CPR duration and achievement of ROSC After ICU cardiac arrest: a single-center study in Al-Jouf, Saudi Arabia

Cardiac arrest in the intensive care unit (ICU) remains associated with substantial mortality despite advances in resuscitation care. Resuscitation duration is an important marker of resuscitation outcome following in-hospital cardiac arrest. This study evaluated the association between resuscitation duration and ROSC achievement among adult cardiac-arrest episodes occurring in the ICU. This retrospective cohort study included adult cardiac-arrest episodes (age ≥ 18 years) occurring in the ICU of a secondary care hospital in Saudi Arabia between January 2023 and December 2024. Demographic, clinical, physiological, laboratory, and resuscitation characteristics were extracted from medical records. The primary outcome was ROSC achievement. Multivariable logistic regression was performed using a primary severity-adjusted model and an expanded clinical model. Patient-clustered robust standard errors were used to account for recurrent cardiac-arrest episodes. A total of 110 adult cardiac-arrest episodes among 78 patients were included; ROSC was achieved in 42 episodes (38.2%). Median CPR duration was significantly shorter in episodes achieving ROSC than in those without ROSC (median [IQR], 7.5 [5.0–14.25] vs. 30.0 [30.0–30.0] minutes; p < 0.001). In the primary model, CPR duration remained strongly associated with ROSC achievement after adjustment for SAPS II (adjusted OR 0.66 per 1-minute increase; 95% CI 0.55–0.79; p < 0.001). The association remained significant in the expanded clinical model incorporating additional demographic, physiological, and laboratory characteristics (adjusted OR 0.59; 95% CI 0.48–0.73; p < 0.001). Shorter resuscitation duration was strongly associated with ROSC achievement among adult cardiac-arrest episodes occurring in the ICU. These findings highlight the strong relationship between resuscitation duration and ROSC achievement in ICU cardiac arrest. Further multicenter studies incorporating detailed arrest characteristics, CPR-quality measures, and long-term neurological outcomes are needed.