Decisions regarding resuscitation during out-of-hospital cardiac arrest (OHCA) are complex and influenced by multiple factors, including paramedics’ individual judgment. These choices—whether to initiate, continue, withhold, or stop resuscitation—can vary widely. This study aimed to investigate how paramedics decide to commence resuscitation using a discrete choice experiment. From October to December 2022, paramedics from ten National Health Service ambulance trusts in England and Wales participated in a discrete choice experiment. Participants evaluated fourteen clinical scenarios, each with thirteen patient and situational attributes, and indicated whether they would offer resuscitation. A total of 864 paramedics completed the survey (median age 36 years, 61.8% male), with around half having less than five years of clinical experience. Overall, there was a general tendency to initiate resuscitation (p < 0.01). Most scenario attributes influenced decisions, except for patient gender. Resuscitation was less likely for patients aged 73 years or older, those with mild dementia, or moderate frailty. Paramedic characteristics such as female gender, very short (<5 years) or long (>10 years) professional experience, lower academic qualification, lower skill level, and fewer OHCA encounters were associated with a higher likelihood of offering resuscitation. Paramedic decisions during OHCA are shaped by a combination of patient characteristics and provider-related factors. Understanding these influences can inform strategies to support consistent, evidence-based resuscitation practices, reduce variability, and align actions with patient and public expectations.
