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. 2025 Jun 24:25:101017.
doi: 10.1016/j.resplu.2025.101017. eCollection 2025 Sep.

Prehospital cardiac arrest resuscitation practices differ around the globe

Jeannett Kjær  1   2 , Louise Milling  1   2 , Anne Craveiro Brøchner  1   3 , Freddy Lippert  4   5 , Stig Nikolaj Blomberg  5   6 , Helle Collatz Christensen  5   6 , Robyn Holgate  7 , Laurie J Morrison  8   9 , Abdullah Bakhsh  10   11 , Søren Mikkelsen  1   2 ; Global Prehospital Resuscitation Network
Collaborators, Affiliations

Prehospital cardiac arrest resuscitation practices differ around the globe

Jeannett Kjær et al. Resusc Plus. .

Abstract

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.

Keywords: Emergency care disparities; Health policies; Health system capacity; Termination of resuscitation (TOR).

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: One of the authors serves in a leadership role as a member of the Board of Directors for the European Association of EMS (unpaid) and is a member of the Executive Board of the Global Resuscitation Alliance (unpaid). Additionally, one of the authors participates in Data Safety Monitoring Boards and advisory boards, including protocol review committees for various trials and networks funded by the NIH, as well as a DSMB for a European trial. All of these roles are unrelated to the scope of this work.

Figures

Fig. 1
Fig. 1
World map of the participating countries.
See this image and copyright information in PMC

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