In-Hospital Cardiac Arrest Management: Retrospective Cohort and Process–Outcomes Analysis in a Costa Rica Hospital

Background/Objectives: In-hospital cardiac arrest (IHCA) remains a critical event with high mortality, requiring coordinated multidisciplinary response. Return of spontaneous circulation (ROSC) and hospital discharge rates are key quality indicators in resuscitation efforts. In Costa Rica, there is limited published data on team performance, protocol adherence, and the pharmacist’s role in code blue events, despite similar evidence gaps across Latin America. This study aimed to evaluate clinical outcomes and operational performance of in-hospital cardiac arrest events at a Costa Rica hospital. Methods: This retrospective cohort study included 77 adult patients who experienced IHCA at Clínica Bíblica between 2020 and 2024. Data collection was conducted between February and May 2025 from electronic medical records and code blue activation logs. Clinical variables, comorbidities, pharmacologic interventions, and outcomes were analyzed. Predictive models (Charlson Comorbidity Index [CCI], IHCA-ROSC, RISQ-PATH) and Kaplan–Meier survival analysis were applied. Results: ROSC was achieved in 55.8% of patients, and 21% were discharged alive. Asystole was the predominant initial rhythm (76.6%), and comorbidities such as renal disease and myocardial infarction were most frequent. A higher comorbidity burden was significantly associated with lower discharge rates (p = 0.032). Despite 98.7% of patients being classified as low probability for ROSC by the IHCA-ROSC model, observed outcomes exceeded expectations (predicted: 5.53% vs. actual: 55.84%; p < 0.000001). The code team adhered to institutional protocols in 100% of cases, with clinical pharmacists playing a key role in documentation and medication tracking. Conclusions: Structured multidisciplinary response was associated with ROSC rates notably higher than predicted by validated models. Opportunities for improvement include post-event laboratory testing, pharmacist-led documentation, and therapeutic hypothermia in shockable rhythms.