Longitudinal exploration of in situ mock code events and the performance of cardiac arrest skills

IntroductionIn-hospital cardiac arrest (IHCA) affects 200 000 adults in the USA each year, and resuscitative efforts are often suboptimal. The objective of this study was to determine whether a programme of ‘mock codes’ improves group-level performance of IHCA skills. Our primary outcome of interest was change in cardiopulmonary resuscitation (CPR) fraction, and the secondary outcomes of interest were time to first dose of epinephrine and time to first defibrillation. We hypothesised that a sustained programme of mock codes would translate to greater than 10% improvement in each of these core metrics over the first 3 years of the programme.MethodsWe conducted mock codes in an urban teaching hospital between August 2012 and October 2015. Mock codes occurred on Telemetry and Medical/Surgical units on day and night shifts. Codes were managed by unit staff and members of the hospital’s ‘Code Blue’ team, and data were recorded by trained observers. Data were summarised using descriptive statistics, and repeated measures outcomes were calculated using a mixed effects model.ResultsFifty-seven mock codes were included in the analysis: 42 on Medical/Surgical units and 15 on Telemetry units. CPR fraction increased by 2.9% per 6-month time interval on Telemetry units, and 1.3% per time interval on Medical/Surgical units. Neither time to first epinephrine dosing nor time to defibrillation changed significantly.ConclusionsWhile we observed a significant improvement in CPR fraction over the course of this programme of mock codes, similar improvements were not observed for other key measures of cardiac arrest performance.

Download Full-text

Abstract 10327: Protected Mock Codes Using In-situ Simulation in Times of the COVID-19 Pandemic

Circulation ◽

10.1161/circ.144.suppl_2.10327 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Lai Ping Atalanta Wan

Keyword(s):

Communication Skills ◽

Pearson Correlation ◽

The Self ◽

In Situ Simulation ◽

Team Members ◽

Self Confidence ◽

Code Blue ◽

Clear Identification ◽

Mock Codes

Introduction: Our hospital faced an uphill battle with increasing clinical emergencies, a surge of patients, and compliance with the new regulations during the COVID-19 pandemic. Thereby, the code blue team developed a protected code blue protocol to minimize the infectious risk of the code team members and provide efficient management of emergencies during a lifesaving situation. Objectives: This project aimed to help the core team members to practice the new protected code blue protocol using in-situ simulation. The drills might improve the self-confidence of the code team members in performing their role, clear identification of themselves, effective communication skills, and teamwork. Methods: The mock code team developed different scenarios and ran the drills in 17 departments in different shifts within 8 weeks. A convenience sample of 269 staff participated in the drills. Participants included physicians, respiratory therapists, nurses, and other disciplinary staff. A debriefing was conducted to identify areas of improvement. Participants completed an evaluation form during the debriefing. The form included questions using a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) to rate the variables. Descriptive statistics and the Pearson correlation coefficient were used to test the hypotheses. Results: Out of the 269 participants, 125 staff completed and returned the evaluation form. The mean overall rating of the protected mock codes was 4.184 at a scale from 1 (very poor) to 5 (excellent) with a standard deviation of .827. The Pearson correlation coefficient ( r ) between the overall rating of the training and the amount of self-confidence in performing their role was .697 ( p =.000); clear identification of themselves was .329 ( p = .000); effective communication skills was .500 ( p = .000); and teamwork was .526 ( p = .000). Limitations: The project was conducted in a teaching hospital. The results might not apply to different care delivery settings. Conclusions: The findings of this project demonstrated that in-situ simulation improved the self-confidence of the code team members, communication skills, and teamwork in performing the protected code blue protocol for a COVID-19 suspected or confirmed patient with cardiac arrest.

Download Full-text

IMPROVING SYSTEM READINESS, STAFF PREPAREDNESS AND PATIENT SAFETY IN A NEW SINGLE FAMILY ROOM NICU THROUGH IN SITU SIMULATION

Paediatrics & Child Health ◽

10.1093/pch/pxy054.042 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e16-e16

Author(s):

Ahmed Moussa ◽

Audrey Larone-Juneau ◽

Laura Fazilleau ◽

Marie-Eve Rochon ◽

Justine Giroux ◽

...

Keyword(s):

Patient Safety ◽

Repeated Measures ◽

Large Scale ◽

Multidisciplinary Teams ◽

Single Family ◽

In Situ Simulation ◽

Ensure Patient Safety ◽

System Readiness ◽

Dependent Samples

Abstract BACKGROUND Transitions to new healthcare environments can negatively impact patient care and threaten patient safety. Immersive in situ simulation conducted in newly constructed single family room (SFR) Neonatal Intensive Care Units (NICUs) prior to occupancy, has been shown to be effective in testing new environments and identifying latent safety threats (LSTs). These simulations overlay human factors to identify LSTs as new and existing process and systems are implemented in the new environment OBJECTIVES We aimed to demonstrate that large-scale, immersive, in situ simulation prior to the transition to a new SFR NICU improves: 1) systems readiness, 2) staff preparedness, 3) patient safety, 4) staff comfort with simulation, and 5) staff attitude towards culture change. DESIGN/METHODS Multidisciplinary teams of neonatal healthcare providers (HCP) and parents of former NICU patients participated in large-scale, immersive in-situ simulations conducted in the new NICU prior to occupancy. One eighth of the NICU was outfitted with equipment and mannequins and staff performed in their native roles. Multidisciplinary debriefings, which included parents, were conducted immediately after simulations to identify LSTs. Through an iterative process issues were resolved and additional simulations conducted. Debriefings were documented and debriefing transcripts transcribed and LSTs classified using qualitative methods. To assess systems readiness and staff preparedness for transition into the new NICU, HCPs completed surveys prior to transition, post-simulation and post-transition. Systems readiness and staff preparedness were rated on a 5-point Likert scale. Average survey responses were analyzed using dependent samples t-tests and repeated measures ANOVAs. RESULTS One hundred eight HCPs and 24 parents participated in six half-day simulation sessions. A total of 75 LSTs were identified and were categorized into eight themes: 1) work organization, 2) orientation and parent wayfinding, 3) communication devices/systems, 4) nursing and resuscitation equipment, 5) ergonomics, 6) parent comfort; 7) work processes, and 8) interdepartmental interactions. Prior to the transition to the new NICU, 76% of the LSTs were resolved. Survey response rate was 31%, 16%, 7% for baseline, post-simulation and post-move surveys, respectively. System readiness at baseline was 1.3/5,. Post-simulation systems readiness was 3.5/5 (p = 0.0001) and post-transition was 3.9/5 (p = 0.02). Staff preparedness at baseline was 1.4/5. Staff preparedness post-simulation was 3.3/5 (p = 0.006) and post-transition was 3.9/5 (p = 0.03). CONCLUSION Large-scale, immersive in situ simulation is a feasible and effective methodology for identifying LSTs, improving systems readiness and staff preparedness in a new SFR NICU prior to occupancy. However, to optimize patient safety, identified LSTs must be mitigated prior to occupancy. Coordinating large-scale simulations is worth the time and cost investment necessary to optimize systems and ensure patient safety prior to transition to a new SFR NICU.

Download Full-text

Time-Response-Histogram-Based Feature of Magnetic Barkhausen Noise for Material Characterization Considering Influences of Grain and Grain Boundary under In Situ Tensile Test

Sensors ◽

10.3390/s21072350 ◽

2021 ◽

Vol 21 (7) ◽

pp. 2350

Author(s):

Jia Liu ◽

Guiyun Tian ◽

Bin Gao ◽

Kun Zeng ◽

Yongbing Xu ◽

...

Keyword(s):

Grain Boundary ◽

Tensile Stress ◽

Material Properties ◽

Ferromagnetic Material ◽

Silicon Steel ◽

Time Response ◽

Barkhausen Noise ◽

Time Interval ◽

Magnetic Barkhausen Noise

Stress is the crucial factor of ferromagnetic material failure origin. However, the nondestructive test methods to analyze the ferromagnetic material properties’ inhomogeneity on the microscopic scale with stress have not been obtained so far. In this study, magnetic Barkhausen noise (MBN) signals on different silicon steel sheet locations under in situ tensile tests were detected by a high-spatial-resolution magnetic probe. The domain-wall (DW) motion, grain, and grain boundary were detected using a magneto-optical Kerr (MOKE) image. The time characteristic of DW motion and MBN signals on different locations was varied during elastic deformation. Therefore, a time-response histogram is proposed in this work to show different DW motions inside the grain and around the grain boundary under low tensile stress. In order to separate the variation of magnetic properties affected by the grain and grain boundary under low tensile stress corresponding to MBN excitation, time-division was carried out to extract the root-mean-square (RMS), mean, and peak in the optimized time interval. The time-response histogram of MBN evaluated the silicon steel sheet’s inhomogeneous material properties, and provided a theoretical and experimental reference for ferromagnetic material properties under stress.

Download Full-text

Forage yield and nutritive value of Elephant grass, Italian ryegrass and spontaneous growing species mixed with forage peanut or red clover

Ciência Rural ◽

10.1590/0103-8478cr20131347 ◽

2014 ◽

Vol 44 (10) ◽

pp. 1845-1852 ◽

Cited By ~ 1

Author(s):

Michelle Schalemberg Diehl ◽

Clair Jorge Olivo ◽

Carlos Alberto Agnolin ◽

Ricardo Lima de Azevedo Junior ◽

Vinícius Felipe Bratz ◽

...

Keyword(s):

Repeated Measures ◽

Nutritive Value ◽

Red Clover ◽

Experimental Period ◽

Italian Ryegrass ◽

Forage Yield ◽

Neutral Detergent Fiber ◽

Elephant Grass ◽

Grazing Systems

The objective of this research was to evaluate of three grazing systems (GS) with elephant grass (EG), Italian ryegrass (IR) + spontaneous growing species (SGS); EG + IR + SGS + forage peanut (FP); and EG + IR + SGS + red clover (RC), during the winter and summer periods in rotational grazing with dairy cattle. Experimental design was completely randomized with three treatments, two replicates with repeated measures. Lactating Holstein cows receiving 1% BW-daily feed supplement with concentrate were used in the evaluation. Eight grazing cycles were performed during the experimental period. The values of pre forage mass and stocking rate were 2.52, 2.60 and 2.99 t ha-1 and 2.64, 2.77 and 3.14 animal unit ha-1, respectively for GS. Samples of forage were collected by hand-plucking technique to analyze the crude protein (CP), neutral detergent fiber (NDF), in situ dry matter digestibility (ISDMD), in situ organic matter digestibility (ISOMD) of forage present between rows of elephant grass, in the rows of elephant grass and the legumes. Higher value of CP, ISOMD and lower of NDF were observed for the grazing systems mixed with legumes forage.

Download Full-text

Radiomorphology of the Habib Sealer-Induced Resection Plane during Long-Time Followup:A Longitudinal Single Center Experience after 64 Radiofrequency-AssistedLiver Resections

HPB Surgery ◽

10.1155/2010/403097 ◽

2010 ◽

Vol 2010 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Robert Kleinert ◽

Roger Wahba ◽

Christoph Bangard ◽

Klaus Prenzel ◽

Arnulf H. Hölscher ◽

...

Keyword(s):

Liver Resection ◽

Morphological Characteristics ◽

Postoperative Mortality ◽

Coagulation Necrosis ◽

Time Interval ◽

Safe Alternative ◽

Time Points ◽

Single Center Experience ◽

Long Time

Background. Radiofrequency (RF-) assisted liver resection devices like the Habib sealer induce a necrotic resection plane from which a small margin of necrotic liver tissue remains in situ. The aim of the present paper was to report our long-time experience with the new resection method and the morphological characteristics of the remaining necrotic resection plane. Methods. 64 RF-assisted liver resections were performed using the Habib sealer. Followup was assessed at defined time points. Results. The postoperative mortality was 3,6% and morbidity was 18%. The followup revealed that the necrotic zone was detectable in all analyzed CT and MRI images as a hypodense structure without any contrast enhancement at all time points, irrespectively of the time interval between resection and examination. Conclusion. Liver resection utilizing radiofrequency-induced resection plane coagulation is a safe alternative to the established resection techniques. The residual zone of coagulation necrosis remains basically unchanged during a followup of three years. This has to be kept in mind when evaluating the follow up imaging of these patients.

Download Full-text

Code blue in the MR suite – a drill to rescue a patients with cardiac arrest from the MR scanner

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-005-9028-9 ◽

2005 ◽

Vol 22 (2) ◽

pp. 257-261 ◽

Cited By ~ 2

Author(s):

Olaf M. Muehling ◽

Armin Huber ◽

Denise Friedrich ◽

Michael Nabauer ◽

Maximilian Reiser ◽

...

Keyword(s):

Cardiac Arrest ◽

Code Blue

Download Full-text

Abstract P14: Estradiol Does Not Improve Survival and Hemodynamic Parameters in Male Piglets after Hemorrhage and Ventricular Fibrillation

Circulation ◽

10.1161/circ.118.suppl_18.s_1448 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Egidijus Semenas ◽

Lars Wiklund

Keyword(s):

Gender Differences ◽

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Hemorrhagic Shock ◽

Repeated Measures ◽

Troponin I ◽

Control Group ◽

Hemodynamic Parameters ◽

Start Time ◽

Arterial Blood

Introduction: Gender differences in organ functions and survival have been described in animal models of trauma and hemorrhagic shock. The female gender is associated with better cardiac, hepatic and immune functions compared to males after hemorrhagic shock. However, data about gender differences in hypovolemic normothermic cardiac arrest is lacking. Hypothesis: We hypothesized that the estradiol given during cardiopulmonary resuscitation (CPR) will improve survival and hemodynamic response in hypovolemic cardiac arrest and subsequent CPR. Methods: Twenty anesthetized male piglets (with a weight of 25.7 ± 1.7 kg [mean ± SD]) were bled 30% via the right femoral artery to a mean arterial blood pressure of 35 mm during 15 minutes. In the end of bleeding period estradiol group (n=10) received 17â-estradiol 50 ìg/kg intravenously, while the control group received no estradiol (n=10). Later all piglets were subjected to 4 min of untreated ventricular fibrillation followed by up to 15 min of open chest CPR. At 5 min of cardiac arrest piglets received vasopressin 0.4 U/kg, amiodarone 0.5 mg/kg, and hypertonic-hyperoncotic solution 3 ml/kg infusion for 20 minutes. Internal defibrillation was attempted from 8 min of cardiac arrest to achieve restoration of spontaneous circulation (ROSC). The experiment was terminated at 3 hours after initial resuscitation. Data were analyzed using Fisher’s exact test, Kaplan-Meier and repeated measures ANOVA methods. Results: All piglets were successfully resuscitated. No significant differences were observed in survival between the groups (p=0.24). All piglets needed dobutamine infusion and no differences were observed in either total dobutamin dose, or infusion start time (p=0.05). No significant changes were observed in any hemodynamic parameters (p>0.05). Troponin I levels did not differ between groups (p>0.75). Conclusions: Intravenous 17â-estradiol does not improve survival and hemodynamic parameters in male piglets after experimental hypovolemic cardiac arrest.

Download Full-text

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

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2010.10.023 ◽

2012 ◽

Vol 42 (1) ◽

pp. 74-78 ◽

Cited By ~ 6

Author(s):

Sultana A. Qureshi ◽

Terence Ahern ◽

Ryan O’Shea ◽

Lorien Hatch ◽

Sean O. Henderson

Keyword(s):

Cardiac Arrest ◽

Code Blue ◽

Hospital Cardiac Arrest

Download Full-text

Successful resuscitation of the patient on extended tocolytic therapy subjected to an urgent cesarean section

Vojnosanitetski pregled ◽

10.2298/vsp0203325d ◽

2002 ◽

Vol 59 (3) ◽

pp. 325-328 ◽

Cited By ~ 3

Author(s):

Biljana Djordjevic ◽

Milos Stojiljkovic ◽

Tatjana Potpara ◽

Dragana Loncar-Stojiljkovic ◽

Ljiljana Vojvodic

Keyword(s):

Cardiac Arrest ◽

Myocardial Ischemia ◽

Adverse Effects ◽

Cesarean Section ◽

Maintenance Therapy ◽

General Anesthesia ◽

Preterm Labor ◽

Intravenous Therapy ◽

Successful Resuscitation ◽

The Usa

Ritodrine is the only medicament approved by FDA in the USA as well as in our country for prevention of the threatening preterm labor. Its adverse effects upon the respiratory and cardiovascular systems, including pulmonary edema and myocardial ischemia, occur more frequently during the intravenous therapy than during the oral maintenance therapy. The aim of this report was to present a patient with cardiovascular adverse effects of ritodrine, who had her pregnancy terminated by an urgent cesarean section under general anesthesia. In the course of operation, the patient had two cardiac arrest (total of 70 min). Resuscitation was performed by direct and indirect heart massage. The patient's condition was stabilized during the next six hours. The patient was transferred to the coronary unit, where the treatment was continued for 30-days period, after which the patient was released home as completely recovered.

Download Full-text