Comparison of code blue application and results in a training and research hospital before and during the COVID-19 pandemic

Background & Objective: Code blue is an emergency management system that allows for a rapid professional response to the patients of cardiopulmonary arrest (CPA) in hospitals. The time to initiate the call and the response of the 'Code Blue Team' may vary in different hospitals, and it me be linked with the survival of the victim. We examined and compared the code blue application utilized in our hospital before and during the COVID-19 pandemic. Methodology: Code Blue Call (CBC) logs from March 01, 2018 to March 31, 2022 were retrospectively analyzed. The study period was divided into two parts: March 01, 2018-February 28, 2020 (Group I, pre-pandemic period) and March 01, 2020-March 31, 2022 (Group II, pandemic period). Result(s): During the study period, a total of 1542 CBC's were received, of which 837 (54.3%) were 'true' CBC's. Of the 837 true CBC's included in the study, 477 (56.7%) were for male patients and 360 (43.3%) were for the females. We evaluated the month-wise distribution of the CBC's;the month with the highest number of calls in Group I was January 2019 (n = 29, 17.3%), while in Group II it was December 2020 (n = 59, 23.1%). The arrival time of the code blue team was significantly different between the groups, e.g., 3.15 +/- 0.52 vs. 3.81 +/- 0.58 min in Group I vs. Group II respectively. Conclusion(s): The intervention times of the code blue team and the success of cardiopulmonary resuscitation were observed to be comparable during the pre-pandemic and pandemic periods. The duration of commencement of intervention is important for the efficacy of cardiopulmonary resuscitation during a pandemic.Copyright © 2023 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.

Association between frailty and clinical outcomes in hospitalised patients requiring Code Blue activation.

BACKGROUND: Code Blues allow a rapid, hospital wide response to acutely deteriorating patients. The concept of frailty is being increasingly recognised as an important element in determining outcomes of critically ill patients. We hypothesised that increasing frailty would be associated with worse outcomes following a Code Blue. AIMS: To investigate the association between increasing frailty and outcomes of Code Blues. METHODS: Single-centre retrospective design of patients admitted to Frankston Hospital in Australia between 1 January 2013 and 31 December 2017 who triggered a Code Blue. Frailty evaluation was made based on electronic medical records as were the details and the outcomes of the Code Blue. The primary outcome measure was a composite of hospital mortality or Cerebral Performance Categories scale ≥3. Secondary outcomes included the immediate outcome of the Code Blue and hospital mortality. RESULTS: One hundred and forty-eight of 911 screened patients were included in the final analysis. Seventy-three were deemed 'frail' and the remainder deemed 'fit'. Seventy-eight percent of frail patients reached the primary outcome, compared with 41% of fit patients (P < 0.001). Multivariable analysis demonstrated frailty to be associated with primary outcome (odds ratio = 2.87; 95% confidence interval (CI) 1.28-6.44; P = 0.01). A cardiac aetiology for the Code Blue was also associated with an increased odds of primary outcome (OR = 3.52; 95% CI 1.51-8.05; P = 0.004). CONCLUSIONS: Frailty is independently associated with the composite outcome of hospital mortality or severe disability following a Code Blue. Frailty is an important tool in prognostication for these patients and might aid in discussions regarding treatment limitations.

Role Delineation of the Code Blue Team: A Quasi-Experimental Study During COVID-19.

INTRODUCTION: The purpose of this study was to assess if implementing a code role delineation intervention in an emergency department would improve the times to defibrillation and medication administration and improve the nurse perception of teamwork. METHODS: A quantitative quasi-experimental study used a retrospective chart review to gather data. A pre- and post-test measured nurse perception of teamwork in a code using the Mayo High Performance Teamwork Scale (MHPTS) after a code role delineation intervention using a paired samples t-test. Pearson r correlations were used to determine relationships between nurse participant (N = 30) demographics and results of the MHPTS scores. RESULTS: A significant increase in teamwork was noted in 5 of the 16 items on the MHPTS regarding improved communication and identified roles in a code: the team leader assures maintenance of an appropriate balance between command authority and team member participation (t = -5.607, P < .001), team members demonstrated a clear understanding of roles (t = -5.415, P < .001), team members repeat back instructions and clarifications to indicate that they heard them correctly (t = -2.400, P = .029), all members of the team are appropriately involved and participate in the activity (t = -2.236, P = .041), and conflicts among team members are addressed without a loss of situation awareness (t = -2.704, P = .016). There was significance between total pre- and post-test scores (t = -3.938, P = .001). DISCUSSION: Implementation of code role delineation identifiers is an effective method of improving teamwork in a code in an emergency department setting.

Comparison of Code Blue Practices Between the First Year of COVID-19 and the Previous Year

Aim: After the coronavirus disease-2019 (COVID-19) infection was declared a pandemic, there were some changes made to the code blue and resuscitation practices. We compared code blue practices between the first year of COVID-19 and the previous year. Methods: We accepted the pre-pandemic (group 1) period from March 11(th), 2019 to March 11(th), 2020, and the post-pandemic (group 2) period from March 11(th), 2020 to March 11(th), 2021. The study was designed as a cross-sectional study. We investigated the incidence of code blue, the unit where the call was made, the team's time of arrival, the return of spontaneous circulation (ROSC), the duration of cardiopulmonary resuscitation, and the general outcomes. We analyzed the 6 month follow-ups of the patients. Results: There was an increase in the incidence of code blue in group 2 (0.4-0.9%). The two groups showed a significant difference in the time of arrival, ROSC, and 1 month and 6 month survival. The ROSC rate and 1 month survival were lower in COVID-19 patients (p < 0.001). Six month survival was lower in COVID-19 patients (p=0.031). We identified 63 faulty calls, and 38 of these patients died within 6 months. Conclusion: The faulty code blue calls may be a predictor of poor prognosis, and early warning systems should be developed for patients with poor conditions.

Just the Facts: Protected code blue - Cardiopulmonary resuscitation in the emergency department during the coronavirus disease 2019 pandemic.

Emergency medical services (EMS) is called for a 65-year-old man with a 1-week history of cough, fever, and mild shortness of breath now reporting chest pain. Vitals on scene were HR 110, BP 135/90, SpO2 88% on room air. EMS arrives at the emergency department (ED). As the patient is moved to a negative pressure room, he becomes unresponsive with no palpable pulse. What next steps should be discussed in order to protect the team and achieve the best possible patient outcome?