Introduction: High quality cardiopulmonary resuscitation (CPR) performed according to the international guidelines has a vital impact on survival of cardiac arrest (CA). The Utstein template (UT) has been used internationally to objectively evaluate different variables of CPR quality and outcome. Objective: To evaluate adherence to CPR guidelines and investigate different variables affecting return of spontaneous circulation (ROSC), degree of neurological deficit and survival to hospital discharge after in-hospital cardiac arrest (IHCA). Methods: A prospective observational study of 126 IHCA from March and through November 2012 out of 5479 patients admitted in cardiology department, Kasralaini University hospital, using a modified UT. Results: CPR was not attempted in 7 cases because of death in 2 and futility in other 5. CA was witnessed in 120 cases (95.2%) and monitored in 110 (87.3%) cases.The initial rhythm was shockable in 19 cases( 15.1%) and non shockable in 107 cases ( 84.9%). ROSC ≥ 20 mins was achieved in 60 cases (50.4%). A CPR duration of 22.5 mins had a sensitivity of 86.7% and a specificity of 81.4%in predicting ROSC ≥ 20 mins. Survival to hospital discharge (STHD) was achieved in 9 cases (75.6%); none of them had neurologic deficit. Witnessed CA and first responder CPR were significant predictors of ROSC (p< 0.004 and 0.02 respectively).Multiple regression analysis idendified first responder CPR as the only independent predictor of ROSC. Initiable shockable rhythm was idendified by univariate and multivariate regression analysis as the only predictor of STHD (both p:0.001). Conclusion: ROSC ≥ 20 mins was achieved in almost half the cases, which is equivalent to other reported series, however STHR was very low (7.1%). There is a gap between Guidelines and its implementation. First responder CPR was an independent predictor of ROSC ≥ 20 mins. Initial shockable rhythm was an independent predictor of STHD. The optimum cut off value for the duration of CPR in predicting ROSC ≥ 20 mins was 22.5 mins with a sensitivity of 86.7% and a specificity of 81.4%.