BACKGROUND: In concordance with the results of large, observational studies, a 2015 European survey suggested variation in resuscitation/end-of-life practices and emergency care organization across 31 countries. The current survey-based study aimed to comparatively assess the evolution of practices from 2015 to 2019, especially in countries with "low" (i.e., average or lower) 2015 questionnaire domain scores. METHODS: The 2015 questionnaire with additional consensus-based questions was used. The 2019 questionnaire covered practices/decisions related to end-of-life care (domain A); determinants of access to resuscitation/post-resuscitation care (domain B); diagnosis of death/organ donation (domain C); and emergency care organization (domain D). Responses from 25 countries were analyzed. Positive or negative responses were graded by 1 or 0, respectively. Domain scores were calculated by summation of practice-specific response grades. RESULTS: Domain A and B scores for 2015 and 2019 were similar. Domain C score decreased by 1 point [95% confidence interval (CI): 1-3; p = 0.02]. Domain D score increased by 2.6 points (95% CI: 0.2-5.0; p = 0.035); this improvement was driven by countries with "low" 2015 domain D scores. In countries with "low" 2015 domain A scores, domain A score increased by 5.5 points (95% CI: 0.4-10.6; p = 0.047). CONCLUSIONS: In 2019, improvements in emergency care organization and an increasing frequency of end-of-life practices were observed primarily in countries with previously "low" scores in the corresponding domains of the 2015 questionnaire.

1st Department of Intensive Care Medicine National and Kapodistrian University of Athens Medical School Evaggelismos General Hospital 45 47 Ipsilandou Street 10675 Athens Greece

Department of Paediatric Anaesthesiology and Intensive Care Medicine University Hospital Brno and Faculty of Medicine Masaryk University 62500 Brno Czech Republic

Paediatric Intensive Care Unit NH Hospital 26801 Hořovice Czech Republic

School of Medicine European University Cyprus Nicosia 2404 Cyprus

Serbian Resuscitation Council 21102 Novi Sad Serbia

UK Critical Care Unit University Hospitals Birmingham NHS Foundation Trust Birmingham B15 2TH UK

University of Antwerp 2000 Antwerp Belgium

Warwick Medical School University of Warwick Coventry CV4 7AL UK

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