Adult basic life support Guidelines

European Resuscitation Council Guidelines 2025 Adult Basic Life Support. Resuscitation 2025;215 (Suppl 1):110771. https://doi.org/10.1016/j.resuscitation.2025.110771 

ERC Authors: Smyth MA, van Goor S, Hansen CM, Fijačko N, Nakagawa NK, Raffay V, Ristagno G, Rogers J, Scquizzato T, Smith CM, Spartinou A, Wolfgang K, Perkins GD, on behalf of the ERC Adult Basic Life Support Collaborators. 

• Everyone can learn how to perform cardiopulmonary resuscitation (CPR).  
• Train ambulance service call handlers in cardiac arrest recognition and telephone-CPR.  
• Recognition of cardiac arrest can be challenging.  
• If a person is found unresponsive, call 999 as soon as possible. Ideally, this should be carried out by a bystander, but if no one else is available you should make the call yourself before assessing whether breathing is normal.  
• The ambulance service call handler will be able to assist you if you are uncertain.  
• If a person is unresponsive with abnormal breathing, assume they are in cardiac arrest.  
• Start chest compressions as soon as possible.  
• Compress the chest at a rate of 100-120 min^-1.  
• Compress to a depth of at least 5 cm, but not more than 6 cm.  
• If providing rescue breaths, deliver just enough air to make the chest start to rise; avoid excessive ventilation.  
• If you are unable to ventilate the chest, consider a foreign body airway obstruction.  
• Anyone can use an Automated External Defibrillator (AED).  
• AEDs should be widely available.  
• Locations of AEDs should be prominently sign-posted with clear signage.  
• AED signage should include a statement that no training is needed to use an AED.  
• AEDs should be housed in unlocked cabinets.  
• AEDs should be accessible 24 hours a day, 7 days a week.  
• The risk of harm from CPR is low. Rescuers should not be concerned that they will cause serious injury if the person is not in cardiac arrest.

There are the following changes to the 2025 Adult Basic Life Support guidelines:

• Call 999 for any unresponsive person. Rescuers no longer need to confirm abnormal breathing before calling. Initiate the call first, then assess breathing while waiting for the call to be answered. The ambulance service call handler will be able to assist you in identifying abnormal breathing, if needed.
• Exercise is a common precipitant of cardiac arrest. The 2021 guidelines emphasised descriptions of slow or laboured breathing as indicators of abnormal breathing. For 2025, we recognise that early after the onset of cardiac arrest, athletes may display a near-normal or panting breathing pattern.

The following has been added to the 2025 Adult Basic Life Support guidelines:

• Details of the role of the ambulance service call handler: The role of the ambulance service call handler is critical to early recognition of cardiac arrest and initiation of CPR.
• There is increasing evidence that finding a person in cardiac arrest and attempting resuscitation is a potentially traumatic experience for many lay rescuers. The 2025 guideline now recognises that lay rescuers and bystanders may benefit from support.

Guidelines 2025 continues to prioritise supporting members of our communities to have the confidence, knowledge and skills to act when someone sustains an out-of-hospital cardiac arrest. The principles of CPR remain the same, and there is an increased emphasis on the difficulty in recognising cardiac arrest and the role that the ambulance service call handlers can play in facilitating this.  

The 2025 guidelines still emphasise that it is more important that people feel able to do something to help than become focused on small details or concerned about causing harm. No greater harm can occur than failing to act when someone requires CPR and defibrillation.

The community response to cardiac arrest remains critical to saving lives. Bystander CPR and use of an AED increase the chances of survival by two to four-fold and are a critical part of the UK government’s strategies to improving survival from out-of-hospital cardiac arrest.  

These guidelines are intended to support members of our communities who may be called upon to act in an emergency and to help save someone’s life. This includes members of the public (including those activated by a smartphone app), children and family members, first responders, and those with a duty to respond (e.g. lifeguards, first aiders). They complement the Resuscitation Council UK Quality Standards for Cardiopulmonary Resuscitation and Automated External Defibrillation Training in the Community, which describe that when a cardiac arrest occurs, systems and education should be in place to ensure that:

• Cardiac arrest is recognised early.
• Help is sought – shout for nearby help and call 999.
• CPR is promptly started according to current guidelines.
• An AED is located, retrieved and used as early as possible.

If you encounter someone who appears to be unresponsive, follow the 3 steps to save a life:

1. Check  

• Is it safe to approach?
• Is the person conscious?

2. Call 999 immediately if they are unresponsive.  

• Assess breathing.
• If you are unsure, the ambulance service call handler will assist you.

3. CPR: Start CPR immediately if they are unresponsive with abnormal breathing.  

• As soon as an AED is available, attach it and follow the AED instructions.
• If you are unsure, the ambulance service call handler will assist you.