BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a major public health problem. This study aims to describe the international variations in the practices related to the initiation, termination, and refraining from resuscitation of adult patients (≥18 years) with a non-traumatic OHCA. METHODS: An exploratory descriptive study was conducted using a cross-sectional online survey. The respondents were recruited using snowball sampling technique. Framework analysis was used to identify key themes in responses, with descriptive statistics summarising data trends. RESULTS: The study collected responses from 59 countries. Our findings reveal that respondents from 59.3% of countries reported that they initiate resuscitation in all cases where the patients do not show obvious signs of irreversible death or do not have confirmed advance directives. Respondents from 15.3% of countries reported that once started, prehospital resuscitation attempts are not terminated. Prehospitally respondents from 20.3% of the countries reported that they rely exclusively on specific criteria to decide when to terminate resuscitation efforts while in 45.8%, these decisions are made at the discretion of the provider. Respondents from most countries (91.5%) reported that they refrain from resuscitation in the presence of obvious signs of irreversible death. Respondents from 57.6% of countries, reported that they refrained from resuscitation if the patient had a confirmed do-not-attempt-cardiopulmonaryresuscitation (DNACPR), while 15.3% mentioned staff safety as a reason to abstain from attempting resuscitation. CONCLUSION: This study reveals global variation in EMS resuscitation practices, reflecting disparities in resources, healthcare infrastructure, EMS system design, community acceptability given cultural and societal norms, and legislation.

Al Malae'b St Jeddah 22254 Saudi Arabia

Department of Anesthesiology and Intensive Care Medicine University Hospital Kolding Sygehusvej 24 6000 Kolding Denmark

Department of Clinical Medicine University of Copenhagen Blegdamsvej 3 2200 Copenhagen Denmark

Department of Regional Health Research Region of Southern Denmark Campusvej 55 5230 Odense Denmark

Division of Emergency Medicine Department of Medicine University of Toronto C David Naylor Building 6 Queen's Park Crescent West 3rd Floor Toronto ON M5S 3H2 Canada

Emergency Medicine King Abdulaziz University Jeddah Saudi Arabia

Emergency Services Sunnybrook Health Sciences Center 2075 Bayview Ave M4N 3M5 Toronto Ontario Canada

ER24 Emergency Management Services 25 Du Toit Street Stellenbosch 7600 South Africa

Falck Denmark Sydhavnsgade 18 2450 København SV Denmark

Prehospital Emergency Medical Services Region Zealand Ringstedgade 61 4700 Næstved Denmark

The Prehospital Research Unit Region of Southern Denmark Odense University Hospital Kildemosevej 15 5000 Odense Denmark

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