Cardiopulmonary resuscitation is a lifesaving emergency procedure which consists of chest compressions often combined with artificial ventilation in efforts to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. Cardiopulmonary resuscitation (CPR) is the main pillar of emergency medical care attempting to reverse cardiac arrest and prevent mortality. The emergency department is the first point contact for critically ill patients and the quality of CPR can significantly influence survival rates and long term neurological outcomes. Despite advances in resuscitation protocols and supportive care, survival after cardiac arrest remains suboptimal in many healthcare settings. So, by focusing on tertiary care centre, this study aim to explore outcomes in setting equipped with advanced resources and multidisciplinary support, thus reflecting the current standards of care in high acuity environment.

This topic aligns with a growing emphesis on evidence based practice in emergency medicine, where outcome analysis can directly inform protocol revisions and quality improvement initiatives. It also provides a strong foundation for future research and potential interventions aimed at improving CPR outcomes. Overall this thesis topic is not only academically enriching but also has the potential to make a meaningful impact on clinical practice, resource utilization and patient survival in emergency settings.

Study Design

Cardiopulmonary resuscitation is a lifesaving emergency procedure consisting of chest compressions often combined with artificial ventilation in efforts to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest.

• High quality Cardiopulmonary Resuscitation improves a victim’s chances of survival^[1]. High quality CPR consists of-

1. Start compressions within 10 seconds after recognizing cardiac arrest.
2. Push hard push fast:

• Compressions @ 100-120/min with depth of
• At least 5cm for adults but no more than 6cm

3. Allow complete chest recoil after each compression.
4. Minimize interruptions in compressions (try to limit interruptions to less than 10 seconds).
5. Give effective breaths. Deliver each breath over 1 second, enough to make the victim’s chest rise. Avoid excessive ventilation.

Cardiac arrest is a medical emergency characterized by abrupt cessation of cardiac mechanical function resulting in insufficient circulation of blood flow, as indicated by the absence of palpable central pulse and aponea, loss of pulse, blood pressure, and spontaneous respiration. Although the condition may be reversible with immediate intervention, it can lead to death if appropriate action is not taken promptly. Basic life support consisting of emergency response system activation, cardiopulmonary resuscitation, and defibrillation with an automated external defibrillator as indicated by the American Heart Association’s guidelines are integral to the management of a cardiac arrest^[1] . CPR is the attempt to restore circulation and maintain the viability of vital organs until the underlying cause for arrest can be addressed and definitive intervention can be initiated^[2] . To achieve this goal, resuscitation is performed in multiple steps including chest compression, maintenance of airways, and rescue breaths or ventilation. If performed successfully, return of spontaneous circulation is achieved. ROSC is defined as return of pulse and its maintenance for longer than 20 min. Another key outcome of CPR is survival to discharge, which is variably defined as a patient transferred from ICU to ward, transferred from one facility to another, or discharged home from hospital under stable conditions. However, favourable outcomes are not always attained post-CPR.

The study conducted in Sri Aurobindo Medical College and PG Institute, a tertiary care centre on 100 cardiac arrest patients undergoing cardiopulmonary resuscitation in which 69.0% were male and 31.0% were female. Out of this 100 patients 33.0% were below 45 years, 41.0% were between 45-65 year and 26.0% were above 65 year of age. Mean age were in between 45-65 year[6,8,9].17.0% of the patient was fully conscious before the cardiac arrest and 4.0% were in altered sensorium and 79.0% were unconscious before the arrest happened. Non shockable rhythms were predominant 78.0% , with shockable rhythms 22.0%. ROSC was achieved in 26.0% patients out of which survival to discharge was achieved only in 11% of the patients similar to the hospitals globally [8,9,10,11] . The most common co-morbidities amongst the cardiac arrest patients were of cardiac diseases 32%. Others included Renal disease 14%, Respiratory 10%, CVA 8%, Carcinoma7% , Gastrointestinal 5%, Road traffic accidents 5% , Poisoning and other condition.

Statistically better survival was noted in patient having cardiac disease with early witness of arrest along with shockable rhythm. Prolonged CPR duration was negatively associated with survival[11,12] .

According to the statistical values there is highly significant association between ROSC and final patient outcome (p value <0.001). this means that ROSC is powerful predictor of patients outcome in this database

Cardiopulmonary resuscitation (CPR) remains a cornerstone of emergency care, where timely intervention can mean the difference between life and death of the patients within the Emergency Department (ED). The efficacy of CPR and factors influencing the outcomes has always been the area of active research as to improve on survival rates in ED.

Studies report world wide shows variability in ROSC and survival to discharge rates. Outcomes of CPR in the ED are generally poor, with studies showing ROSC rates ranging from 25% to 35%, and survival to hospital discharge rates between 5% and 15% depending on the setting and population studied in different areas ^[3–5] . For instance, Alhaj Zeen et al. reported a ROSC rate of 30.2% and a survival to discharge rate of 11.4% in a tertiary hospital in Saudi Arabia ^[3] . Similarly, a study in Malaysia documented ROSC in 25.8% of patients and survival to discharge in only 4.2% ^[4] . These statistics underscore the critical need for prompt and effective resuscitation measures, as well as post-resuscitation care.

Despite methodical CPR protocols, persistent challenges exist, including inconsistent adherence to guidelines in some settings, limitations in staff training, and variation in equipment or response time, which may account for the plateau in survival improvements seen over recent decades^[6,11]. Multicenter and prospective studies are recommended for future research to standardize the evaluation of prognostic indicators and enhance the generalizability of results across different emergency departments^[6,12] .

Outcomes of patients undergoing CPR in emergency departments of tertiary care centers, as evidenced by ROSC and survival to discharge rates, remain consistent with global reports ^[6,12]. CPR duration beyond 30 minutes is associated with a marked decline in successful outcomes. Systemic efforts to enhance training, implement real time performance feedback, and apply rapid multidisciplinary team response can further improve the outcome^[13]. Finally, developing prospective, identifying at-risk populations, and implementing targeted interventions to increase survival and reduce neurological disability following in-hospital cardiac arrest^[6,13] .

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