<b>In-Hospital Cardiac Arrest Management: A Retrospective Study in the Emergency Department</b>

Background: In-hospital cardiac arrest (IHCA) in the emergency department (ED) remains a high-mortality event, and locally generated outcome data from low- and middle-income settings are limited. Objective: To describe the characteristics, management, and outcomes of ED-based IHCA in a tertiary-care hospital and to evaluate differences in outcomes by initial cardiac arrest rhythm. Methods: This retrospective observational study was conducted in the Emergency Department of Lady Reading Hospital, Peshawar, from June 2025 to December 2025. Adult patients (≥18 years) who developed cardiac arrest in the ED after arrival and received cardiopulmonary resuscitation were included; out-of-hospital cardiac arrest and documented do-not-resuscitation cases were excluded. Data were extracted from ED records and CPR logs using standardized definitions. The primary outcome was return of spontaneous circulation (ROSC); secondary outcomes were survival to ED disposition and survival to hospital discharge. Results: Eighty-six patients were included (mean age 58.4 ± 15.2 years; 60.5% male). Initial rhythms were pulseless electrical activity in 44.2%, asystole in 37.2%, and shockable rhythms in 18.6%. ROSC occurred in 31/86 (36.0%), survival to ED disposition in 18/86 (20.9%), and survival to hospital discharge in 9/86 (10.5%). Shockable rhythms were associated with higher ROSC than non-shockable rhythms (62.5% vs 30.0%; OR 3.89, 95% CI 1.25–12.10; p=0.018). Conclusion: ED-based IHCA was associated with low survival to hospital discharge, with non-shockable rhythms predominating and conferring poorer outcomes. Strengthening early recognition, high-quality resuscitation, and optimized post-arrest care may improve survival.