HRS position statement: Changing the tide in CPR and AED education for students in the United States

Out-of-hospital cardiac arrest remains a leading cause of mortality in the United States, with survival critically dependent on timely bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use. Despite strong evidence supporting early intervention, bystander-initiated CPR remains suboptimal, with persistent racial, demographic, socioeconomic, literacy-related, and geographic disparities. National legislative efforts have been hampered by inadequate funding. To improve out-of-hospital cardiac arrest survival and address these disparities, the Institute of Medicine has identified US high school students as a prime target for CPR education and AED use. Although most US states have legislated mandates for CPR and AED education, there is no consistent, standardized implementation process. 1-time or didactic-only training, limited hands-on practice, lack of longitudinal reinforcement, and inequitable AED access undermine effectiveness. This Heart Rhythm Society Scientific Statement evaluates the current landscape of CPR and AED education for US high school students, including the effectiveness of state legislative mandates, implementation strategies, and disparities in access and outcomes. We identify critical gaps and propose evidence-based solutions and an implementation framework for uniform, effective, and equitable initial and longitudinal CPR and AED training aiming to transform generations of US high school students into lifesavers.