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

Sai, Venkat; Lakshmi, Lakshmi

doi:10.65188/nurexus.1068

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

Page 16

Journal of MedVerse Research & Practice

ISSN: 3107-4278

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

Cardiac Arrest

Dr. Venkat Sai

1

, Dr. Lakshmi

2

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

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

ORIGINAL ARTICLE

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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

Study Design

This retrospective record-based cohort study was conducted to evaluate survival outcomes and neurological

prognosis at 72 hours among adult patients who experienced in-hospital cardiac arrest (IHCA). The study

assessed early post-resuscitation survival and identified clinical factors associated with favorable

neurological recovery following successful cardiopulmonary resuscitation (CPR).

Study Setting and Duration

The 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 equipped with dedicated neurocritical care and advanced cardiac life support facilities. Consecutive

eligible patients admitted during the predefined study period were identified through hospital medical

records and included in the analysis.

Study Population

A total of 108 consecutive adult patients aged more than 18 years who experienced in-hospital cardiac arrest

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and underwent cardiopulmonary resuscitation according to the American Heart Association (AHA)

guidelines were included in the study. Cardiac arrest was defined as the sudden cessation of cardiac

mechanical activity confirmed by the absence of a palpable pulse and apnea or agonal breathing requiring

immediate initiation of CPR.

Inclusion and Exclusion Criteria

Adult patients aged more than 18 years who experienced in-hospital cardiac arrest and received

standardized cardiopulmonary resuscitation were included. Patients with out-of-hospital cardiac arrest,

those younger than 18 years, individuals with documented do-not-resuscitate (DNR) or do-not-intubate

(DNI) orders, and patients who developed cardiac arrest during surgical procedures were excluded from

the study.

Data Collection

Data were retrospectively extracted from standardized cardiopulmonary resuscitation records, hospital case

files obtained from the Medical Records Department, laboratory databases, intensive care records, and

neuroimaging reports using a structured data collection form. Demographic information including age and

gender was recorded. Clinical variables included pre-existing comorbidities such as hypertension, diabetes

mellitus, coronary artery disease, chronic kidney disease, respiratory disorders, hypotension, renal

dysfunction, and other significant medical illnesses. Information regarding the location of cardiac arrest,

initial documented cardiac rhythm (shockable or non-shockable), duration of cardiopulmonary

resuscitation, time to defibrillation when indicated, and achievement of return of spontaneous circulation

(ROSC) was documented. Post-resuscitation variables including requirement for mechanical ventilation,

vasopressor or inotropic support, renal replacement therapy, targeted neuroprotective interventions, and

intensive care unit admission were also recorded.

Data Tool

The primary outcomes of the study were survival at 72 hours following cardiac arrest and neurological

prognosis at 72 hours after successful resuscitation. Secondary outcomes included return of spontaneous

circulation and survival to hospital discharge. Neurological status was assessed using the Cerebral

Performance Category (CPC) score, where a CPC score of 1 or 2 was considered a favorable neurological

outcome and a CPC score of 3 to 5 was considered an unfavorable neurological outcome. Additional

neurological assessment included Glasgow Coma Scale (GCS), pupillary light reflex, brainstem reflexes,

and neuroimaging findings whenever available.

Ethical Considerations

The study protocol was reviewed and approved by the Institutional Ethics Committee of Narayana Medical

College, Nellore. Written informed consent for the use of anonymized clinical data for research purposes

was obtained from the patients' legally authorized representatives before inclusion in the study. Strict

confidentiality was maintained throughout the study by assigning unique identification numbers to all

participants, and no personally identifiable information was disclosed during data collection, analysis, or

publication.

Statistical Analysis

All collected data were entered into Microsoft Excel for data cleaning and coding before being analyzed

using the Statistical Package for the Social Sciences (SPSS) software. Continuous variables were expressed

as mean ± standard deviation, while categorical variables were presented as frequencies and percentages.

Associations between clinical variables and survival or neurological outcomes were evaluated using the

Chi-square test or Fisher's exact test for categorical variables and the independent sample t-test for

continuous variables. Variables that showed statistical significance in univariate analysis were entered into

multivariate logistic regression analysis to identify independent predictors of favorable neurological

outcome at 72 hours. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated,

and a p-value of less than 0.05 was considered statistically significant.

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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

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).

Table 3: Survival Outcomes

Outcome

Frequency (%)

ROSC Achieved

70 (64.8%)

Survived at 72 Hours

42 (38.9%)

Survived to Discharge

32 (29.6%)

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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%)

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,

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

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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]

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 centre 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-centre design with possible documentation bias and limited

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

prospective multicentre 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.

Declaration

Funding: None

Conflict of Interest: None declared

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