Winchana Srivilaithon, MD¹ , Thosapol Ueamsaranworakul, MD¹

Objective: The optimal duration of cardiopulmonary resuscitation (CPR) in emergency department cardiac arrest (EDCA) patients remains uncertain. This study aimed to determine the association between CPR duration and survival outcomes among EDCA patients.

Materials and Methods: This retrospective observational study included adult patients with non-traumatic cardiac arrest in the ED between January 2012 and December 2024. Patients were categorized based on whether they achieved sustained return of spontaneous circulation (ROSC). Multivariable logistic regression analyses were performed to identify associations between CPR duration and 1) survival to hospital discharge and 2) survival with a favorable neurological outcome, adjusting for demographic, prehospital, and resuscitation-related variables.

Results: Among 1,711 EDCA patients, 931 (54.4%) achieved sustained ROSC. The median total CPR duration was 11 minutes (IQR 5 to 27) among patients with sustained ROSC and 33 minutes (IQR 30 to 45) among those without. Survival to hospital discharge occurred in 16.3%, and a favorable neurological outcome in 7.8%. Each 1-minute increase in CPR duration was associated with decreased odds of survival to hospital discharge (adjusted OR 0.93, 95% CI 0.92 to 0.95, p<0.001) and favorable neurological outcome (adjusted OR 0.91, 95% CI 0.88 to 0.95, p<0.001). Compared with CPR of 10 minutes or less, the adjusted ORs for survival to discharge were 0.67, 0.16, 0.08, and 0.06 for durations of 11 to 20, 21 to 30, 31 to 40, and more than 40 minutes, respectively. For a favorable neurological outcome, the corresponding adjusted ORs were 0.32, 0.11, 0.04, and 0.04. The 50th, 75th, 90th, 95th, and 99th percentiles of CPR duration for patients without survival to hospital discharge were 7, 14, 30, 41, and 89 minutes, respectively; and 6, 12, 28, 42, and 61 minutes for patients without a favorable neurological outcome.

Conclusion: The patients requiring prolonged CPR duration in the ED were strongly associated with reduced survival and poorer neurological outcomes. The likelihood of meaningful survival declined after 30 minutes of resuscitation.

Received 10 November 2025 | Revised 18 February 2026 | Accepted 20 February 2026

DOI: 10.35755/jmedassocthai.2026.5.03899