Predictors of immediate survival in Emergency Department cardiac arrest in Ethiopia: Insights from a resource-limited setting.

Background: In-hospital cardiac arrest (IHCA) in Emergency Departments (EDs) remains a leading cause of mortality, particularly in low-resource countries. This study aims to identify the clinical characteristics and predictors of immediate survival among ED cardiac arrest patients in Ethiopian hospitals. Methods: A retrospective cross-sectional study was conducted among 215 adult patients who experienced IHCA in the EDs of Saint Paul's Hospital Millennium Medical College and Addis Ababa Burn, Emergency, and Trauma Hospital between January 2022 and December 2023. Logistic regression was used to identify predictors of immediate survival, defined as returns of spontaneous circulation sustained for at least one hour. Results: Among 215 patients, the mean age was 50.7 years, and 58.6 % were male. The overall immediate survival rate was 46.5 % (n = 100). Independent predictors of survival included male sex (AOR 2.20; 95 % CI 1.06-2.89), respiratory failure as the cause of arrest (AOR 15.04; 95 % CI 2.34-95.13), continuous cardiac monitoring (AOR 4.94; 95 % CI 1.59-15.39), and initial shockable rhythms-ventricular fibrillation (AOR 37.93; 95 % CI 2.20-655.58) or pulseless ventricular tachycardia (AOR 25.64; 95 % CI 5.08-129.47). Admission for sepsis was associated with lower survival (AOR 0.05; 95 % CI 0.01-0.68). Conclusion: Nearly half of patients with ED cardiac arrest in Ethiopia achieved immediate survival. Continuous monitoring, rapid recognition of shockable rhythms, and prompt management of reversible causes such as respiratory failure improve outcomes, while sepsis remains a predictor of poor survival. Strengthening ED monitoring and resuscitation capacity could improve cardiac arrest outcomes in similar African settings.