Kjær, JMilling, LBrøchner, ACLippert, FBlomberg, SNChristensen, HCHolgate, RMorrison, LJBakhsh, AMikkelsen, SAlsulimani, LKPopela, SVidunová, JKPeran, DGregor, RPapousek, RSimić, ACairol, AIngelmo, VSBBjörnsson, HMStammet, PEscalante-Kanashiro, RNikolaidou, OKarageorgos, VAslanidis, TWallner, BRief, MEichinger, MChakra Rao, SSCSinghMD, BBirkun, AAAguilera, PBakker, JZaher, MSAlwajeeh, SATanabe, SIwami, TSaito, SFraga-Sastrias, JMKittivo, JEAchiro, KONdinda, CMonsieurs, KSnijders, EAbdullah, NStanton, DMeyer, JTCrawford, SJLoghmari, DTurkia, HBBarbaria, WWijesuriya, NDilruk Indika Rathnayake, RMWoltman, NMesa-Gaerlan, FJConvocar, PVelasco, BPAlihodžić, HAlrawashdeh, AAlwidyan, MTSoares-Oliveira, MMota, MCao, YYao, PKin Lam, RPCheung, ACKBogár, BTemesvari, PGebei, RKaraaslan, PSofuoglu, TCiocan, LJaeger, DSung, CWChen, CHGellerfors, MWahlin, RRSchell, COGardiner, FNichols, MPerillo, SReid, DMohrsen, SCorfield, ARAllen, MFalcetta, SMenarini, MRehn, MKramer-Johansen, JBredmose, PPOlasveengen, TMUleberg, OWilson, TLindner, TWJacobsen, LFormo, AElden, TOlsen, MSKowalski, MDerkowski, TSwain, Andrew2025-08-122025-08-122025-09-01Resuscitation Plus, ISSN: 2666-5204 (Print); 2666-5204 (Online), Elsevier BV, 25, 101017-101017. doi: 10.1016/j.resplu.2025.1010172666-52042666-5204http://hdl.handle.net/10292/19664Background: 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.© 2025 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/ licenses/by/4.0/).32 Biomedical and Clinical Sciences3201 Cardiovascular Medicine and HaematologyCardiovascularHeart DiseaseClinical ResearchGeneric health relevanceHealth system capacityTermination of resuscitation (TOR)Emergency care disparitiesHealth policiesJournal ArticleOpenAccess10.1016/j.resplu.2025.101017