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EVALUATION OF CODE BLUE

Year 2023, Volume: 2 Issue: 3, 94 - 109, 26.12.2023

Abstract

Objectives
Code Blue is a worldwide code system that aims to increase the success of cardiopulmonary resuscitation (CPR) through rapid, effective intervention in in-hospital cardiac arrests (IHCA).

This study aimed to investigate the code blue practices, reasons for calls, the quality of intervention, and mortality rates in Dokuz Eylul University Hospital.

Methods
Code blue calls between 2015 and 2019 were retrospectively analyzed. Demographic data, diagnosis, comorbidities, length of hospitalization, and resuscitation management were examined. (Ethics Committee Decision No: 2015/24-04).

Results
The study was analyzed by including the data of 337 cases after excluding 35 incorrect calls. Of the calls, 57 (16.9%) were for outpatients and 280 (83.1%) were for inpatients. The mean age of the patients was 63.76±19.77 years; 158 were female (46.9%), and 179 were male (53.1%). The mean time the code blue team took to reach the scene was 3.02±0.85 minutes for outpatients and 3.28±1.70 minutes for inpatients. No significant difference was found in the time distribution of code blue calls, such as day/night and weekdays/weekends. Resuscitation management of 240 (71.2%) patients who underwent CPR among a total of 337 code blue calls; the number of 211 (87.9%) patients whose first cardiac arrest rhythm was non-shock rhythm was significantly higher than the number of 29 (12.1%) patients whose first cardiac arrest rhythm was shock rhythm (p=0.009). The ROSC rate was 17.6% in rhythms with shock and 82.4% without shock. This difference was statistically significant (p=0.009). CPR duration was significantly shorter in rhythms with shock compared to rhythms without shock (29.75±38.52 vs. 32.66±18.95 min). There was no significant correlation between the first rhythm and gender, age, comorbidities, or length of hospitalization. 14.2% of patients who underwent CPR were discharged. Of those intubated for respiratory arrest, 27.3% were discharged.

Conclusion:
The key to an effective code blue implementation is the quality and timeliness of interventions. Knowing the expected roles and responsibilities during code blue is essential for patients undergoing CPR. Therefore, early recognition and prevention of situations that may cause cardiac arrests and regular training for healthcare professionals are also necessary to improve survival.

References

  • Kiliç, N. T., Kuvaki, B., Özbilgin, Ş., & Incesu, M. (2022). Dokuz Eylül Üniversitesi Tip Fakültesi Hastanesinde Mavi Kod Uygulamalarinin Değerlendirilmesi. Türk Resüsitasyon Dergisi, 1(1), 19-34.
  • Andersen LW, Holmberg MJ, Løfgren B, Kirkegaard H, Granfeldt A. Adult in-hospital cardiac arrest in Denmark. Resuscitation. 2019;140:31–6.
  • Ohbe H, Tagami T, Uda K, Matsui H, Yasunaga H. Incidence and outcomes of in-hospital cardiac arrest in Japan 2011–2017: a nationwide inpatient database study. J Intensive Care. 2022;10:10.
  • Holmberg MJ, Ross CE, Fitzmaurice GM, Chan PS, Duval-Arnould J, Grossestreuer AV, et al. Annual incidence of adult and pediatric in-hospital cardiac arrest in the United States. Circ Cardiovasc Qual Outcomes. 2019;12:e005580.
  • NCAA. National Cardiac Arrest Audit key statistics. [Internet]. https://www.icnarc.org/DataServices/Attachments/Download/510fe606-a30b-ea11-911e-00505601089b
  • Nolan JP, Soar J, Smith GB, Gwinnutt C, Parrott F, Power S, et al. Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit. Resuscitation. 2014;85:987–92.
  • Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-Hospital Cardiac Arrest, A Review. JAMA. 2019 Mar 26;321(12):1200-1210.
  • Hillman K, Parr M, Flabouris A, Bishop G, Stewart A. Redefining in-hospital resuscitation: the concept of the medical emergency team. Resuscitation. 2001;48:105–10.
  • Factora F, Maheshwari K, Khanna S, Chahar P, Ritchey M, O’Hara JJ, et al. Effect of a rapid response team on the incidence of in-hospital mortality. Anesth Analg. 2022;135:595–604.
  • Tezcan Keleş G, Özbilgin Ş, Uğur L, Birbiçer H, Akın Ş, Kuvaki B, Doruk N, Türkan H, Akan M. Evaluation of Cardiopulmonary Resuscitation Conditions in Turkey: Current Status of Code Blue. Turk J Anaesthesiol Reanim. 2021 Feb;49(1):30-36. doi: 10.5152/TJAR.2021.136. Epub 2021 Mar 1. PMID: 33718903; PMCID: PMC7932719.
  • Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS. Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012;367:1912–20.
  • Nallamothu BK, Guetterman TC, Harrod M, Kellenberg JE, Lehrich JL, Kronick SL, et al. How do resuscitation teams at top-performing hospitals for in-hospital cardiac arrest succeed? A qualitative study. Circulation. 2018;138:154–63.
  • Fernando SM, Tran A, Cheng W, Rochwerg B, Taljaard M, Vaillancourt C, et al. Pre-arrest and intra-arrest prognostic factors associated with survival after in-hospital cardiac arrest: Systematic review and meta-analysis. BMJ. 2019;367:l6373
  • Perman, S. M., Stanton, E., Soar, J., Berg, R. A., Donnino, M. W., Mikkelsen, E. M., et all. Location of in hospital cardiac arrest in the United States: variability in event rate and outcomes. American Heart Association Resuscitation. 2016; 5(10):e003638.
  • Høybye M, Stankovic N, Holmberg M, Christensen HC, Granfeldt A, Andersen LW. In-hospital vs. out-of-hospital cardiac arrest: patient characteristics and survival. Resuscitation. 2021;158:157–65.
  • Fernando, S. M., Tran, A., Cheng, W., Rochwerg, B., Taljaard, M., Vaillancourt, C. et all. Pre-arrest and intra-arrest prognostic factors associated with survival after in-hospital cardiac arrest: systematic review and meta-analysis. BMJ. 2019; 367.
  • Høybyea, M., Stankovica, N., Lauridsena, K. G., Holmberga, M. J., Andersen, W. L., Granfeldt, A. Pulseless electrical activity vs. asystole in adult in-hospital cardiac arrest: Predictors and outcomes. Resuscitation. 2021;165:50-57.
  • Grasner J-T, Herlitz J, Tjelmeland IBM, et al. European Resuscitation Council Guidelines 2021: Epidemiology of cardiac arrest in Europe. Resuscitation. 2021:1-19. doi:10.1016/j.resuscitation.2021.02.007
  • Greif, Robert, et al. "European resuscitation council guidelines for resuscitation 2015: section 10. Education and implementation of resuscitation." Resuscitation 95 (2015): 288-301.
  • Topel, A., İskit, A. T., Hacettepe Üniversitesi Sıhhiye Yerleşkesinde Kardiyopulmoner Arreste Yönelik Oluşturulan Mavi Kod Uygulamasının Süreç Ve Sonuçlarının Değerlendirilmesi. Epidemiyoloji Programı. yüksek lisans tezi. 2016.
  • Cooper S, C. J. Predicting survival, in-hospital cardiac arrests: resuscitation survival variables and training effectiveness. Resuscitation. 1997; 35, 17–22.

MAVİ KOD UYGULAMALARININ DEĞERLENDİRİLMESİ

Year 2023, Volume: 2 Issue: 3, 94 - 109, 26.12.2023

Abstract

Amaç
Mavi kod tüm dünyada hastane içi kardiyopulmoner arrestlere hızlı, etkili müdahaleyle Kardiyopulmoner Resüsitasyonun (KPR) başarısını artırmayı amaçlayan bir kod sistemidir.

Bu çalışmada, Dokuz Eylül Üniversitesi Hastanesinde yapılan mavi kod uygulamaları, çağrı nedenleri, müdahalenin niteliği ve mortalite oranlarının araştırılması amaçlanmıştır.

Yöntem
2015-2019 yılları arasındaki mavi kod çağrıları retrospektif olarak incelendi. Demografik veriler, tanı, ek hastalıklar, hastane yatış süreleri ve KPR uygulanan hastalar arasında resüsitasyon uygulamaları ile ilgili özellikler incelendi. (Etik kurul Karar No:2015/24-04).

Bulgular
Çalışmanın analizi 35 yanlış çağrı dışlandıktan sonra
337 olgunun verileri dahil edilerek yapıldı. Çağrıların 57’sinin (%16,9) ayaktan hastalar için yapıldığı, 280 ‘inin (%83,1) yatan hastalar için yapıldığı tespit edildi. Hastaların yaş ortalaması 63,76±19,77 yıl ve 158’i kadın (%46,9), 179‘u erkek (%53,1) olarak saptandı. Mavi kod ekibinin olay yerine ulaşma sürelerine bakıldığında yatışı olmayan hastalar için 3,02±0,85 dakika ve yatışı olan hastalar için 3,28±1,70 dakika idi. Mavi kod çağrısının gündüz/gece ve hafta içi/hafta sonu gibi zaman dağılımında anlamlı bir fark bulunmadı. Toplam 337 mavi kod çağrısı arasında KPR yapılan 240 (%71,2) olgunun resüsitasyon karakteristikleri; ilk kardiyak arrest ritmi şok uygulanmayan ritmi olan 211 (%87.9) hasta sayısı, şok uygulanan ritm olan 29 (%12.1) hasta sayısından anlamlı olarak fazla idi (p=0,009). Şok uygulanan ritimlerde SDGD oranı %17.6 ve şok uygulanmayan ritmlerde % 82.4 idi. Bu fark istatistiksel olarak anlamlı idi (p=0,009). Şok uygulanan ritimlerde KPR süresi şok uygulanmaya ritim ile karşılaştırıldığında anlamlı olarak daha kısa idi (29,75±38,52 vs 32,66±18,95 min). İlk ritimle cinsiyet, yaş, ek hastalıklar ve hastane yatış süresi arasında anlamlı bir ilişki bulunmadı. KPR yapılan hastaların %14.2 si taburcu oldu. Solunum arresti nedeni ile entübe edilenlerin %27.3’ü taburcu oldu.

Sonuç
Etkili bir mavi kod uygulamanın anahtarı, müdahalelerin kalitesi ve zamanında yapılmasıdır. KPR uygulanacak hastalar için, mavi kod sırasında beklenen rolleri ve sorumlulukları bilmek önemlidir. O nedenle de mavi kod sonuçlarının hastanemizde iyileştirilmesi için, kardiyak arrestlere neden olabilecek durumların erken fark edilip önlenmesi ve bu amaçla kurum içi düzenli eğitimlerin verilmesi de gerekmektedir.

References

  • Kiliç, N. T., Kuvaki, B., Özbilgin, Ş., & Incesu, M. (2022). Dokuz Eylül Üniversitesi Tip Fakültesi Hastanesinde Mavi Kod Uygulamalarinin Değerlendirilmesi. Türk Resüsitasyon Dergisi, 1(1), 19-34.
  • Andersen LW, Holmberg MJ, Løfgren B, Kirkegaard H, Granfeldt A. Adult in-hospital cardiac arrest in Denmark. Resuscitation. 2019;140:31–6.
  • Ohbe H, Tagami T, Uda K, Matsui H, Yasunaga H. Incidence and outcomes of in-hospital cardiac arrest in Japan 2011–2017: a nationwide inpatient database study. J Intensive Care. 2022;10:10.
  • Holmberg MJ, Ross CE, Fitzmaurice GM, Chan PS, Duval-Arnould J, Grossestreuer AV, et al. Annual incidence of adult and pediatric in-hospital cardiac arrest in the United States. Circ Cardiovasc Qual Outcomes. 2019;12:e005580.
  • NCAA. National Cardiac Arrest Audit key statistics. [Internet]. https://www.icnarc.org/DataServices/Attachments/Download/510fe606-a30b-ea11-911e-00505601089b
  • Nolan JP, Soar J, Smith GB, Gwinnutt C, Parrott F, Power S, et al. Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit. Resuscitation. 2014;85:987–92.
  • Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-Hospital Cardiac Arrest, A Review. JAMA. 2019 Mar 26;321(12):1200-1210.
  • Hillman K, Parr M, Flabouris A, Bishop G, Stewart A. Redefining in-hospital resuscitation: the concept of the medical emergency team. Resuscitation. 2001;48:105–10.
  • Factora F, Maheshwari K, Khanna S, Chahar P, Ritchey M, O’Hara JJ, et al. Effect of a rapid response team on the incidence of in-hospital mortality. Anesth Analg. 2022;135:595–604.
  • Tezcan Keleş G, Özbilgin Ş, Uğur L, Birbiçer H, Akın Ş, Kuvaki B, Doruk N, Türkan H, Akan M. Evaluation of Cardiopulmonary Resuscitation Conditions in Turkey: Current Status of Code Blue. Turk J Anaesthesiol Reanim. 2021 Feb;49(1):30-36. doi: 10.5152/TJAR.2021.136. Epub 2021 Mar 1. PMID: 33718903; PMCID: PMC7932719.
  • Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS. Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012;367:1912–20.
  • Nallamothu BK, Guetterman TC, Harrod M, Kellenberg JE, Lehrich JL, Kronick SL, et al. How do resuscitation teams at top-performing hospitals for in-hospital cardiac arrest succeed? A qualitative study. Circulation. 2018;138:154–63.
  • Fernando SM, Tran A, Cheng W, Rochwerg B, Taljaard M, Vaillancourt C, et al. Pre-arrest and intra-arrest prognostic factors associated with survival after in-hospital cardiac arrest: Systematic review and meta-analysis. BMJ. 2019;367:l6373
  • Perman, S. M., Stanton, E., Soar, J., Berg, R. A., Donnino, M. W., Mikkelsen, E. M., et all. Location of in hospital cardiac arrest in the United States: variability in event rate and outcomes. American Heart Association Resuscitation. 2016; 5(10):e003638.
  • Høybye M, Stankovic N, Holmberg M, Christensen HC, Granfeldt A, Andersen LW. In-hospital vs. out-of-hospital cardiac arrest: patient characteristics and survival. Resuscitation. 2021;158:157–65.
  • Fernando, S. M., Tran, A., Cheng, W., Rochwerg, B., Taljaard, M., Vaillancourt, C. et all. Pre-arrest and intra-arrest prognostic factors associated with survival after in-hospital cardiac arrest: systematic review and meta-analysis. BMJ. 2019; 367.
  • Høybyea, M., Stankovica, N., Lauridsena, K. G., Holmberga, M. J., Andersen, W. L., Granfeldt, A. Pulseless electrical activity vs. asystole in adult in-hospital cardiac arrest: Predictors and outcomes. Resuscitation. 2021;165:50-57.
  • Grasner J-T, Herlitz J, Tjelmeland IBM, et al. European Resuscitation Council Guidelines 2021: Epidemiology of cardiac arrest in Europe. Resuscitation. 2021:1-19. doi:10.1016/j.resuscitation.2021.02.007
  • Greif, Robert, et al. "European resuscitation council guidelines for resuscitation 2015: section 10. Education and implementation of resuscitation." Resuscitation 95 (2015): 288-301.
  • Topel, A., İskit, A. T., Hacettepe Üniversitesi Sıhhiye Yerleşkesinde Kardiyopulmoner Arreste Yönelik Oluşturulan Mavi Kod Uygulamasının Süreç Ve Sonuçlarının Değerlendirilmesi. Epidemiyoloji Programı. yüksek lisans tezi. 2016.
  • Cooper S, C. J. Predicting survival, in-hospital cardiac arrests: resuscitation survival variables and training effectiveness. Resuscitation. 1997; 35, 17–22.
There are 21 citations in total.

Details

Primary Language Turkish
Subjects Anaesthesiology
Journal Section Original Articles
Authors

Şule Özbilgin 0000-0002-2940-8988

Beyza Çalış 0000-0001-6095-1455

Gözde Gürsoy Çirkinoğlu 0000-0002-9649-533X

Bahar Kuvaki 0000-0002-5160-0634

Publication Date December 26, 2023
Submission Date December 16, 2023
Acceptance Date December 21, 2023
Published in Issue Year 2023 Volume: 2 Issue: 3

Cite

AMA Özbilgin Ş, Çalış B, Gürsoy Çirkinoğlu G, Kuvaki B. MAVİ KOD UYGULAMALARININ DEĞERLENDİRİLMESİ. TJR. December 2023;2(3):94-109.