Survival Outcomes and Neurological Prognosis at 72 Hours Following In-Hospital Cardiac Arrest

Sai V et al | DOI: 10.65188/nurexus.1068

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Journal of MedVerse Research & Practice

ISSN: 3107-4278

Survival Outcomes and Neurological Prognosis at 72 Hours Following In-Hospital

Cardiac Arrest

Dr. Venkat Sai

, Dr. Lakshmi

Assistant Professor, Professor

Department of Emergency Medicine, Narayana Medical College, Nellore

Email ID: venkat442@gmail.com

Submission Date: 25.01.2026

Accepted Date:19.02.2026

Published Date: 28.02.2026

DOI: 10.65188/nurexus.1068

article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted

use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Abstract

Background: In-hospital cardiac arrest (IHCA) remains a major cause of mortality and neurological disability

despite advances in resuscitation science. Early return of spontaneous circulation (ROSC) and post-resuscitation

neurological recovery are critical determinants of long-term survival. Evaluation of survival milestones and

predictors of neurological outcomes within the first 72 hours is essential for optimizing clinical decision-making and

resource allocation.

Objective: To assess survival rates to ROSC, 72-hour survival, and hospital discharge, and to evaluate neurological

prognosis at 72 hours following resuscitation among adult patients with in-hospital cardiac arrest. The study also

aimed to identify pre-arrest, intra-arrest, and post-arrest factors associated with survival and neurological outcomes.

Methods: A retrospective record-based cohort study was conducted in the Department of Emergency Medicine and

Critical Care at Narayana Medical College, Nellore. A total of 108 adult patients who experienced IHCA and

underwent cardiopulmonary resuscitation were included. Data were extracted from CPR records and medical case

files. Survival outcomes were assessed at ROSC, 72 hours, and discharge. Neurological status was evaluated using

the Cerebral Performance Category (CPC) score at 72 hours. Statistical analysis was performed using SPSS.

Associations were examined using Chi-square and independent t-tests, and multivariate logistic regression identified

independent predictors of favorable neurological outcome. A p-value <0.05 was considered statistically significant.

Results: ROSC was achieved in 64.8% of patients, 72-hour survival was 38.9%, and survival to discharge was 29.6%.

Favorable neurological outcome (CPC 1–2) at 72 hours was observed in 11.1% of patients. Shockable rhythm, shorter

CPR duration, absence of pre-arrest hypotension, and early initiation of post-resuscitation care were significantly

associated with survival and good neurological outcome. Prolonged CPR duration and non-shockable rhythms

independently predicted poor prognosis.

Conclusion: Survival and neurological recovery following IHCA remain limited. Early rhythm recognition, rapid

resuscitation, and optimized post-arrest care are crucial determinants of improved outcomes.

Keywords: In-hospital cardiac arrest; Return of spontaneous circulation; Neurological prognosis; CPC score;

Cardiopulmonary resuscitation; Survival outcomes.

Introduction

In-hospital cardiac arrest (IHCA) remains a significant cause of morbidity and mortality worldwide despite

advancements in resuscitation science and critical care practices. The incidence of IHCA varies globally,

with estimates ranging between 1 and 6 events per 1,000 hospital admissions [1]. Although prompt

cardiopulmonary resuscitation (CPR) and adherence to Advanced Cardiac Life Support (ACLS) protocols

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have improved immediate survival rates, overall survival to hospital discharge remains modest, typically

reported between 15% and 25% [2]. Beyond survival, neurological recovery following resuscitation

represents a crucial determinant of long-term quality of life and functional independence.

Return of spontaneous circulation (ROSC) is the first critical milestone in resuscitation outcomes. However,

achieving ROSC does not guarantee favorable neurological recovery. Post-cardiac arrest syndrome,

characterized by cerebral hypoxia, myocardial dysfunction, and systemic inflammatory response,

significantly influences survival and neurological prognosis [3]. Studies have shown that early

identification of prognostic indicators during the first 24 to 72 hours post-resuscitation is essential for

guiding clinical management and family counseling [4].

Neurological outcome following IHCA is commonly assessed using the Cerebral Performance Category

(CPC) score, which categorizes patients based on functional neurological status [5]. Favorable neurological

outcome is generally defined as CPC scores of 1 or 2, representing good cerebral performance or moderate

disability, whereas CPC scores of 3 to 5 indicate severe disability, coma, or death. Despite advances in

post-resuscitation care, the proportion of patients achieving favorable neurological outcomes remains low,

often below 10% in many cohorts [6].

Several pre-arrest, intra-arrest, and post-arrest variables have been associated with survival and

neurological recovery. Pre-arrest factors such as age, comorbid conditions, and baseline neurological status

influence the likelihood of meaningful recovery [7]. Intra-arrest factors including initial cardiac rhythm,

duration of CPR, time to defibrillation, and quality of chest compressions are critical determinants of

outcome [8]. Shockable rhythms such as ventricular fibrillation and pulseless ventricular tachycardia are

consistently associated with higher survival rates compared to non-shockable rhythms such as asystole and

pulseless electrical activity [9]. Additionally, prolonged CPR duration is strongly correlated with poor

neurological outcome due to sustained cerebral hypoperfusion [10].

Post-resuscitation care plays a vital role in neurological preservation. Targeted temperature management,

hemodynamic optimization, early coronary angiography when indicated, and controlled ventilation

strategies have been shown to improve outcomes in selected patients [11]. Biomarkers such as serum

lactate, along with neurophysiological assessments and imaging studies, provide supplementary

information for prognostication during the early post-arrest period [12,13].

The present study was conducted at Narayana Medical College, Nellore, to assess survival outcomes and

neurological prognosis at 72 hours following resuscitation among adult patients experiencing in-hospital

cardiac arrest. Furthermore, the study aimed to identify demographic characteristics and pre-arrest, intra-

arrest, and post-arrest factors associated with survival and favorable neurological outcome. By analyzing

these determinants, this study seeks to contribute to improved risk stratification and optimization of post-

cardiac arrest management in tertiary care settings.

Materials and Methods

This retrospective record-based cohort study was conducted in the Department of Neurology in

collaboration with the Department of Emergency Medicine and Critical Care at Narayana Medical College,

Nellore, India, a tertiary care teaching hospital with established neurocritical care and advanced

resuscitation facilities. The study included adult patients who experienced in-hospital cardiac arrest (IHCA)

and underwent cardiopulmonary resuscitation (CPR) during the defined study period.

A total of 108 consecutive adult patients aged more than 18 years who sustained IHCA and received CPR

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according to American Heart Association guidelines were included. Cardiac arrest was defined as the

sudden cessation of cardiac mechanical activity confirmed by absence of pulse and apnea or agonal

breathing requiring immediate CPR initiation. Patients with out-of-hospital cardiac arrest, those aged less

than 18 years, patients with documented do-not-resuscitate (DNR) or do-not-intubate (DNI) status, and

cardiac arrests occurring during surgical procedures were excluded.

Data were extracted from standardized CPR records, hospital case files obtained from the Medical Records

Department, laboratory databases, and neuroimaging reports using a structured data collection form to

ensure uniformity. Demographic variables included age and gender. Pre-arrest variables such as

comorbidities, hypotension, respiratory insufficiency, renal dysfunction, and prior cardiac disease were

recorded. Intra-arrest variables included location of arrest, initial documented rhythm (shockable or non-

shockable), duration of CPR, time to defibrillation when applicable, and achievement of return of

spontaneous circulation (ROSC). Post-resuscitation variables included requirement for mechanical

ventilation, inotropic support, dialysis, and neuroprotective interventions. Survival outcomes were assessed

at predefined milestones including ROSC, survival at 72 hours post-resuscitation, and survival to hospital

discharge. Neurological prognosis was evaluated at 72 hours using the Cerebral Performance Category

(CPC) score. Favorable neurological outcome was defined as CPC score 1 or 2, and unfavorable outcome

as CPC score 3 to 5. Additional neurological assessment included Glasgow Coma Scale, pupillary and

brainstem reflex evaluation, and relevant neuroimaging findings where available.

Data were entered into Microsoft Excel and analyzed using Statistical Package for the Social Sciences

(SPSS). Continuous variables were expressed as mean ± standard deviation and categorical variables as

frequency and percentage. Associations were assessed using Chi-square test and independent sample t-test.

Multivariate logistic regression analysis was performed to identify independent predictors of favorable

neurological outcome. A p-value <0.05 was considered statistically significant. The study received ethical

clearance from the Institutional Ethics Committee of Narayana Medical College, Nellore. Written informed

consent was obtained from the patients’ legally authorized representatives prior to inclusion in the study.

Confidentiality was strictly maintained by assigning unique identification numbers, and no identifiable

patient information was disclosed at any stage of the research.

Results

A total of 108 adult patients with in-hospital cardiac arrest (IHCA) who underwent cardiopulmonary

resuscitation were included in the study.

Table 1: Baseline Demographic Characteristics

Variable

Total (n=108)

Mean Age (years)

59.8 ± 14.2

Age >60 years

58 (53.7%)

Male

68 (63.0%)

Female

40 (37.0%)

The mean age of patients was 59.8 ± 14.2 years, with more than half (53.7%) aged above 60 years. A male

predominance (63.0%) was observed. Advanced age was frequently associated with poorer survival

outcomes. These findings indicate that elderly males constitute a significant proportion of IHCA cases.

Table 2: Pre-Arrest Clinical Characteristics

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Variable

Frequency (%)

Hypertension

62 (57.4%)

Diabetes Mellitus

48 (44.4%)

Prior Heart Failure

36 (33.3%)

Hypotension Pre-Arrest

41 (38.0%)

Respiratory Insufficiency

52 (48.1%)

Hypertension (57.4%) and diabetes (44.4%) were common comorbidities. Pre-arrest hypotension was

present in 38.0% and respiratory insufficiency in 48.1%, both significantly associated with reduced 72-hour

survival (p = 0.02). These comorbid conditions likely contributed to compromised physiological reserve

prior to arrest.

Figure 1: Intra-Arrest Variables

Shockable rhythms were observed in 31.5% of patients and were strongly associated with improved 72-

hour survival (p = 0.001). Prolonged CPR duration (>20 minutes) significantly predicted poor survival (p

<0.001). Arrests occurring in monitored critical care areas had better survival outcomes (p = 0.04), likely

due to rapid intervention.

Table 3: Survival Outcomes

Outcome

Frequency (%)

ROSC Achieved

70 (64.8%)

Survived at 72 Hours

42 (38.9%)

Survived to Discharge

32 (29.6%)

ROSC was achieved in 64.8% of patients. However, survival declined to 38.9% at 72 hours and 29.6% at

discharge. This highlights the progressive attrition in survival following initial resuscitation.

Table 4: Neurological Outcome at 72 Hours (CPC Score)

CPC Category

Frequency (%)

CPC 1–2 (Favorable)

12 (11.1%)

CPC 3–5 (Unfavorable)

96 (88.9%)

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Only 11.1% of patients achieved favorable neurological outcome (CPC 1–2) at 72 hours. The majority

(88.9%) had severe disability, coma, or death. Favorable CPC was significantly associated with shockable

rhythm (p = 0.002) and CPR duration <20 minutes (p <0.001). Neurological prognosis remains poor despite

ROSC.

Table 5: Independent Predictors of Favorable Neurological Outcome

Variable

Adjusted Odds Ratio (AOR)

95% CI

p-value

Shockable Rhythm

4.2

1.8–9.6

0.001

CPR Duration <20 min

5.1

2.2–11.4

<0.001

Absence of Pre-Arrest Hypotension

2.6

1.1–6.3

0.03

Early Post-Resuscitation Care

2.9

1.2–6.8

0.02

Shockable rhythm (AOR 4.2; p = 0.001) and shorter CPR duration (AOR 5.1; p <0.001) were the strongest

independent predictors of favorable neurological outcome. Absence of pre-arrest hypotension and timely

post-resuscitation care also significantly improved prognosis. These findings emphasize the importance of

early rhythm recognition and rapid resuscitative response.

Discussion

The present study evaluated survival outcomes and neurological prognosis following in-hospital cardiac

arrest (IHCA) and identified key determinants influencing both survival and functional recovery. The

ROSC rate of 64.8% observed in our cohort aligns with previously reported tertiary care data; however,

survival declined to 38.9% at 72 hours and 29.6% at discharge, reflecting the well-recognized post-

resuscitation attrition phenomenon. Girotra et al. [14] similarly reported that although ROSC rates may

exceed 60%, discharge survival often remains below 30%, highlighting the ongoing challenge of sustaining

recovery beyond the immediate resuscitation phase.

Advanced age was common in our cohort, with more than half of patients above 60 years. Increasing age

has consistently been associated with reduced survival after IHCA. Andersen et al. [15] demonstrated a

progressive decline in survival probability with advancing age, though selected elderly patients may still

achieve meaningful neurological recovery. These findings emphasize that while age influences prognosis,

it should be considered alongside other clinical variables.

Pre-arrest physiological instability significantly impacted outcomes. Pre-arrest hypotension and respiratory

insufficiency were associated with reduced 72-hour survival in our study. Sandroni et al. [16] highlighted

that compromised hemodynamic status prior to arrest limits cerebral perfusion reserve, predisposing to

severe hypoxic injury. Chan et al. [17] similarly observed that pre-existing organ dysfunction predicts

poorer survival and neurological recovery. These findings underscore the importance of early identification

and stabilization of high-risk inpatients.

Intra-arrest variables exerted the strongest influence on survival and neurological outcomes. Shockable

rhythms were independently associated with favorable neurological prognosis (AOR 4.2; p = 0.001).

Meaney et al. [18] reported significantly higher survival rates in patients with ventricular fibrillation or

pulseless ventricular tachycardia compared to non-shockable rhythms. Shockable rhythms typically

represent primary cardiac etiologies amenable to rapid defibrillation, explaining their better outcomes.

Duration of CPR was the most powerful predictor of neurological recovery in our cohort. CPR lasting less

than 20 minutes independently predicted favorable CPC outcome (AOR 5.1; p <0.001). Reynolds et al. [19]

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demonstrated that the probability of neurologically intact survival decreases sharply with prolonged

resuscitation, particularly beyond 20–30 minutes. Goldberger et al. [20] further emphasized that extended

CPR duration is rarely associated with meaningful recovery. These findings highlight the critical

importance of early recognition, prompt response, and high-quality chest compressions. Arrests occurring

in critical care areas were associated with better survival, likely due to continuous monitoring and rapid

code team activation. Andersen et al. [21] reported that monitored hospital settings significantly reduce no-

flow time, improving outcomes. Neurological recovery remained limited, with only 11.1% achieving

favorable CPC scores at 72 hours. This proportion is consistent with registry data indicating favorable

neurological outcomes in approximately 8–15% of IHCA cases [22]. Sandroni et al. [23] emphasized that

early neurological evaluation within 72 hours is essential for prognostication but should be interpreted

cautiously to avoid premature decision-making.

Post-resuscitation care also influenced outcomes. Early hemodynamic optimization and ventilatory support

were associated with improved neurological prognosis. Callaway et al. [24] highlighted the importance of

comprehensive post-cardiac arrest care, including oxygenation control and targeted management of

secondary brain injury. Multivariate analysis in our study confirmed that shockable rhythm, shorter CPR

duration, absence of pre-arrest hypotension, and timely post-resuscitation care independently predicted

favorable neurological outcome, consistent with registry-based analyses by Holmberg et al. [25].

Strengths: Provides institution-specific data from a tertiary care center in India with structured survival

milestones and standardized neurological assessment using CPC score. Comprehensive analysis of pre,

intra, and post arrest variables with multivariate regression strengthens validity.

Limitations: Retrospective single center design with possible documentation bias and limited

generalizability. No long term neurological follow up and variability in post resuscitation care. Larger

prospective multicenter studies are needed.

Conclusion

This study evaluated survival milestones and neurological prognosis at 72 hours following in-hospital

cardiac arrest and identified key determinants influencing outcomes. Although return of spontaneous

circulation was achieved in a considerable proportion of patients, survival significantly declined by 72

hours and hospital discharge, and favorable neurological recovery remained limited. Shockable initial

rhythm and shorter duration of cardiopulmonary resuscitation emerged as the strongest independent

predictors of favorable neurological outcome, while pre-arrest hypotension and prolonged resuscitation

were associated with poor prognosis. These findings fulfill the primary objectives of estimating survival

rates at defined milestones and identifying pre-arrest, intra-arrest, and post-arrest factors associated with

survival and neurological recovery. The results emphasize that early rhythm recognition, rapid initiation of

high-quality CPR, and optimized post-resuscitation care are critical for improving neurologically intact

survival following IHCA. Institutional strategies focusing on early warning systems, code team efficiency,

and standardized post-arrest protocols may enhance outcomes in tertiary care settings.

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