2025+AHA心肺复苏与心血管急救指南-第2部分：证据评估和指南制定

INTRODUCTION

This section describes the process of creating the 2025 American Heart Association (AHA) Guidelines for Cardio-pulmonary Resuscitation and Emergency Cardiovascular Care (ECC), including the process of evidence evaluation and the format of the guideline document; the formation of the AHA and AHA/American Academy of Pediatrics (AAP) Writing Groups; the guideline development, review, and approval process; and the management of potential conflicts of interest.

# METHODOLOGY AND EVIDENCE REVIEW

The 2025 Guidelines are designed to present a com-prehensive compilation of guidance for cardiopulmonary resuscitation and ECC.These guidelines,including those for adult basic and advanced life support, pediatric ba-sic and advanced life support, neonatal resuscitation,resuscitation education science, special circumstances,post-cardiac arrest care, ethics, and systems of care,are based on an evidence evaluation process conducted

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Table 1. GRADE Terminology for Strength of Recommendation and Criteria for Evidence Certainty Assessment®

|Strength of recommendation|||| |---|---|---|---| |Strong recommendation = We recommend|Weak recommendation = We suggest||| |Assessment criteria for certainty of effect|||| |Study design|Certainty of effect begins at this level|Lower if|Higher if| |Randomized trial|High or moderate|Risk of bias Inconsistency Indirectness Imprecision Publication bias|Large effect Dose response All plausible confounding would reduce demonstrated effect or would suggest a spurious effect when results show no effect| |Observational trial|Low or very low|Risk of bias Inconsistency Indirectness Imprecision Publication bias|Large effect Dose response All plausible confounding would reduce demonstrated effect or would suggest a spurious effect when results show no effect|

GRADE indicates Grading of Recommendations Assessment, Development, and Evaluation.

by the International Liaison Committee on Resuscita-tion(ILCOR) published as the 2025 ILCOR Consensus on Science With Treatment Recommendations(CoSTR),'1 and an independent evidence review process conducted by the 2025 Guideline writing groups.

The ILCOR Scientific Advisory Committee, consist-ing of experts in evidence review, created a method-ological governance process for evidence evaluation used to develop the 2025 CoSTR.1 This process pro-duced 3 types of evidence reviews: systematic reviews,scoping reviews, and evidence updates. New for the 2025 Guidelines, the AHA also developed an internal evidence review process to address specific content areas not reviewed by the ILCOR evidence review pro-cess that were deemed important to users of the AHA guidelines.

# ILCOR Systematic Review

Systematic reviews were conducted by ILCOR task force members with expertise in systematic reviews and the content area following standardized procedures.2 The methodology was based on the Preferred Report-ing Items for Systematic Reviews and Meta-Analyses3 and the approach proposed by the Grading of Recom-mendations Assessment, Development and Evaluation(GRADE) Working Group.4 The overall process was co-ordinated by the Scientific Advisory Committee of ILCOR and guided by the task force Scientific Advisory Commit-tee representatives.

In brief, each ILCOR task force identified and priori-tized questions to be addressed by using the PICOST(population, intervention, comparator, outcome, study design, time frame) format.5 A detailed search for rele-vant publications was performed on MEDLINE,Embase,and Cochrane Library databases, with identified publi-cations screened for further evaluation. Two systematic reviewers conducted a risk-of-bias assessment for each relevant study by using Cochrane and GRADE criteria for randomized controlled trials,6 Quality Assessment of Diagnostic Accuracy Studies, version 2, for studies of diagnostic accuracy,7 and GRADE criteria for obser-vational and interventional studies informing therapy or

<EndOfPara>prognosis questions. ${ }^{4}$ In addition to assessing scientific bias, the Cochrane risk-of-bias tool also considers both the source of funding and potential conflicts of inter-est of authors of the study. The reviewers created evi-dence profile tables containing information on all study outcomes. Using the GRADE approach, ${ }^{8}$ the certainty of evidence (ie, confidence in the estimate of the effect)was categorized as high, moderate, low, or very low on the basis of the study methodologies. The certainty of evidence was upgraded for a dose-response or large effect, and downgraded for bias, inconsistency, indirect-ness, imprecision, or publication bias (Tables 1 and 2). ${ }^{9}$Any unresolved disparity between reviewer assessments was resolved through discussions and consensus with the task force representative of the Scientific Advisory Committee and, if disagreement remained, by the larger task force.

The ILCOR task forces reviewed, discussed, and debated the studies and systematic review analyses,drafting a consensus on science statement and a written summary of identified evidence and evidence certainty for each outcome. When there was consensus, the task force developed consensus treatment recommendations,labeled as strong or weak and either for or against a therapy, prognostic tool, or diagnostic test, noting the certainty of the evidence. In addition, each topic summary included the PlICOST question and a justification and evidence-to-decision framework section, capturing the values and preferences considered by the task force as well as a list of knowledge gaps. Public input was sought for the draft CoSTR statements. ${}^{10}$ The task forces con-sidered all public comments when finalizing the CoSTR statements. A task force insights approach was used rather than a formal CoSTR when there were insufficient data to support a recommendation. All CoSTR state-ments from 2021 to 2025 underwent peer review by at least 5 subject matter experts and were endorsed by the ILCOR board before publication.

ILCOR Scoping Review

The purpose of a scoping review is to provide an overview of the extent, range, and nature of research activity; to

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Table 2. GRADE Terminology®

|Term|Explanation| |---|---| |Risk of bias|Study limitations in randomized trials include lack of allocation concealment, lack of blinding, incomplete accounting of patients and outcome events, selective outcome reporting bias, and stopping early for benefit. Study limitations in observational studies include failure to apply appropriate eligibility criteria, flawed measurement of exposure and outcome, failure to adequately control confounding, and incomplete follow-up.| |Inconsistency|Criteria for inconsistency in results include the following: Point estimates vary widely across studies; Cls show minimal or no overlap; statistical test for heterogeneity shows a low P value; and the $/$2 is large(a measure of variation in point estimates resulting from among-study differences).| |Indirectness|Sources of indirectness include data from studies with differences in population(eg, OHCA instead of IHCA, adults instead of children), differences in the intervention (eg, different compression-ventilation ratios), differences in outcome, and indirect comparisons.| |Imprecision|Low event rates or small sample sizes will generally result in wide Cls and therefore imprecision.| |Publication bias|Several sources of publication bias include the tendency not to publish negative studies and the influence of industry-sponsored studies. An asymmetrical funnel plot increases suspicion of publication bias.| |Good practice statements|Guideline panels often consider it necessary to issue guidance on specific topics that do not lend themselves to a formal review of research evidence. The reason might be that research into the topic is unlikely to be located or would be considered unethical or infeasible. Criteria for issuing a nongraded good practice statement include the following: There is overwhelming certainty that the benefits of the recommended guidance will outweigh harms, and a specific rationale is provided; the statements should be clear and actionable to a specific target population; the guidance is deemed necessary and might be overlooked by some providers if not specifically communicated; and the recommendations should be readily implementable by the specific target audience to which the guidance is directed.|

CI indicates confidence interval; GRADE, Grading of Recommendations As-sessment, Development, and Evaluation; IHCA, in-hospital cardiac arrest; and OHCA, out-of-hospital cardiac arrest.

clarify key concepts; to identify gaps; or to identify topics for future systematic reviews.11 One difference between scoping reviews and systematic reviews is that scoping reviews attempt to provide an overview of a broad topic with a large and diverse body of literature, and to pro-duce a summary of the studies, but not a magnitude of effect. Systematic reviews address a narrow, more clearly focused research question. Scoping reviews are helpful in examining emerging areas of research, clarifying key concepts, and identifying gaps in knowledge. Addition-ally, scoping reviews do not include formal evaluation of the certainty of evidence or risk of bias and are not assessed according to GRADE recommendations. Due to these differences, unlike the treatment recommenda-tions that can arise from a systematic review, scoping reviews cannot result in CoSTR without an additional sys-tematic review. Scoping reviews can, however, result in

the development of good practice statements. Although ILCOR does not create or alter treatment recommenda-tions without a systematic review, if the topic of a scop-ing review is thought to be of particular interest to the resuscitation community, good practice statements are often made. Good practice statements represent expert opinion informed by the very limited evidence available. ${}^{12}$

The methodology for conducting a scoping review was based on the Preferred Reporting Items for System-atic Reviews and Meta-Analyses Extension for Scoping Reviews.3,13,14 Each task force identified questions to be reviewed, presented in the PICOST or population, con-cept, context format. MEDLINE,Embase, and Cochrane databases were searched to identify relevant publica-tions, with additional databases searched where appro-priate. Those performing the scoping reviews extracted data to create summary tables. The task force then reviewed the studies and the evidence tables, develop-ing a consensus narrative summary of the evidence and an overview of the task force insights including knowl-edge gaps and research priorities. Each topic narrative summary and overview of task force insights(including why the topic was reviewed, narrative evidence summary,and a narrative report of the task force discussions), as well as the complete scoping review, were posted on the ILCOR website for public review and input,13 with final versions included in the appendix and summarized in the body of the relevant task force CoSTR publication. When ILCOR task forces believed there was a need to make a clinical recommendation after performing a scoping review or evidence update(because no treatment recom-mendations can be made without a full systematic review under ILCOR policy),task forces were permitted to make expert consensus-based good practice statements.These statements were designed to reflect what experts in the resuscitation science community believe are the current best practices when sufficient data are not yet available to support such conclusions. In such cases,ILCOR expects that such statements can be replaced with formal treatment recommendations through the CoSTR process in the future as more research becomes available.

ILCOR Evidence Update

ILCOR evidence updates involve a systematic way of searching the literature and updating an overview of the evidence available on a particular PICOST topic of in-terest for ILCOR.15 The evidence updates may be done to evaluate the existence of new research related to an already commissioned PICOST or may be done as preliminary work related to a newly developed PICOST topic. The evidence update reviewers used PubMed to conduct searches of English language publications indexed in the MEDLINE database. When the search strategies from previous reviews were available, these

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were repeated. Searching beyond the MEDLINE data-base was optional and at the discretion of the reviewer.Reviewers identified relevant new studies, guidelines,and systematic reviews, and completed an evidence up-date worksheet, which included the research question,the search strategy, and a table summarizing any new evidence.13 After review by the ILCOR Science Advisory Committee Chair, the evidence update worksheet was included in the relevant 2025 CoSTR task force publi-cation appendix and cited within the body of the manu-script. As mentioned, a good practice statement could be added by an ILCOR task force after an evidence up-date was performed.

AHA Evidence Evaluation

An internal AHA evidence evaluation process was used to support recommendation updates or the development of new recommendations if applicable. These reviews are specifically conducted when current ILCOR evi-dence synthesis outputs(eg, systematic review, scoping review, or evidence update) are not available. Evidence reviewers followed a standard operating procedure for evidence review developed by the AHA ECC Committee based on systematic review methodology and supported by designated information specialists with expertise in systematic literature review methodology.4,15 The process was designed to provide a comprehensive synthesis of all available evidence on a topic to support the develop-ment of specific guidelines. It was designed to ensure rigor and feasibility, providing guidance and support for writing group members to conduct the searches and evi-dence synthesis for submission to the writing group chair and section authors.

Where possible, evidence reviews were conducted by 2 independent reviewers assigned by the writing group chair. Reviewers defined the elements of a PICOST research question if the clinical area under review allowed for this. The determination of these elements was set a priori to guide the development of the search strategy in collaboration with the AHA librarians, to assist in the development of inclusion and exclusion criteria for article selection, and to guide data abstraction when relevant articles were identified. If the PICOST approach was not relevant for a particular area, reviewers defined the clinical area of interest, the specific terms used to define that area, and as many of the elements of the PICOST as possible. Reviewers codedeveloped search strategies with the AHA librarians. Depending on the topic area and availability of published data, literature searches were limited to randomized clinical trials, or expanded to include nonrandomized trials, observational studies, or case studies. Literature searching included the follow-ing online databases: MEDLINE, PubMed,Embase, and the Cochrane Library. For guideline updates, searches were limited to the time period following the last search date reported in the prior version of the guideline. In the

case of a new guideline or full revision, no time limits on searches were imposed unless the writing group deter-mined that a different time frame was appropriate. The 2 reviewers then independently reviewed citations for inclusion, and evaluated included studies for risk of bias using the Robins-l tool for nonrandomized studies16 and the Cochrane risk-of-bias tool for randomized control trial designs.6 Disagreements in study selection, risk-of-bias evaluation, and data abstraction were resolved through consensus building between the 2 reviewers. When con-sensus could not be reached, a third reviewer was used to resolve the disagreement.

The output from this process,including data abstracted from each study relevant to the PICOST question, was documented in a standardized evidence review form, and then returned to the writing group chair for distribution to the members. Reviewers used their review of the litera-ture, with risk-of-bias assessments considered, to pro-pose a summary of the evidence and to suggest either no change to prior recommendations, to suggest modifi-cations to existing recommendations, or to draft entirely new recommendations. The results of these reviews by the Writing Groups were under embargo and therefore were not posted for public comment.

Adolopment of External Guidelines

One opportunity to enhance and streamline the 2025 guideline process has been the ability to integrate ex-ternal systematic reviews and guidelines into the AHA guideline process. This can be in the form of adopting existing recommendations or developing recommenda-tions based on the available evidence synthesis termed adolescence. An adoption evaluation process was used when a writing group identified a need for guidance on a particular topic, but existing guidelines or system-atic reviews from external organizations, not directly af-filiated with ECC, already provided valuable, high-quality information.17 Instead of creating new guidelines, ado-lopment allowed writing groups to leverage this informa-tion, provided the external guideline fit specific criteria.When a writing group identified the need for adolescence of external publications, there was first an initial com-prehensive search of existing AHA guidelines(eg, AHA/American College of Cardiology, AHA/American Stroke Association) to ensure no conflicts existed between the adopted adolescence and current AHA recommen-dations. The writing group then presented their justifi-cation for adoptionment along with their AHA guideline search results to the Science Subcommittee leadership[Chair(MD), Vice Chair(JB) and Immediate Past Chair(ARP)], and the AHA Vice President for Science and In-novation (CS) for approval. Once approved, the writing group conducted a thorough assessment of the external guideline's methodology to ensure rigor. Key elements such as the search strategy, inclusion/exclusion crite-ria, data extraction, bias assessments, GRADE evidence

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profile tables, and meta-analyses were evaluated. Writ-ing groups were permitted to incorporate guidelines from other organizations, even if their development process was less rigorous(eg, did not use multiple databases),provided their evidence review process was transparent.These requests were evaluated on a case-by-case basis,with input from Science Subcommittee leadership and AHA staff. Alternatively, writing groups could choose to conduct an evidence review that included these external guidelines and their recommendations, using them as part of the broader body of evidence to inform recom-mendations. With this approach, rather than adoption of external guidelines, external guidelines could be used to contribute to the overall evidence base for guideline development by the writing groups.

GUIDELINE FORMAT

Similar to the 2020 Guidelines, the 2025 Guide-lines are organized in knowledge chunks, grouped into discrete modules of information on specific top-ics or management issues. ${}^{18}$ Each modular knowledge chunk includes a table of recommendations, a synopsis,recommendation-specific supportive text, and, when ap-propriate, figures, flow diagrams of algorithms, and ad-ditional tables. Hyperlinked references are provided to facilitate quick access and review.

With the addition of“Part 3: Ethics” in the 2025 Guide-lines, a narrative review format was also used to allow for detailed discussion of complicated ethical issues. The science review for ethics content followed a more tradi-tional literature review process without development of a standard knowledge chunk format that resulted in rec-ommendations, synopses, and recommendation-specific supporting text found elsewhere in the 2025 Guidelines.After a review of the literature by 2 or more writing group members, it was then reviewed and refined by all writ-ing group members. There was no generation of recom-mendations with Class of Recommendation and Level of Evidence as found in other chapters.

FORMATION OF THE GUIDELINE WRITING GROUPS

The AHA strives to ensure that each guideline writing group includes requisite expertise and diversity, repre-sentative of the broader medical community by select-ing experts from a wide array of scientific backgrounds,geographic regions of North America, sexes, races, eth-nicities, intellectual perspectives, experience levels, and scopes of clinical practice. Volunteers with an interest and recognized expertise in resuscitation are nominated by the writing group chair, selected by the AHA ECC Committee, and approved by the AHA Manuscript Over-sight Committee. All volunteer selection is conducted by

volunteers through the AHA ECC Committee without AHA staff influence.

The Adult Basic and Advanced Life Support Writing Group included experts in emergency medicine, criti-cal care, cardiology, toxicology, neurology, emergency medical services, education, research, and public health.The Pediatric Basic and Advanced Life Support Writ-ing Group consisted of pediatric clinicians, including intensivists, cardiac intensivists, cardiologists, emer-gency physicians, and emergency medicine nurses. The Neonatal Resuscitation Writing Group included neona-tal physicians and nurses with backgrounds in clinical medicine, education, research, and public health, and an obstetrician-gynecologist. The Pediatric Advanced Life Support, Pediatric Basic Life Support, and Neonatal Resuscitation Writing Groups were jointly appointed by AHA and AAP, with a co-chair and half the writing group members appointed by each organization. The Resus-citation Education Science Writing Group consisted of experts in resuscitation education, clinical medicine(ie,pediatrics, intensive care, emergency medicine), nurs-ing,prehospital care, and health services and education research. The Systems of Care Writing Group included experts in clinical medicine, education, research, and public health. The Ethics Writing Group included experts in emergency medicine, critical care medicine, neurocrit-ical care, cardiology, and emergency medical services,including experts in neonatal, pediatric, adult medicine,and medical ethics in each domain. Before appointment,writing group members completed a disclosure of rel-evant relationships with industry. Writing group members also adhered to all AHA requirements for management of any potential intellectual and financial conflicts of interest. The AAP appointed a writing group member to the Education Science, Ethics, Evidence Evaluation,Special Circumstances, and Systems of Care Writing Groups. For each Writing Group, the exact constituents,affiliations, and conflicts of interest are noted at the end of their respective Guideline chapter.

GUIDELINES DEVELOPMENT, REVIEW,AND APPROVAL

Each writing group reviewed all relevant and current AHA guidelines for cardiopulmonary resuscitation and ECC,19-25 pertinent CoSTR evidence and recommenda-tions from 2020 through 2025,1,9,10,26-33 all relevant IL-COR evidence updates, and all AHA evidence evaluation worksheets to determine if current guidelines should be reaffirmed, revised, or retired, or if new recommendations were needed. Recommendations were eligible for retire-ment if the topic became accepted best practices such that alternative treatments were not considered in prac-tice, no additional studies were published or underway since the last published guideline, and future research

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Table 3. Applying Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care(Updated December 2024)*

CLASS(STRENGTH) OF RECOMMENDATION

Class 1(STRONG)

Benefit >>> Risk

Suggested phrases for writing recommendations:

● Is recommended

● Is indicated/useful/effective/beneficial

● Should be performed/administered/other

● Comparative-Effectiveness Phrases†:

- Treatment/strategy A is recommended/indicated in preference to treatment B

- Treatment A should be chosen over treatment B

Class 2a(MODERATE)

Benefit >> Risk

Suggested phrases for writing recommendations:

•Is reasonable

• Can be useful/effective/beneficial

•Comparative-Effectiveness Phrases$\dagger$

- Treatment/strategy A is probably recommended/indicated in preference to treatment B

It is reasonable to choose treatment A over treatment B

Class 2b (WEAK)

Benefit ≥ Risk

(Expert Opinion)

Suggested phrases for writing recommendations:

● May/might be reasonable

● May/might be considered

•Usefulness/effectiveness is unknown/unclear/uncertain or not well-established

Class 3: No Benefit(MODERATE)Benefit= Risk(Generally,LOE A or B use only)

Suggested phrases for writing recommendations:

● Is not recommended

● Is not indicated/useful/effective/beneficial

● Should not be performed/administered/other

Class 3: HARM(STRONG)

Risk> Benefit

Suggested phrases for writing recommendations:

· Potentially harmful

● Causes harm

● Associated with excess morbidity/mortality

● Should not be performed/administered/other

LEVEL(QUALITY) OF EVIDENCE#

Level A

•High-quality evidence\# from more than 1 RCT

•Meta-analyses of high-quality RCTs

•One or more RCTs corroborated by high-quality registry studies

Level B-R

(Randomized)

•Moderate-quality evidence\# from 1 or more RCTs

•Meta-analyses of moderate-quality RCTs

Level B-NR

(Nonrandomized)

•Moderate-quality evidence\# from 1 or more well-designed, well-executed nonrandomized studies,observational studies, or registry studies

Meta-analyses of such studies

(Limited Data)

Level C-LD

Randomized or nonrandomized observational or registry studies with limitations of design or execution

•Meta-analyses of such studies

Physiological or mechanistic studies in human subjects

Level C-EO

(Expert Opinion)

● Consensus of expert opinion based on clinical experience

COR and LOE are determined independently (any COR may be paired with any LOE).

A recommendation with LOE C does not imply that the recommendation is weak. Many important clinical questions addressed in guidelines do not lend themselves to clinical trials. Although RCTs are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective.

* The outcome or result of the intervention should be specified (an improved clinical outcome or increased diagnostic accuracy or incremental prognostic information).

+For comparative-effectiveness recommendations(COR 1 and 2a; LOE A and B only), studies that support the use of comparator verbs should involve direct comparisons of the treatments or strategies being evaluated.

$\ddagger$ The method of assessing quality is evolving, including the application of standardized, widely-used, and preferably validated evidence grading tools; and for systematic reviews, the incorporation of an Evidence Review Committee.

COR indicates Class of Recommendation; EO, expert opinion;LD,limited data; LOE, Level of Evidence; NR, nonrandomized;R,randomized; and RCT,randomized controlled trial.

was unlikely. All retired recommendations were listed in a table at the end of the guideline chapter with the related PICOST.

Following evaluation of all relevant evidence, the writing groups drafted,reviewed, and approved recommendations,comparisons to each recommendation a Class of Recom-

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mendation(ie, strength) and Level of Evidence(ie, quality;Table 3). The process for recommendation development followed was as previously described and set forth by the American College of Cardiology/American Heart Asso-ciation Joint Committee on Clinical Practice Guidelines.34 Consistent with these standards, recommendations were drafted following the knowledge chunk format applied in the 2020 AHA Guidelines.18 Once drafted, each knowl-edge chunk was reviewed by the AHA ECC Science Sub-committee leadership[Chair (MD), Vice Chair (JB), and Immediate Past Chair(ARP)] for science and content. The knowledge chunks were also reviewed by the AHA Vice President for Science and Innovation(CS) and Senior Sci-ence Editors(ID and SS) for consistency of language and format. Feedback was then returned to the writing group for consideration. All final guideline decisions were made by vote of the writing group members and was solely the purview of the writing group.

Each of the 2025 Guidelines articles was submitted for blinded peer review to 5 to 10 subject matter experts nominated by the AHA and AAP, as appropriate. Subject matter expert reviewers were required to disclose relation-ships with industry and any other potential conflicts of inter-est, and all disclosures were reviewed by AHA staff. Peer reviewer feedback was provided for guidelines for draft for mat and again in final format. AHA policy requires that offi-cial positions and guidelines of the AHA must be reviewed and approved by the Board of Directors or its Executive Committee or both. Upon completion of peer review, these guidelines were reviewed and edited for publication by the AHA Science Advisory and Coordinating Committee and the AHA Executive Committee following the standard review process for all official AHA documents with legal,communications, and science staff to ensure risk mitigation and accurate alignment with the AHA mission. To maintain the highest level of methodological rigor and transparency,the 2025 AHA/ECC Guidelines were developed consis-tent with the domains of the Appraisal of Guidelines for Research& Evaluation II Instrument,35 and a description is provided in the online Supplement to this Part.

MANAGEMENT OF POTENTIAL CONFLICTS OF INTEREST

The AHA, AAP, and ILCOR have rigorous conflict of inter-est policies and procedures to minimize the risk of bias or improper influence during development of the CoSTRs and the AHA guidelines. All 3 organizations followed these policies34,36,37 throughout the 2025 evidence evaluation and document preparation process. Anyone involved in any part of this process was required to disclose all commercial re-lationships and other potential conflicts(including elelec-tual) both before joining the writing group and during writing group activities. These disclosures were reviewed before assignment of task force chairs and members, writing group chairs and members, consultants, and peer reviewers. In

keeping with the AHA conflict of interest policy, the chair and most members(>50%) of each ILCOR task force and each AHA/AAP writing group had to be free of relevant conflicts. Writing group members were not allowed to par-ticipate in drafting recommendation text or to vote on any final recommendation for which they had a relevant conflict.Writing group members who recused themselves from vot-ing on a topic due to a relevant conflict were documented.Importantly, recognizing the potential for conflict for AHA staff, no AHA employee or leadership were involved in guideline recommendation development or voting. Appen-dix 1 lists writing group members' disclosures information for this Part. Peer reviewers were also required to disclose relationships with industry and any other potential conflicts of interest; these disclosures appear in Appendix 2.

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ARTICLE INFORMATION

The American Heart Association requests that this document be cited as fol- Lops:Anal Charp A, Bartja JA, Blockoff MH, Drennan IR, Mahgoub M, Schexnayer SM, Rodriguez AJ, Sasson C, Wright JI, Brooks SC, Atkins DL, Del Rios M. Part 2: evidence evaluation and guidelines development: 2025 American Heart As-sociation Guidelines for Cardopulmonary Resuscitation and Emergency Car-dovascular Care. Circulation. 2025;152(suppl 2):S313-S322. doi:10.1161/CR.00000000000000000

Panchal et al

Evidence Evaluation and Guidelines Development:2025 AHA Guidelines for CPR and ECC

Disclosures

Appendix 1. Writing Group Disclosures

|Writing group member|Employment|Research grant|Other research support|Speakers' bureau/ honoraria|Expert witness|Ownership interest|Consultant/ advisory board|Other| |---|---|---|---|---|---|---|---|---| |Ashish R. Panchal|The Ohio State University Wexner Medical Center|None|None|None|None|None|None|None| |Jason A. Bartos|University of Minnesota Division of Cardiovascular Medicine|None|None|None|None|None|None|None| |Dianne L. Atkins|University of Iowa|None|None|None|None|None|None|None| |Steven C. Brooks|Queen's University (Canada)|Action First Aid;Canadian Institute of Health Researcht; GoodSAMt; Heart and Stroke Foundationt; Southeastern Ontario Academic Medical Organizationt; Zoll Medical Corporationt; PulsePoint Foundationt|None|American College of Cardiology Georgia Chapter*|None|Rapid Response Revivalt|None|Rapid Response Revivalt| |Marina Del Rios|The University of Chicago Medicine|NIH*|None|None|None|None|None|None| |lan R. Drennan|Sunnybrook Health Sciences Centre and University of Toronto (Canada)|ZOLL Medicalalt|None|ZOLL Medicalt|None|None|None|None| |Melissa Mahgoub|American Heart Association|None|None|None|None|None|None|None| |Amber J. Rodriguez|American Heart Association|None|None|None|None|None|None|None| |Comilla Sasson|American Heart Association|None|None|None|None|None|None|None| |Stephen M. Schexnayder|University of Arkansas/ Arkansas Children's Hospital|None|None|None|None|None|American Heart Associationt|None| |Jaylen I. Wright|American Heart Association|None|None|None|None|None|None|None| |Myra H. Wyckoff|UT Southwestern Pediatrics|None|None|None|None|None|None|None| ||||||||||

This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be"significant" if(a) the person receives$5000 or more during any 12-month period, or 5% or more of the person's gross income; or(b) the person owns 5% or more of the voting stock or share of the entity, or owns$5000 or more of the fair market value of the entity. A relationship is considered to be"modest" if it is less than"significant" under the preceding definition.*Modest.

*Modest.

tSignificant.

Panchal et al

Evidence Evaluation and Guidelines Development:2025 AHA Guidelines for CPR and ECC

Appendix 2. Reviewer Disclosures

|Reviewer|Employment|Research grant|Other research support|Speakers bureau/ honoraria|Expert witness|Ownership interest|Consultant/ advisory board|Other| |---|---|---|---|---|---|---|---|---| |Marc Berg|Stanford University|None|None|None|None|None|None|None| |Clifton W. Callaway|University of Pittsburgh|NIH(Grants to study emergency care, including treatment of cardiac arrest and cardiac emergencies)t|None|None|None|None|None|None| |Benson Hsu|University of South Dakota|None|None|None|None|None|None|None| |Eddy Lang|University of Calgary (Canada)|None|None|None|None|None|None|None| |Vinay M.|Children's Hospital|Zoll Medical(Research Grant to my institution)t; Laerdal Foundation|None|None|None|None|None|Citizen CPR Foundation Board"; International Liaison Committee on Resuscitation Board"| |Nadkarni|Philadelphia, University of Pennsylvania|(Foundation Research Grant to my institution)t; Nihon Kohden Corporation(Research Grant to my Institution)*; RCI Partners (Research Grant to my Institute)"; Philips Medical(Research Grant to my Institution)*; Defibtech(Research Grant to my Institution)"; Nicoletti Family Philanthropy(Unrestricted grant to my institution)*; National Institutes of Health (PLCECAP: Multicenter Cardiac Arrest Cooling trial for children (Co- l); National Institutes of cardiac arrest (Co- I)); National Institutes of Health (OPTIVENT); National Institutes of Health (PEDICA)t; US Department of Defense(Mitochondrial Health: pGz)t; NovoNordisk(WECAN)t; Agency for Healthcare Research and Quality (P-WIN)t; Agency for Healthcare Research and Quality (Patient Safety Learning Laboratory)t|None|None|None|None|Citizen CPR Foundation Board"; International Liaison Committee on Resuscitation Board"|Society of Critical Care Medicine (President (2023-2024))t|

This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Ques-tionnaire, which all reviewers are required to complete and submit. A relationship is considered to be“significant” if(a) the person receives$5000 or more during any 12-month period, or 5% or more of the person's gross income; or(b) the person owns 5% or more of the voting stock or share of the entity, or owns$5000 or more of the fair market value of the entity. A relationship is considered to be“modest” if it is less than“significant” under the preceding definition.

*Modest.

tSignificant.