Aim <p>To assess the impact of time to return of spontaneous circulation (ROSC) on early in-hospital neurological function and long-term survival in survivors after out-of-hospital cardiac arrest (OHCA).</p> Methods <p>This retrospective cohort study included survivors of OHCA admitted to the cardiology ward at Aarhus University Hospital. Patients were included from June 2020 to February 2024 and data were collected through review of medical records. Primary outcome was neurological function, and patients were stratified by modified Rankin Scale (mRS) at hospital discharge: good neurological outcome (mRS 0–2) and poor neurological outcome (mRS 3–6). Secondary outcomes were cognitive function assessed with Montreal Cognitive Assessment (MoCA) at hospital discharge and 180-day survival.</p> Results <p>In total, 321 patients were included, of which 232 (72%) had good neurological outcome and 89 (28%) had poor neurological outcome. Every 5-min increase in time to ROSC was associated with decreased odds of good neurological outcome (OR 0.88, 95% CI 0.81–0.95, <i>p</i> &lt; 0.0001). This association remained significant after adjusting for age and primary rhythm (OR_adjusted 0.86, 95% CI 0.78–0.95, <i>p</i> = 0.004). Patients with good neurological outcome had significantly higher MoCA scores (median 23 vs. 18, <i>p</i> &lt; 0.001). In-hospital mortality was 6% and time to ROSC was not significantly associated with 180-day mortality.</p> Conclusion <p>In initial OHCA survivors transferred to the cardiology ward, increased time to ROSC was independently associated with decreased odds of good neurological function at hospital discharge, even after adjusting for age and primary rhythm. The majority of patients had good neurological function at hospital discharge. In this population time to ROSC was not associated with mortality.</p> Graphical Abstract <p>Figure created by the authors using Microsoft PowerPoint.</p> <p></p>