A Standardized Code Blue Team Eliminates Variable Survival from In-hospital Cardiac Arrest

Abstract Background COVID-19 pandemic has resulted in significant strain on healthcare resources and this requires diligent resource re-allocation. We aim to describe the incidence and outcomes of in-hospital cardiac arrest (IHCA) during this period as compared to non-pandemic period. Methods We conducted a retrospective study in a tertiary care hospital in Singapore. The study compared the incidence and outcomes of code blue activations over a 3-month period from March to May 2020 (COVID-19 period) with the same months in 2019 (pre-COVID-19 period). The primary outcome of the study was the rate of survival to hospital discharge for IHCA. The secondary outcomes included incidence of all code blue activation per 1000 hospital admissions, incidence of IHCA per 1000 hospital admissions. Outcomes The rate of survival to hospital discharge for IHCA was 5.88% in the COVID-19 period as compared to 10.0% in the pre-COVID-19 period [odds ratio (OR), 0.72; 95% confidence interval (CI), 0.26-1.95]. Compared to pre-COVID-19 period, there were more IHCA incidences per 1000 hospital admissions in the COVID-19 period (1.86 vs 1.03; OR, 1.81; 95% CI, 0.78-4.41). Conclusions The study observed a trend towards higher incidence of IHCA and lower rate of survival to hospital discharge during COVID-19 pandemic compared to pre-COVID-19 period.

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Code blue pit crew model: A novel approach to in-hospital cardiac arrest resuscitation

Resuscitation ◽

10.1016/j.resuscitation.2019.06.290 ◽

2019 ◽

Vol 143 ◽

pp. 158-164 ◽

Cited By ~ 6

Author(s):

Carleen R. Spitzer ◽

Kimberly Evans ◽

Jeri Buehler ◽

Naeem A. Ali ◽

Beth Y. Besecker

Keyword(s):

Cardiac Arrest ◽

Code Blue ◽

Novel Approach ◽

Hospital Cardiac Arrest

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Predictors of survival and good neurological outcomes after in-hospital cardiac arrest

10.22514/sv.2021.009 ◽

2021 ◽

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Cerebral Performance Category ◽

Tertiary Hospital ◽

Spontaneous Circulation ◽

Activation Time ◽

Factors Affecting ◽

Neurologic Outcomes ◽

Code Blue ◽

Hospital Cardiac Arrest

Objectives: This study aimed to investigate the effect of the code blue activation system and factors affecting patients’ survival to discharge and neurologic outcomes after in-hospital cardiac arrest. Methods: We retrospectively reviewed the data of patients aged ≥ 18 years who experienced in-hospital cardiac arrest between July 2014 and September 2019 at a tertiary hospital. The outcomes included survival to hospital discharge and neurologic outcomes (cerebral performance category score). Results: In total, 605 patients were included. The rate of survival to discharge was 21.8%(n = 132), and the rate of sustained return of spontaneous circulation was 69.7% (n = 422). Predisposing conditions, such as sepsis, cancer, pneumonia, and use of vasopressors, were associated with poor prognosis, and the survival rate was low (P = 0.01). The rate of survival to discharge was higher in patients who underwent defibrillation (odds ratio: 2.48, 95% confidence interval: 1.36-4.53) than in those who did not. The median cardiopulmonary resuscitation (CPR) duration time was 11.0 and 26.5 min in the survival and non-survival groups, respectively (P < 0.01). Code blue activation to CPR team arrival time (advanced cardiovascular life support activation time) was not significantly different within 1 minute in both groups (P = 0.95). Similarly, no differences in basic life support activation time and first time to defibrillation were observed between the survival and non-survival groups. Among survivors, factors affecting favorable neurologic outcomes were young age, cerebral performance before CPR, whether witnessed, admission days, and CPR duration. Conclusions: The compulsory availability of a systematic code blue activation is not sufficient. Further, appropriate monitoring and continuous observation are crucial for improving survival to discharge and neurologic outcomes and preventing cardiac arrest in high-risk patients.

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Attention Code Blue: a comprehension of in-hospital cardiac arrest from a multispeciality hospital in South India

Critical Care ◽

10.1186/cc14492 ◽

2015 ◽

Vol 19 (Suppl 1) ◽

pp. P412

Author(s):

M Hisham ◽

MN Sivakumar ◽

T Sureshkumar ◽

R Kumar ◽

A Satheesh

Keyword(s):

Cardiac Arrest ◽

South India ◽

Code Blue ◽

Hospital Cardiac Arrest

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Implementasi Early Warning Score pada Kejadian Henti Jantung di Ruang Perawatan Rumah Sakit Dr. Hasan Sadikin Bandung yang Ditangani Tim Code Blue Selama Tahun 2017

Jurnal Anestesi Perioperatif ◽

10.15851/jap.v7n1.1583 ◽

2019 ◽

Vol 7 (1) ◽

pp. 33-41

Author(s):

Nurul Subhan ◽

Gezy Weita Giwangkencana ◽

M. Andy Prihartono ◽

Doddy Tavianto

Keyword(s):

Cardiac Arrest ◽

General Hospital ◽

Early Warning ◽

Medical Records ◽

Vital Signs ◽

Early Warning Score ◽

Ward Staff ◽

Cross Sectional ◽

Code Blue ◽

Hospital Cardiac Arrest

Angka kejadian henti jantung di rumah sakit sangat bervariasi. Sebagian besar kasus henti jantung didahului oleh penurunan kondisi pasien yang digambarkan dengan gangguan parameter tanda vital. Keberhasilan Early warning score (EWS) dalam menurunkan angka kejadian henti jantung dipengaruhi oleh implementasi yang baik dari instrumen EWS sesuai dengan pedoman yang ditetapkan. Penelitian ini bertujuan melihat implementasi EWS di RSUP Dr. Hasan Sadikin Bandung. Penelitian bersifat deskriptif dengan desain potong lintang menggunakan data rekam medis pasien henti jantung di ruang perawatan yang ditangani oleh tim Code Blue selama tahun 2017, dan dilakukan pada bulan November 2018. Data EWS 6 jam sebelum dan saat henti jantung, serta tindak lanjut yang dilakukan setelah penilaian EWS dicatat. Didapatkan 87 data rekam medis henti jantung yang memenuhi kriteria inklusi dan tidak termasuk eksklusi. Di antaranya, 72% memiliki catatan EWS lengkap, 9% memiliki catatan EWS tidak lengkap, dan 18% tidak memiliki data EWS. Dari 63 data rekam medis yang memiliki data EWS lengkap hanya 21% yang mendapat tindak lanjut yang sesuai dengan standar prosedur operasional EWS. Simpulan penelitian ini adalah implementasi EWS di ruang rawat inap RSUP Dr. Hasan Sadikin belum cukup memuaskan. Tindak lanjut yang dilakukan setelah penilaian EWS belum sesuai dengan standar prosedur operasional EWS yang berlaku.Implementation of Early Warning Score to Patients with In-Hospital Cardiac Arrest in Dr. Hasan Sadikin General Hospital Managed by Code Blue Team Incidence of in-hospital cardiac arrest varies greatly around the world. Most in-hospital cardiac arrests are preceded with physiological deteriorations that manifest as alterations in vital signs. The success of early warning score (EWS) in reducing the incidence of cardiac arrest is influenced by the good implementation of EWS instruments by ward staff in accordance with the guidelines The aim of this study was to assess to what degree EWS was implemented at Dr. Hasan Sadikin General Hospital Bandung. This was a cross sectional descriptive study on patients with in-hospital cardiac arrest managed by the code blue team during 2017 that was conducted in November 2018. EWS 6 hour prior to cardiac arrest event, EWS at the event, and action taken upon finding an abnormal value were obtained from medical records. Eighty seven medical records were included. Of these, 72% medical records had complete EWS data, 9 medical records had incomplete EWS data, and 18% medical records had no EWS recorded. From those 63 medical records with complete EWS recorded, only 21% had been managed correctly according to the EWS guideline. This study concludes that the implementation of EWS in the wards of Dr. Hasan Sadikin General Hospital Bandung has not been completely satisfactorily. Actions taken after EWS assessment are still not accordance with the EWS guideline.

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