This retrospective study included 9,386 adults with non-traumatic out-of-hospital cardiac arrest treated through Tianjin Emergency Medical Center during 2023–2024. Sustained return of spontaneous circulation through emergency department arrival and handover occurred in 678 patients (7.2%). An initially shockable rhythm was associated with higher odds of ROSC (adjusted OR 2.850, 95% CI 2.390–3.397). A prediction nomogram developed using a random 7:3 training–test split achieved a test-set AUC of 0.775 (95% CI 0.745–0.805), with an optimism-corrected C-index of 0.7679 after bootstrap internal validation.
The model showed internal discrimination for sustained ROSC, not survival or neurological recovery. Its predictive associations do not establish treatment effects or justify care-limitation decisions.
Study limitation: Retrospective data from one emergency medical centre and internal validation alone limit confidence in transportability to other resuscitation systems.
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