Part 4: Systems of Care: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Improving survival and quality of life after cardiac arrest requires integrated systems of people, protocols, policies, and resources along with ongoing data acquisition and review. Such systems of care, which are highly influenced by the environment in which they operate, produce efficiency and effectiveness in responding to cardiac arrest. Part 4 of the 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care focuses on systems of care, emphasizing elements that are relevant to a broad range of resuscitation situations. The chapter follows the Chain of Survival, beginning with prevention and preparedness to resuscitate, proceeding to early identification of cardiac arrest, and moving to effective resuscitation through to post–cardiac arrest care, survivorship, and recovery. This Part provides cardiac arrest systems of care guidelines on how to train specific personnel, protocols that have been demonstrated to be effective, as well as the incorporation of nonhuman resources to optimize cardiac arrest care with ongoing debriefing and quality improvement strategies. Specific to out-of-hospital cardiac arrest, included are recommendations about emergency medical services team composition and transport recommendations, community initiatives to promote lay rescuer response, public access defibrillation and naloxone, and an enhanced role for emergency telecommunicators. Germane to in-hospital cardiac arrest are recommendations about cardiac arrest prevention and code team composition. Specific recommendations about extracorporeal membrane oxygenation cardiopulmonary resuscitation, transport to specialized cardiac arrest centers, organ donation, survivorship systems, and performance measurement across the continuum of resuscitation situations are also included.