BLS Guidelines 2023: The Latest Updates

ProTrainings BLS Guidelines 2023: The Latest Updates

CPR and BLS: the two certifications offering lifesaving knowledge and techniques. Those interested in the latest updates look to the American Heart Association (AHA), which publishes the BLS guidelines for Americans to follow. These updates are based on advice offered by the International Liaison Committee on Resuscitation (ILCOR).

ILCOR, which is made up of representatives from the leading resuscitation organizations worldwide, typically updates its advice on the BLS guidelines every five years. The last updates were in 2020.

While there are no new BLS guidelines for 2023, it is always important to review past updates so you can maintain the latest knowledge in BLS.

Read on to revisit the most up-to-date BLS guidelines so you can ensure your knowledge is in line with the latest information in 2023.

What to Know About the 2020 – 2023 BLS Guidelines

ILCOR updates its recommendations every five years, and last issued guidance in 2020, which applies until the next recommendations are issued. Here are some updates to the BLS guidelines 2020-2023 and how they differed from 2015.


The BLS guidelines in 2020 were updated to reflect the best way to provide ventilation when resuscitating a patient. The guidelines instruct the person giving resuscitation to administer one breath for every six seconds for respiratory arrest with or without an advanced airway. This is the same for cardiac arrest with an advanced airway. 

Sixth Link to Adult Chain of Survival

The Chain of Survival is an operational framework that can be used to assess the response to out of hospital cardiac arrest (OHSA). Prior to the 2020 BLS guidelines updates, there were five links: 

  • Immediate recognition of cardiac arrest and activation of the emergency response system
  • Early cardiopulmonary resuscitation
  • Rapid defibrillation 
  • Effective advanced cardiac life support
  • Integrated post-resuscitation care

A sixth link, recovery, was added to both the in-hospital and out-of-hospital Chain of Survival in the 2020 updates, which is still valid in the BLS guidelines 2023. The process of recovery from cardiac arrest extends long after initial hospitalization. This link focuses on support for physical, cognitive, and emotional well-being. The BLS guidelines state the process should begin at initial hospitalization and continue for as long as needed.

Early Use of Epinephrine

The BLS guidelines emphasized the role of early epinephrine use for non-shockable rhythms after starting CPR. Epinephrine is a drug given intravenously to reverse the effects of cardiac arrest by increasing blood pressure in the patient. 

The 2020 BLS guidelines emphasize how important it is to use epinephrine quickly to give the patient the best chance of surviving cardiac arrest.

Intravenous Access Preferred Over Intraosseous

Intravenous (IV) access is preferred as the route of medication administration during resuscitation. Intraosseous (IO), when the drug is injected into bone marrow, may be considered after IV is attempted or considered not feasible. 

ProTrainings BLS Guidelines 2023: The Latest Updates

Revised Cardiac Arrest in Pregnancy Advice

The recommended time in which cesarean delivery should be made in pregnant patients was changed from “if no return of spontaneous circulation (ROSC) in four minutes” to “if no ROSC in 5 minutes.”

Who Needs to Abide by The 2020 – 2023 Guidelines?

Absolutely anyone who holds a BLS card or provides BLS training must abide by these updates. Any changes to the BLS guidelines will be incorporated into new training, and all certified providers will keep an eye on these updates and alter their training to include them.

When Will New Guidelines Come Out?

ILCOR typically updates CPR and BLS guidelines every five years. The group reviews the most up-t0-date scientific data on how to most effectively deliver first aid that offers the best chance of survival. The information is passed to the AHA, which is then tasked with relaying this information to the U.S. in a way that means training companies, healthcare providers, and anyone else who wants to know about delivering safe CPR can be clear on the most recent advice and practices. 

With the last updates issued in 2020, we can expect to see new BLS guidelines in 2025. 

ILCOR also issues advice on what should appear in the CPR guidelines. Read our guide to the 2023 CPR guidelines and requirements for more information.

Who Should Be Certified in BLS?

Examples of people whose workplace requires them to be BLS trained include those in the medical field such as doctors, dentists and nurses. However, those you wouldn’t normally expect may be required to be BLS trained. 

Professions such as lifeguards, school bus drivers and police officers are usually required by their employers to gain a certification and be up to speed with the latest BLS guidelines. Employers from many sectors require their employees to hold a BLS card. 

BLS Updates: How They Affect a BLS Certification

A BLS certificate lasts for two years from the date the certificate was issued. This means that even if there are many changes to the guidelines the year following your certification, you can still consider yourself to be certified. After your first certificate has expired, you can take a renewal course, which will cover any updates to the BLS guidelines that have happened since you were last certified. 

Does My Out of Date Card Become Invalid?

Your out of date card is not considered invalid, but you will no longer be eligible to take a shorter renewal course, meaning you will need to take the full-length BLS course as if you were gaining the certification for the first time. You have until 30 days after the expiration date on your card to take a renewal course. Taking courses at least every two years ensures you are aware of the most current BLS guidelines.

Those holding a BLS card should take note of any updates to BLS guidelines, however small. Not only do you operate using the most up-to-date medical practices by following these guidelines, you may just save a life. 
Contact us at ProTrainings to discover how we can automate the BLS certification renewal process for you or your entire team.