caused by a breathing problem.
On a vessel where evacuation may take 30 minutes to several hours, oxygenating the blood through ventilation becomes progressively more important the longer resuscitation continues.
3. The Radio Call Is Part of the Chain
The 2025 guidelines assigned their highest evidence rating (Class 1, Level A) to telecommunicator CPR — dispatcher-guided compression instruction to bystanders over the phone. The maritime equivalent is your MAYDAY call to the Coast Guard, or (concurrently) your telehealth provider. The dispatcher can actively guide CPR quality while you’re waiting for help. Make the call early, keep the channel open, and let them help you. The radio call is no longer background noise in the protocol — it’s a recognized link in the survival chain.
4. AED Access on Vessels
Early defibrillation remains the single most effective intervention for sudden cardiac arrest. SOLAS and STCW do not mandate AEDs on all vessel classes. The AHA’s data makes a strong case for carrying one regardless of regulatory requirement. If there’s an AED aboard, attach it as soon as possible and follow the prompts. If available help allows, place the pads while good compressions are being performed. If it’s just you, leave the patient and get the AED. Place the pads ASAP. Generally, prioritize the AED over compressions if it’s not more than a few minutes away.
Should you buy an AED for your boat? I carry one — though it’s worth being clear-eyed about the limits: a patient resuscitated with CPR and an AED is still suffering the underlying problem that got them there (an acute MI, for example). The AED buys time. The patient still needs definitive hospital care.
For the budget-conscious, there is a sizeable recertified AED market worth exploring. We’ll cover that in the next post on defibrillators for the marine environment, including waterproofing ratings and what to look for in a marine-specific unit.
What You Do in the First 10 Minutes
Start CPR immediately. Compress hard (2–2.4 inches on the sternum — the breastbone), compress fast (100–120 per minute), let the chest fully recoil between compressions. In an adult, you will very likely feel a crunch for the first half dozen compressions. This is natural. Rotate rescuers every 2 minutes — compression quality degrades fast with fatigue. Make the MAYDAY call simultaneously. Attach the AED if available. Keep the person warm — hypothermia can complicate resuscitation significantly and may require prolonged CPR before termination, as in cold water drowning and other cold-etiology arrests.
The 2025 AHA update reinforces what the maritime setting already knows: resources are limited, help is far, and the people doing CPR, coupled with defibrillation, in the first minutes, is the most important controllable variable for you. Advanced care depends on access to help — which, offshore, may be a long way away.
References
AHA 2025 Guidelines for CPR & ECC. Circulation, October 22, 2025. Part 1: Executive Summary — 2025 AHA Guidelines. ahajournals.org
IMO: STCW Convention and Code, Medical Training Standards