Cardiopulmonary Resuscitation & Emergency Cardiovascular Care
IMBR Study Room | March 2026
First comprehensive revision since 2020 — spanning BLS to post-cardiac arrest care, systems of care, and ethics.
All ages, all settings — simplified and unified
Key emphasis: Health equity, CPR disparities, dispatcher-guided CPR, public access to naloxone & AEDs
| Parameter | Value |
|---|---|
| Rate | 100–120/min |
| Depth | ≥2 inches (≈5 cm) |
| Recoil | Allow full chest recoil |
| Interruptions | Minimize to <10 sec |
| Type | 2020 | 2025 |
|---|---|---|
| Untrained | Hands-only | Hands-only ✓ |
| Trained | Hands-only preferred | 30:2 ✓ |
| Healthcare | 30:2 | 30:2 |
💡 Key change: Trained rescuers now advised to give ventilations
2025: 5 back blows + 5 abdominal thrusts (alternating) — was "back blows OR abdominal thrusts"
✗ ELIMINATED in 2025
✓ Two-Thumb Encircling Hands — Preferred for ALL Rescuers
15:2 — Single or two rescuers
Approximately 1.5 inches (4 cm)
100–120/min
Two-thumb encircling hands (preferred)
2 min CPR → then call emergency (if alone)
Higher coronary perfusion pressure & systolic BP
Unresponsive • Respiratory depression/apnea • Pinpoint pupils (miosis) • Cyanosis
| IM/SQ | 0.4–1 mg |
| Auto-injector | Per device |
| Nasal spray | Per device |
💡 IM/SQ preferred by lay rescuers • No contraindications in suspected overdose
From routine induction of hypothermia → Actively prevent fever and maintain sustained controlled normothermia
Timing: ≥72 hours after ROSC and normothermia • Method: Multimodal approach (clinical, EEG, imaging, biomarkers) — No single test is definitive
BLS fundamentals unchanged — 100–120/min, depth ≥2 inches, minimize interruptions
Trained lay rescuers: 30:2 — not hands-only if trained and willing
Infant CPR: Two-thumb only — two-finger technique eliminated
FBAO: 5+5 — alternate 5 back blows and 5 abdominal thrusts
Women: Defibrillate without hesitation — remove clothing quickly
New opioid algorithm — naloxone is critical; give immediately
Head-up CPR & DSD: NOT recommended as routine ACLS
TTM: ≥36 hours of normothermia — prevent fever, not induce hypothermia
Post-ROSC MAP ≥65 mmHg — hemodynamic optimization alongside TTM
Neuroprognostication: multimodal at ≥72 hours — no single test is definitive
Questions?