This retrospective cohort examined EMS-agency variation in resuscitation decisions for non-traumatic out-of-hospital cardiac arrest using 2018–2024 data. Resuscitation was not initiated in 76,859 of 560,240 encounters (13.7%). Among 309,048 encounters eligible for the Universal termination-of-resuscitation rule, 175,826 (56.9%) underwent termination. After adjustment, substantial agency-level variation remained: median odds ratios were 2.30 (95% confidence interval 2.21–2.38) for non-initiation and 4.13 (3.87–4.26) for termination, representing the median increase in odds between similar encounters treated by two randomly selected agencies.
Resuscitation initiation and termination varied substantially between EMS agencies despite adjustment. These findings support further investigation of decision-making consistency, but do not establish which agency practices are appropriate or improve outcomes.
Study limitation: Residual confounding may explain some variation; the abstract does not report survival or assess the appropriateness of individual decisions.
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