Analysis of 880 Japanese patients undergoing emergency surgery for acute type A aortic dissection revealed a stark mortality gradient based on pre-operative CPR duration. Patients requiring CPR for 15 minutes or longer faced 57.3% 30-day mortality versus 9.7% in those needing no resuscitation, representing a 7.66-fold increased death risk. Even brief CPR under 15 minutes elevated neurological complication rates to 38.5% compared to 18% in non-CPR cases. This preprint study provides crucial data for one of cardiovascular medicine's most challenging scenarios. Acute aortic dissection with cardiac arrest historically carries devastating prognosis, forcing surgeons into difficult triage decisions under extreme time pressure. The clear 15-minute threshold offers a potential clinical decision point, though the retrospective design and institutional variation limit definitive conclusions. The finding aligns with broader resuscitation research showing progressive organ damage with prolonged arrest, but this specific population and timeframe adds valuable precision. As a preprint awaiting peer review, these results require validation before changing practice protocols. However, the large cohort and clear dose-response relationship suggest this could meaningfully inform surgical candidacy discussions and family counseling in these critical situations.