Peer Review History

Original SubmissionApril 22, 2026
Decision Letter - Martin Kieninger, Editor

PONE-D-25-67187Outcomes of In-hospital Cardiac Arrest: Insights from a Medical Intensive Care UnitPLOS One

Dear Dr. Kailasam,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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We look forward to receiving your revised manuscript.

Kind regards,

Martin Kieninger

Academic Editor

PLOS One

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This study assessed prognostic factors associated with mortality in patients with in-hospital cardiac arrest (IHCA) and reported several significant findings. Overall, the study is interesting, and the manuscript is well written. However, I have one minor concern regarding the prevalence of do-not-resuscitate (DNR) orders among patients who achieved return of spontaneous circulation (ROSC) after IHCA, as well as the potential confounding effect of DNR status on the study outcomes.

Reviewer #2: This study evaluated the association between cardiopulmonary resuscitation (CPR) duration and clinical outcomes in patients with in-hospital cardiac arrest (IHCA). The authors found that shorter CPR duration was associated with a higher survival rate.

In addition to CPR duration, it would be helpful if the causes of IHCA could be identified and reported, as the underlying etiology may significantly influence outcomes. Moreover, the use of further advanced interventions, such as extracorporeal membrane oxygenation (ECMO) and percutaneous coronary intervention (PCI), should be included in the analysis if these data are available.

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Reviewer #1: No

Reviewer #2: No

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Revision 1

Response to Reviewer #1

Reviewer #1: This study assessed prognostic factors associated with mortality in patients with in-hospital cardiac arrest (IHCA) and reported several significant findings. Overall, the study is interesting, and the manuscript is well written. However, I have one minor concern regarding the prevalence of do-not-resuscitate (DNR) orders among patients who achieved return of spontaneous circulation (ROSC) after IHCA, as well as the potential confounding effect of DNR status on the study outcomes.

Response:

We completely agree with the reviewer that DNR status is a crucial factor that can influence post-arrest outcomes. Unfortunately, specific data regarding post-ROSC DNR orders were not captured in our record database for this cohort.

Response to Reviewer #2

Reviewer #2: This study evaluated the association between cardiopulmonary resuscitation (CPR) duration and clinical outcomes in patients with in-hospital cardiac arrest (IHCA). The authors found that shorter CPR duration was associated with a higher survival rate.

In addition to CPR duration, it would be helpful if the causes of IHCA could be identified and reported, as the underlying etiology may significantly influence outcomes. Zudem, the use of further advanced interventions, such as extracorporeal membrane oxygenation (ECMO) and percutaneous coronary intervention (PCI), should be included in the analysis if these data are available.

Response:

Regarding advanced interventions like ECMO and PCI, our institution operates under specific protocols where patients with primary cardiac/coronary diseases were admitted to a separate Cardiac ICU and excluded from this specific study population, resulting in lack of that data. We have clarified this structural aspect of our study population in the Methods section and limitations in our study population

Attachments
Attachment
Submitted filename: Response to reviewers.docx
Decision Letter - Martin Kieninger, Editor, Martin Kieninger, Editor

Outcomes of In-hospital Cardiac Arrest: Insights from a Medical Intensive Care Unit

PONE-D-25-67187R1

Dear Dr. Kailasam,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Martin Kieninger

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have satisfactorily addressed the reviewers’ comments and revised the manuscript accordingly. The revisions have significantly strengthened the manuscript, and I have no additional concerns.

Reviewer #2: The authors have responded appropriately to the reviewers’ comments, and the manuscript has been revised accordingly. The quality and clarity of the manuscript have improved substantially after revision. Overall, the authors have adequately addressed the major concerns raised during the review process, and I have no further comments or suggestions.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review?  For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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Formally Accepted
Acceptance Letter - Martin Kieninger, Editor, Martin Kieninger, Editor

PONE-D-25-67187R1

PLOS One

Dear Dr. Kailasam,

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team.

At this stage, our production department will prepare your paper for publication. This includes ensuring the following:

* All references, tables, and figures are properly cited

* All relevant supporting information is included in the manuscript submission,

* There are no issues that prevent the paper from being properly typeset

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Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Prof. Dr. Martin Kieninger

Academic Editor

PLOS One

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