Background: In-hospital cardiac arrest (IHCA) is often the end result of a progressive deterioration in respiratory and circulatory functions in critically ill patients. Cardiopulmonary resuscitation (CPR) is a lifesaving procedure required to bring back the heart function at the time of cardiac arrest. The outcomes of IHCA at Muhimbili National Hospital (MNH) has not been studied despite of Paediatric Advanced Life Support (PALS) training. Objectives: This study sought to determine the outcomes and factors associated with survival at 24 hours after in-hospital paediatric CA in the Emergency Medicine Department of Muhimbili National Hospital (EMD-MNH) in Tanzania. Methodology: A retrospective cohort study was conducted at the EMD-MNH. Patients ages 1 month to 18 years who underwent cardiopulmonary resuscitation between January 2016 to December 2019 were enrolled. Data was retrieved retrospectively from Emergency Medicine Department Electronic Medical Records System (EMD-EMR) and reported using the Utstein-style guidelines, entered into Epidata V.3.1 and analyzed in Stata version 14.1. Bivariate and Multivariate logistic regression analyses were performed to assess factors that are associated with survival at 24 hours among patients who had IHCA. Results: A total 136 patients with IHCA were evaluated, majority 108 (79.4%) of whom were children aged ≤ 5 years. After initial CPR, the sustained return of spontaneous circulation was achieved in 70 (51.5%) patients, survival at 24 hours was attained in 43 (31.3%) of patients, and only 7 patients (5.2%) survived to hospital discharge. In the multivariate analysis, the factors associated with survival at 24 hours were; CPR event during the day/evening (AOR = 5.02, 95% CI: 1.12-22.4, p=0.035), duration of CPR ≤ 20 minutes (AOR = 9.09, 95% CI: 1.49-55.3, p=0.017), epinephrine ≤2 doses (AOR = 4.8, 95% CI: 1.01-22.93, p=0.049), reversible causes of cardiac arrest identified (AOR = 12.38, 95% CI: 3.26-58.5, p=0.001), being monitored (AOR = 45.63, 95% CI: 1.08-193.15, p=0.046), and having assisted/mechanical ventilation after CPR (AOR = 15.95, 95% CI: 3.26-78.05, p=0.001). Conclusions and Recommendations: One in every three paediatric patients who had IHCA survived at 24 hours. Although half of the paediatric patients with IHCA had sustained ROSC, only one in ten of those who had initial survival, survived to hospital discharge. The overall survival to hospital discharge after in-hospital paediatric CA at the EMD is unacceptably poor.

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