The Effects of the Establishment of Code-Blue Team on In-Hospital Care of Patients with Cardiac Arrest

Introduction: Debriefing sessions after in-hospital cardiac arrest have been demonstrated to improve teamwork and survival outcomes. Though recommended in 2020 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, implementation remains low. Hypothesis: We postulated that a didactic training session provided to code leaders would increase rates of participation of AHA-recommended post-arrest debriefing sessions. Methods: Surveys were distributed to hospital personnel who participate in code blue/ERTs at an academic, tertiary-care medical center. Questions were graded on Likert scale to assess provider-reported perceptions of teamwork, communication, and confidence in conducting and participating in Code Blues. Participants were stratified in groups depending on whether they had previously participated in debriefing sessions. Primary outcomes were quantified using a Likert-type scale ranging from 1 to 5. Surveys were compared to surveys from prior years to assess if the intervention of a code blue didactics lecture delivered to code leaders resulted in any change in overall participation rate in the debriefing protocol. Results: Among 181 participants (61% female), 32% were residents, 54% nurses, 1.7% respiratory therapists. Self-evaluated current knowledge of ACLS protocols was significantly higher in the debriefing group (p = 0.0098), while there were no differences in perceived communication (p=0.76), and confidence in leading (p = 0.2) and participating (p = 0.2). We did not find a statistically significant difference in debriefing participation rate after our intervention (57% pre vs 58% post intervention, p=0.8), even when stratified by hospital role: critical care nurses (50% vs 71%, p=0.3), non-ICU nurses (68% vs 57%, p=0.3) and residents (67% vs 50%, p=0.2). Conclusions: Our study demonstrated that participation in post-code debriefing sessions was associated with a statistically significant increase in knowledge of cardiac arrest protocols. A code blue didactics lecture did not result in a statistically significant increase in post-arrest debriefing participation. Further study to elucidate methods to enhance adoption of this crucial, guideline recommended practice is warranted.

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Abstract 343: Association Between Hospital Arrival Time and Outcomes in Patients With Out-of-Hospital Cardiac Arrest Due to Acute Myocardial Infarction: JAAM-OHCA Study Group

Circulation ◽

10.1161/circ.138.suppl_2.343 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Hayato Hosoda ◽

Atsushi Hirayama ◽

Yoshio Tahara ◽

Takahiro Nakashima ◽

Yu Kataoka ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Arrest ◽

Observational Study ◽

Hospital Care ◽

Arrival Time ◽

Night Time ◽

Hospital Arrival ◽

Regular Time ◽

Neurologically Intact

Background: Whether arrival time is associated with in-hospital managements and outcomes in patients out-of-cardiac arrest (OHCA) due to acute myocardial infarction (AMI) is still unclear. Methods: We conducted a multi-institutional, observational study (JAAM-OHCA study) of OHCA from June 2014 through December 2015 in Japan. The primary exposure was hospital arrival time divided into three groups, defining weekday regular time as 8:00 AM to 4:59 PM, weekday night time as 5:00PM to 7:59AM, and weekends/holidays as Saturday, Sunday and holidays. The outcome measures were in-hospital managements (i.e., percutaneous coronary intervention [PCI], intra-aortic balloon pump [IABP], extracorporeal cardiopulmonary resuscitation [ECPR], and target temperature management [TTM]), and neurologically intact survival at 30-day. To determine the associations of hospital arrival time with these outcomes, we constructed logistic regression models adjusting for patient characteristics, out-of-hospital care and in-hospital care, with generalized estimating equations accounting for patient clustering within hospitals. Results: We recruited 13,491 patients with OHCA. Of these, 852 had return of spontaneous circulation and was diagnosed as AMI; n=299 arrived during weekday regular time; n=265 arrived during weekday night time; n=288 arrived during weekends or holidays. Finally, a total of 219 (25.7%) OHCA patients had neurologically intact survival at 30-day. The rates of in-hospital management were not different among the three groups except IABP use (P<0.01). Compared to patients arrived during weekday regular time, neurologically intact survival rate at 30-day was not significantly different in patients arrived during weekday night time and weekends/holiday (26.1% [78 of 299] in weekday regular time group, 22.6% [60 of 265] in weekday night time group, and 28.1% [81 of 288] in weekends/holidays group) with corresponding adjusted odds ratios of 0.80 (95% confidence interval [CI] 0.45-1.40; P=0.43) and 0.96 (95% CI 0.57-1.63; P=0.89). Conclusion: In this observational study of adult patients with OHCA due to AMI, in-hospital managements and outcomes were not differed across hospital arrival time groups.

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Impact of implementing novel automated code blue activation system on in-hospital cardiac arrest: A single center study

Resuscitation ◽

10.1016/j.resuscitation.2020.10.023 ◽

2020 ◽

Vol 157 ◽

pp. 149-155

Author(s):

Faheem Ahmed Khan ◽

Ting Lyu ◽

Eng Kiang Lee ◽

Shekhar Dhanvijay ◽

Amit Kansal ◽

...

Keyword(s):

Cardiac Arrest ◽

Single Center ◽

Code Blue ◽

Single Center Study ◽

Activation System ◽

Hospital Cardiac Arrest ◽

Center Study

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Out-of-hospital Care of Critical Drug Overdoses Involving Cardiac Arrest

Academic Emergency Medicine ◽

10.1111/j.1553-2712.2004.tb01373.x ◽

2004 ◽

Vol 11 (1) ◽

pp. 71-74 ◽

Cited By ~ 11

Author(s):

Valentine L. Paredes ◽

Thomas D. Rea ◽

Mickey S. Eisenberg ◽

Leonard A. Cobb ◽

Michael K. Copass ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Care ◽

Drug Overdoses

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Out-of-hospital care of critical drug overdoses involving cardiac arrest

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2004.06.015 ◽

2004 ◽

Vol 44 (3) ◽

pp. 288

Author(s):

R.J. Hamilton

Keyword(s):

Cardiac Arrest ◽

Hospital Care ◽

Drug Overdoses

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The Postcardiac Arrest Consult Team: Impact on Hospital Care Processes for Out-of-Hospital Cardiac Arrest Patients

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2016.12.033 ◽

2017 ◽

Vol 52 (2) ◽

pp. 268-269

Author(s):

Kimberly Hill

Keyword(s):

Cardiac Arrest ◽

Hospital Care ◽

Care Processes ◽

Hospital Cardiac Arrest

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In-Hospital Cardiac Arrest in the Cardiac Catheterization Laboratory: Effective Transition from an ICU- to CCU-Led Resuscitation Team

Journal of Interventional Cardiology ◽

10.1155/2019/1686350 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Rajat Sharma ◽

Hilary Bews ◽

Hardeep Mahal ◽

Chantal Y. Asselin ◽

Megan O’Brien ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiac Catheterization ◽

Tertiary Care ◽

Pulseless Electrical Activity ◽

Hospital Length Of Stay ◽

Health Concern ◽

Catheterization Laboratory ◽

Cardiac Catheterization Laboratory ◽

Coronary Syndrome ◽

Code Blue

Objectives. (1) To examine the incidence and outcomes of in-hospital cardiac arrests (IHCAs) in a large unselected patient population who underwent coronary angiography at a single tertiary academic center and (2) to evaluate a transitional change in which the cardiologist is positioned as the cardiopulmonary resuscitation (CPR) leader in the cardiac catheterization laboratory (CCL) at our local tertiary care institution. Background. IHCA is a major public health concern with increased patient morbidity and mortality. A proportion of all IHCAs occurs in the CCL. Although in-hospital resuscitation teams are often led by an Intensive Care Unit- (ICU-) trained physician and house staff, little is known on the role of a cardiologist in this setting. Methods. Between 2012 and 2016, a single-center retrospective cohort study was performed examining 63 adult patients (70 ± 10 years, 60% males) who suffered from a cardiac arrest in the CCL. The ICU-led IHCAs included 19 patients, and the Coronary Care Unit- (CCU-) led IHCAs included 44 patients. Results. Acute coronary syndrome accounted for more than 50% of cardiac arrests in the CCL. Pulseless electrical activity was the most common rhythm requiring chest compression, and cardiogenic shock most frequently initiated a code blue response. No significant differences were observed between the ICU-led and CCU-led cardiac arrests in terms of hospital length of stay and 1-year survival rate. Conclusion. In the evolving field of Critical Care Cardiology, the transition from an ICU-led to a CCU-lead code blue team in the CCL setting may lead to similar short-term and long-term outcomes.

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