Research Article
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Analysis of “Code Blue” events in a single center: A cohort study with 419 incidents

Year 2019, , 155 - 158, 25.02.2019
https://doi.org/10.28982/josam.519289

Abstract

Aim: Cardiac arrest sustains a significant cause of in-hospital morbidity and mortality worldwide and “Code Blue” (emergency code) is defined as a hospital code used to indicate a patient requiring immediate resuscitation. In this study we aimed to evaluate the ‘‘code Blue’’ events retrospectively in our hospital.

Methods: Data were collected from the file book that is contained the patients’ name, protocol numbers, duration of arrivals to the arrest locale, final results of CPR and the CPR team’s names, locales of “code blue”. Patients’ gender, locales of “code blue”, false or right “code blue” situations, final results were analyzed. 

Results: One hundred-nineteen “code blue” situations were analyzed, 132 of 339 true “code blue” patients died at the locale after CPR. One hundred-forty four patients were transferred to reanimation unit, 29 were to the coronary intensive care unit (ICU), 28 were to the cardio-vascular surgery ICU, four were to pediatric-ICU and two were taken to the emergency operations. Also 113 of these 207 remaining patients were died in these units in later times, 94 patients survived. Eighty of them were determined as false code blue.

Conclusions: Even the situation is in-hospital cardiac arrest and the CPR is performed by skilled team mortality rate may still be high. To prevent the false code blue situations, in-house training is indispensable for every hospital workers.

References

  • 1. Adamski J, Nowakowski P, Goryński P, Onichimowski D, Weigl W. Incidence of in-hospital cardiac arrest in Poland. Anaesthesiol Intensive Ther. 2016;48[5]:288-93.
  • 2. Cooper S, Cade J. Predicting survival, in-hospital cardiac arrests: resuscitation survival variables and training effectiveness. Resuscitation. 1997;35:17–22.
  • 3. Herlitz J, Bang A, Alsen B, et al. Characteristics and outcome among patients suffering from in-hospital cardiac arrest in relation to whether the arrest took place during office hours. Resuscitation 2002;53:127–33.
  • 4. Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14,720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003;58:297–308.
  • 5. Peters R, Boyde M. Improving survival after in-hospital cardiac arrest: the Australian experience. Am J Crit Care. 2007;16:240–6.
  • 6. Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA. 2006;295:50–7. 7. Brindley PG, Markland DM, Mayers I, et al. Predictors of survival following in-hospital adult cardiopulmonary resuscitation. CMAJ. 2002;167:343–8.
  • 8. Sochi K, Singla MK, Shrivastava A. Impact of advanced cardiac life support training program on the outcome of cardiopulmonary resuscitation in a tertiary care hospital. Indian J Crit Care Med. 2011;15:209–12.
  • 9. Shin TG, Jo IJ, Song HG, Sim MS, Song KJ. Improving Survival Rate of Patients with In-Hospital Cardiac Arrest: Five Years of Experience in a Single Center in Korea. Korean Med Sci. 2012;27:146-52.
  • 10. Schwartz BC, Jayaraman D, Warshawsky PJ. Survival from in-hospital cardiac arrest on the Internal Medicine clinical teaching unit. Can J Cardiol [Internet]. 2013;29[1]:117–21.
  • 11. Sittichanbuncha Y, Prachanukool T, Sawanyawisuth K. A 6-year experience of CPR outcomes in an emergency department in Thailand. Ther Clin Risk Manag. 2013;9[1]:377–81.
  • 12. Amer MS, Abdel Rahman TT, Aly WW, Ahmad NG. Cardiopulmonary resuscitation: outcome and its predictors among hospitalized elderly patients in Egypt. Geriatr Gerontol Int [Internet]. 2014;14[2]:309–14.
  • 13. Kantamineni P, Emani V, Saini A, Rai H, Duggal A. Cardiopulmonary Resuscitation in the Hospitalized Patient: Impact of System-Based Variables on Outcomes in Cardiac Arrest. Am J Med Sci [Internet]. 2014;348[5]:377–81.
  • 14. 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[8]:987–92.
  • 15. Pantazopoulos I, Tsoni A, Kouskouni E, Papadimitriou L, Johnson EO, Xanthos T. Factors influencing nurses' decisions to activate medical emergency teams. J Clin Nurs. 2012;21:2668–78.
  • 16. Lenfant C. Chest pain of cardiac and noncardiac origin. Metabolism. 2010;59[supl. 1]: S41–S46.
  • 17. Greenslade JH, Hawkins T, Parsonage W, Cullen L. Panic Disorder in Patients Presenting to the Emergency Department With Chest Pain: Prevalence and Presenting Symptoms. Heart, Lung and Circulation. 2017;26[12]:1310–6.
  • 18. Büyükaslan H, Basmacı Kandemir S, Asoğlu M, Kaya M, Gökdemir MT, et al. Evaluation of oxidant, antioxidant, and S100B levels in patients with conversion disorder.. Neuropsychiatr Dis Treat. 2016;12:1725–9.
  • 19. Şahin Ş, Aybastı Ö, Elboğa G, Altındağ A, Tamam L. Majör depresyonda elektrokonvulsif terapinin oksidatif metabolizma üzerine etkisi. Cukurova Med J. 2017;42(3):513-7.
  • 20. Walker FO, Alessi AG, Digre KB, McLean WT. Psychogenic respiratory distress. Arch Neurol. 1989 Feb;46[2]:196-200.
  • 21. Eroglu SE, Onur O, Urgan O, Denizbasi A, Akoglu H. Blue code: Is it a real emergency? World J Emerg Med. 2014;5[1]:20–3.
  • 22. Sobański JA, Popiołek L, Klasa K, Rutkowski K, Dembińska E et al. Neurotic personality and pseudo-cardiac symptoms in a day hospital patients diagnosed at pretreatment between 2004 and 2014. Psychiatr Pol. 2016;50[1]:213-46.
  • 23. Centers for Disease Control and Prevention [CDC]. State-specific mortality from sudden cardiac death - United States, 1999. MMWR Morb Mortal Wkly Rep. 2002 Feb 15;51[6]:123-6.

Tek merkezde “Mavi Kod” olaylarının analizi: 419 vakalı kohort çalışma

Year 2019, , 155 - 158, 25.02.2019
https://doi.org/10.28982/josam.519289

Abstract

Amaç: Kardiyak arrest, dünya çapında hastane içi morbidite ve mortalitenin önemli bir nedenini olup “Mavi Kod” (acil durum kodu), hemen resüsitasyon gerektiren bir hastayı belirtmek için kullanılan bir hastane kodu olarak tanımlanmaktadır. Bu çalışmada, hastanemizde verilen mavi kodları retrospektif olarak değerlendirmeyi amaçladık.

Yöntemler: Çalışma verileri, hastanın adının, protokol numaralarının, olay yerine varış sürelerinin, resüsitasyon ekibinin adlarının, olay yerinin olduğu “Mavi Kod” defterinden toplandı. Hastaların cinsiyeti, “Mavi Kod” bölgelerinin yerleri, yanlış veya doğru “Mavi Kod” durumları, hastaların nihai sonuçları analiz edildi.

Bulgular: 419 “Kod mavi” durumu incelendi, 339 hastanın 132'sinin olay yerinde resüsitasyon sonrasında öldüğü görüldü. Yüz kırk dört hasta reanimasyon ünitesine, 29'u koroner yoğun bakıma, 28'i kalp-damar cerrahisi yoğun bakımına, 4'ü pediatrik yoğun bakıma ve 2'si acil operasyona alındı. Ayrıca bu 207 hastanın 113'ü bu birimlerde daha sonra öldü, 94 hasta hayatta kaldı. Seksen, mavi kod yanlış olarak belirlendi.

Sonuçlar: Kardiyak arrest durumu hastane içinde bile olsa ve resüsitasyon yetenekli bir ekip tarafından yapılsa bile ölüm oranı hala yüksektir. Yanlış mavi kod durumlarını önlemek için, tüm hastane çalışanlarına kurum içi eğitimler vazgeçilmezdir.

References

  • 1. Adamski J, Nowakowski P, Goryński P, Onichimowski D, Weigl W. Incidence of in-hospital cardiac arrest in Poland. Anaesthesiol Intensive Ther. 2016;48[5]:288-93.
  • 2. Cooper S, Cade J. Predicting survival, in-hospital cardiac arrests: resuscitation survival variables and training effectiveness. Resuscitation. 1997;35:17–22.
  • 3. Herlitz J, Bang A, Alsen B, et al. Characteristics and outcome among patients suffering from in-hospital cardiac arrest in relation to whether the arrest took place during office hours. Resuscitation 2002;53:127–33.
  • 4. Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14,720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003;58:297–308.
  • 5. Peters R, Boyde M. Improving survival after in-hospital cardiac arrest: the Australian experience. Am J Crit Care. 2007;16:240–6.
  • 6. Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA. 2006;295:50–7. 7. Brindley PG, Markland DM, Mayers I, et al. Predictors of survival following in-hospital adult cardiopulmonary resuscitation. CMAJ. 2002;167:343–8.
  • 8. Sochi K, Singla MK, Shrivastava A. Impact of advanced cardiac life support training program on the outcome of cardiopulmonary resuscitation in a tertiary care hospital. Indian J Crit Care Med. 2011;15:209–12.
  • 9. Shin TG, Jo IJ, Song HG, Sim MS, Song KJ. Improving Survival Rate of Patients with In-Hospital Cardiac Arrest: Five Years of Experience in a Single Center in Korea. Korean Med Sci. 2012;27:146-52.
  • 10. Schwartz BC, Jayaraman D, Warshawsky PJ. Survival from in-hospital cardiac arrest on the Internal Medicine clinical teaching unit. Can J Cardiol [Internet]. 2013;29[1]:117–21.
  • 11. Sittichanbuncha Y, Prachanukool T, Sawanyawisuth K. A 6-year experience of CPR outcomes in an emergency department in Thailand. Ther Clin Risk Manag. 2013;9[1]:377–81.
  • 12. Amer MS, Abdel Rahman TT, Aly WW, Ahmad NG. Cardiopulmonary resuscitation: outcome and its predictors among hospitalized elderly patients in Egypt. Geriatr Gerontol Int [Internet]. 2014;14[2]:309–14.
  • 13. Kantamineni P, Emani V, Saini A, Rai H, Duggal A. Cardiopulmonary Resuscitation in the Hospitalized Patient: Impact of System-Based Variables on Outcomes in Cardiac Arrest. Am J Med Sci [Internet]. 2014;348[5]:377–81.
  • 14. 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[8]:987–92.
  • 15. Pantazopoulos I, Tsoni A, Kouskouni E, Papadimitriou L, Johnson EO, Xanthos T. Factors influencing nurses' decisions to activate medical emergency teams. J Clin Nurs. 2012;21:2668–78.
  • 16. Lenfant C. Chest pain of cardiac and noncardiac origin. Metabolism. 2010;59[supl. 1]: S41–S46.
  • 17. Greenslade JH, Hawkins T, Parsonage W, Cullen L. Panic Disorder in Patients Presenting to the Emergency Department With Chest Pain: Prevalence and Presenting Symptoms. Heart, Lung and Circulation. 2017;26[12]:1310–6.
  • 18. Büyükaslan H, Basmacı Kandemir S, Asoğlu M, Kaya M, Gökdemir MT, et al. Evaluation of oxidant, antioxidant, and S100B levels in patients with conversion disorder.. Neuropsychiatr Dis Treat. 2016;12:1725–9.
  • 19. Şahin Ş, Aybastı Ö, Elboğa G, Altındağ A, Tamam L. Majör depresyonda elektrokonvulsif terapinin oksidatif metabolizma üzerine etkisi. Cukurova Med J. 2017;42(3):513-7.
  • 20. Walker FO, Alessi AG, Digre KB, McLean WT. Psychogenic respiratory distress. Arch Neurol. 1989 Feb;46[2]:196-200.
  • 21. Eroglu SE, Onur O, Urgan O, Denizbasi A, Akoglu H. Blue code: Is it a real emergency? World J Emerg Med. 2014;5[1]:20–3.
  • 22. Sobański JA, Popiołek L, Klasa K, Rutkowski K, Dembińska E et al. Neurotic personality and pseudo-cardiac symptoms in a day hospital patients diagnosed at pretreatment between 2004 and 2014. Psychiatr Pol. 2016;50[1]:213-46.
  • 23. Centers for Disease Control and Prevention [CDC]. State-specific mortality from sudden cardiac death - United States, 1999. MMWR Morb Mortal Wkly Rep. 2002 Feb 15;51[6]:123-6.
There are 22 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research article
Authors

Betül Kocamer Şimşek 0000-0001-8220-9542

Ahmet Aykut Akyılmaz This is me 0000-0003-2689-4391

Publication Date February 25, 2019
Published in Issue Year 2019

Cite

APA Kocamer Şimşek, B., & Akyılmaz, A. A. (2019). Analysis of “Code Blue” events in a single center: A cohort study with 419 incidents. Journal of Surgery and Medicine, 3(2), 155-158. https://doi.org/10.28982/josam.519289
AMA Kocamer Şimşek B, Akyılmaz AA. Analysis of “Code Blue” events in a single center: A cohort study with 419 incidents. J Surg Med. February 2019;3(2):155-158. doi:10.28982/josam.519289
Chicago Kocamer Şimşek, Betül, and Ahmet Aykut Akyılmaz. “Analysis of ‘Code Blue’ Events in a Single Center: A Cohort Study With 419 Incidents”. Journal of Surgery and Medicine 3, no. 2 (February 2019): 155-58. https://doi.org/10.28982/josam.519289.
EndNote Kocamer Şimşek B, Akyılmaz AA (February 1, 2019) Analysis of “Code Blue” events in a single center: A cohort study with 419 incidents. Journal of Surgery and Medicine 3 2 155–158.
IEEE B. Kocamer Şimşek and A. A. Akyılmaz, “Analysis of ‘Code Blue’ events in a single center: A cohort study with 419 incidents”, J Surg Med, vol. 3, no. 2, pp. 155–158, 2019, doi: 10.28982/josam.519289.
ISNAD Kocamer Şimşek, Betül - Akyılmaz, Ahmet Aykut. “Analysis of ‘Code Blue’ Events in a Single Center: A Cohort Study With 419 Incidents”. Journal of Surgery and Medicine 3/2 (February 2019), 155-158. https://doi.org/10.28982/josam.519289.
JAMA Kocamer Şimşek B, Akyılmaz AA. Analysis of “Code Blue” events in a single center: A cohort study with 419 incidents. J Surg Med. 2019;3:155–158.
MLA Kocamer Şimşek, Betül and Ahmet Aykut Akyılmaz. “Analysis of ‘Code Blue’ Events in a Single Center: A Cohort Study With 419 Incidents”. Journal of Surgery and Medicine, vol. 3, no. 2, 2019, pp. 155-8, doi:10.28982/josam.519289.
Vancouver Kocamer Şimşek B, Akyılmaz AA. Analysis of “Code Blue” events in a single center: A cohort study with 419 incidents. J Surg Med. 2019;3(2):155-8.