Could Ray have survived at the end?

Short of an official word on the matter (which I'm cannot find and, as Meat Trademark has mentioned, there doesn't seem to be a commentary track either), this is inconclusive. This IMDb section discusses the contrasting evidence: Ray's voiceover ending with "And I really, really hoped I wouldn't die" could be interpreted one way or the other, as well as the fact that the paramedic is taking the oxygen mask off him.

To add confusion to the matter, the original script says the medics aren't hopeful about Ray's chances, but then reveals that Ray survived his wounds and is trying to kill himself again, cutting to black before revealing if he succeeds. The fact that this scene was cut (and the voiceover was added) suggests that the film's ending is intentionally ambivalent: what's important is that Ray now embraces life. But whether he actually lives or not, it's left up to us.

I know im almost a year or so too late, but I think he was already dead when he got to Bruges. He was killed on the train/or en route to Bruges, and his grief about the kid kept him locked on earth, forcing him to try and deal with his grief, allowing him to pass on out of limbo/Bruges. That's why he refers to it as hell, and that's why he says at the end, "I really hoped I wouldn't die. idk just a far out deep thought I had." And that is why he has to return to Bruges when he gets on the train, and he is not charged by the police. because he is in limbo, already dead.

The ending has been intentionally left ambiguous which is fitting because it's hard to decide whether he deserved to die or not after all that had happened before. However, the narrative at the end is not only in past tense, it also seems like a reflection upon a rather old memory which indicates that he has either survived or is in some form of after-life, unless of course, the narration is just for effect. He says that while being taken to the ambulance, he wondered if hell was spending the rest of eternity in Bruges which gives the impression that he still doesn't know what happens in after-life or if there is one. So chances are he isn't dead while narrating the ending and had probably somehow survived the injuries.

I think he survived because throughout the movie it was always showing characters worrying about facing the future guilt. If he doesnt die, it has all 3 outcomes of the guilt. Ken dies for trying to avoid the guilt. Harry dies because he causes guilt. If ray lives, it means he has to live on with guilt.