Quality of Cardiopulmonary Resuscitation among In-Hospital Cardiac Arrest Patients at a Major Tertiary Hospital in Saudi Arabia

Background: In-hospital cardiac arrest (IHCA) continues to present significant challenges to healthcare providers, with survival outcomes often falling short of global benchmarks. Understanding the clinical and system-related factors associated with return of spontaneous circulation (ROSC) and survival to discharge (STD) is critical for improving resuscitation practices and patient safety. Aim: To identify the clinical and operational factors influencing ROSC and STD among adult patients who experienced IHCA at a tertiary hospital in Saudi Arabia. Design: Retrospective descriptive study. Setting: The study was conducted at King Saud Medical City (KSMC), a Joint Commission International (JCI) and CBAHI-accredited tertiary hospital in Riyadh, Saudi Arabia. Tool of Data Collection: Data were extracted from 1,474 CPR records between January 2017 and January 2019 using a modified Utstein-style in-hospital cardiac arrest template. The tool captured variables related to patient demographics, arrest characteristics, team response, initial rhythm, location, and outcomes. Statistical analysis was performed using SPSS version 24. Results: Out of 1,474 cases, 570 (38.7%) achieved ROSC and 60 (10.5%) survived to hospital discharge. ROSC was significantly associated with witnessed arrests (p=0.01), monitored locations (p<0.01), initial shockable rhythm (p<0.01), and shorter CPR duration (p=0.02). STD was similarly associated with witnessed status (p=0.04), monitored areas (p<0.01), shockable rhythm (p=0.02), full team attendance (p=0.03), rapid team response (p<0.01), and reduced CPR duration (p=0.03). Conclusion: The findings highlight key predictors of successful resuscitation outcomes. Despite the data being collected several years ago, the hospital continues to implement structured mock codes and BLS training. These results offer valuable benchmarking insights to guide future quality improvement efforts and post-resuscitation care protocols. Recommendations: Healthcare institutions should strengthen CPR training, enhance early defibrillation and team readiness, and conduct regular audits of resuscitation outcomes. Further studies are recommended to measure the impact of newly implemented policies using prospective data.