COVID-19 SERVİSİNDE MAVİ KOD DENEYİMLERİMİZ

Yıl 2022, Cilt: 1 Sayı: 3, 139 - 147, 29.12.2022

Nurcan Doruk , Aslınur Sagün , Handan Birbiçer , Ayşe Güsün Halitoğlu , Emine Kübra Berent

Öz

Amaç
Covid-19 aeresol yoluyla bulaşan ve sıklıkla mortal seyreden bir hastalıktır. Hastalığın seyri esnasında sıklıkla hipoksi veya tromboembolik olaylara bağlı olarak ani kardiyak arrest (KA) gelişebilmekte ve kardiyopulmoner resüsitasyon (KPR) uygulanması gerekmektedir. Çağırılan mavi kod ekiplerinin hastaya yaklaşımları sırasında kendi güvenliklerini sağlamaları önemlidir. Bu durum hastaya müdahaleyi geciktirmekte ve resüsitasyonun etkinliğini sınırlayabilmektedir. Bu çalışma ile Covid-19 tanılı KA olgularında mavi kod deneyimlerimizi sunmayı amaçladık.

Yöntem
Etik Kurul Onayı alındıktan sonra pandemi öncesi 1 Mart 2019 - 29 Şubat 2020 tarihleri arasında servislerden ve pandeminin başlamasıyla 1 Mart 2020 - 1 Mart 2021 tarihleri arasında Covid-19 servislerinden gelen mavi kod çağrıları retrospektif olarak incelendi. Hastaların demografik verileri, mavi kod ekibinin olay yerine ulaşma süresi, arrestin tipi, yapılan müdahaleler, arrest ritmi, resüsitasyon süresi ve resüsitasyon sonucu kaydedildi.

Bulgular
Pandemi öncesi 12 mavi kod çağrısı yapılırken, pandemi esnasında toplam 25 hasta için mavi kod çağrısı yapıldığı saptandı. Demografik veriler incelendiğinde pandemi öncesi hastaların büyük çoğunluğu erkek iken, pandemi sonrası kadın erkek oranı benzerdi. Yaş ortalamalarına bakıldığında ise pandemi öncesi 61.58 ± 8.6 iken pandemi döneminde 72.25 ± 10.7 idi (p<0.01). Pandemi öncesi mavi kod ekibinin olay yerine ulaşma süresi ortalama 2.5 ± 1.3 iken pandemi esnasında 3.44 ± 1.7 dakika idi (p<0.007). Hastaların hepsinde kanser, serebrovasküler hastalık daha sık olmak üzere yandaş hastalıklar mevcuttu. Pandemi öncesi KA kardiyak nedenlere bağlı gelişirken, pandemi esnasında sıklıkla solunumsal nedenlere bağlı olarak geliştiği izlendi. Başlangıç arrest ritimleri ise pandemi öncesi %60 pandemi döneminde ise %72,7 oranında asistoli olarak izlendi. Kardiyopulmoner resüsitasyon (KPR) süresi her iki dönemde benzer olarak saptandı. KPR’ye yanıt pandemi döneminde öncesine göre daha düşük saptandı.

Sonuç
Mavi kod ekibimiz çağrıya kişisel koruyucu ekipmanlarını (KKE) giyerek gitmektedirler. Hem ekipmanları giymek hem de bu kıyafetlerle hareket etmek zor olmasına rağmen olması gerekenden çok az bir gecikmeyle olay yerine ulaşmışlar ve gerekli müdahaleleri yapmışlardır. Pandemi döneminde güvenlikle ilgili olabilecek gecikmeleri önlemek için KA riski olan hastayı erken tanınması ve hastaya primer bakan ekibin güvenli temel yaşam desteği uygulamaları ile ilgili olarak eğitilmesinin uygun olacağı kanaatindeyiz. Ancak Covid 19’un önlenmesi ve tedavi edilmesi güç olan hipoksi ve tromboembolik olaylara neden olmasının da KPR başarısını etkileyeceğini unutmamalıyız.

Anahtar Kelimeler

Pandemi, Kardiyak Arrest, Mavi Kod, Kardiyopulmoner Resüsitasyon

CODE BLUE EXPERIENCES IN COVID-19 WARDS

Öz

Objective
The coronavirus disease-2019 (COVID-19) is transmitted by aerosol and often mortal. During the course of the disease, sudden cardiac arrest (CA) may develop, often due to hypoxia or thromboembolic events, and cardiopulmonary resuscitation (CPR) is required. It is important that the code blue teams that are called to ensure their own safety during their approach to the patient. This situation delays the intervention to the patient and may limit the effectiveness of resuscitation. With this study, we aimed to present our code blue experiences in CA cases diagnosed with Covid-19.

Methods
After the Ethics Committee Approval was obtained, the code blue calls from the wards between March 1, 2019 and February 29, 2020 before the pandemic and from the Covid-19 wards between March 1, 2020 and March 1, 2021, with the onset of the pandemic, were retrospectively analysed. Demographic data of the patients, time of arrival of the code blue team to the scene, type of arrest, interventions, arrest rhythm, resuscitation period and resuscitation results were recorded.

Results
While 12 code blue calls were made before the pandemic, it was determined that code blue calls were made for a total of 25 patients during the pandemic. When the demographic data were examined, the majority of the patients were male before the pandemic, while the female-to-male ratio was similar after the pandemic. When the mean age was 61.58 ± 8.6 before the pandemic, it was 72.25 ± 10.7 during the pandemic period (p<0.01). While the mean time for the code blue team to reach the scene was 2.5 ± 1.3 minutes before the pandemic, it was 3.44 ± 1.7 minutes during the pandemic (p<0.007). All of the patients had concomitant diseases, including cancer and cerebrovascular disease more frequently. While CA developed due to cardiac causes before the pandemic, it was observed that it often developed due to respiratory causes during the pandemic. Initial arrest rhythms were observed as asystole at a rate of 60% before the pandemic and 72.7% during the pandemic period. Cardiopulmonary resuscitation (CPR) duration was found to be similar in both periods. The response to CPR was found to be lower during the pandemic period than before.

Conclusion
Our code blue team goes to the call wearing their personal protective equipment (PPE). Although it was difficult both to wear the equipment and to act with these clothes, they reached the scene with minimum delay and made the necessary interventions. Our opinion is that early identification of the patient with CA risk and training of the primary care team about safe basic life support practices would be appropriate in order to prevent delays that may be related to safety during the pandemic period. However, we should not forget the fact that Covid 19 causes hypoxia and thromboembolic events, which are difficult to prevent and treat, will also affect the success of CPR.

Anahtar Kelimeler

Pandemic, Cardiac Arrest, Code blue, Cardiopulmonary resuscitation

Kaynakça

• Wadhera RK, Wadhera P, Gaba P, Figueroa JF, Joynt KE, Maddox, et al. Variation in COVID-19 hospitalizations and deaths across New York city boroughs. JAMA. 2020;323:2192–2195. Doi: 10.1001/jama.2020.7197
• Shao F, Xu S, Ma X, Xu Z, Lyu J, Ng M, et al. In-hospital cardiac arrest outcomes among patients with COVID-19 pneumonia in Wuhan, China. Resuscitation. 2020 Jun;151:18-23.
• Nolan JP, Monsieurs KG, Bossaert L, Böttiger B.W., Greif R, Lott C, et al; European Resuscitation Council COVIDGuideline Writing Groups. European Resuscitation Council COVID-19 guidelines executive summary. Resuscitation. 2020 Aug; 153:45-55.
• Morrison LJ, Neumar RW, Zimmerman JL, Link MS, Newby NK, McMullan BY., et al.; American Heart Association Emergency Cardiovascular Care Committee, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on P. Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: a consensus statement from the American Heart Association. Circulation. 2013;127(14):1538–1563.
• Nolan JP, Soar J, Smith GB, Gwinnutt C, Parrott F, Power S, et al.; National Cardiac Arrest Audit. Incidence and outcome of inhospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit. Resuscitation. 2014;85(8):987–992.
• Hayek SS, Brenner SK, Azam TU, Shadid HR, Anderson E, Pan M., et al.; In-hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study. BMJ. 2020 Sep 30;371:m3513.
• Zhou F,Yu T, Du R, Fan G, Liu Y, Liu Z., et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;6736:19.
• Miles JA, Mejia M, Rios S, Sokol SI, Lanston M, Hahn S., et al. Characteristics and Outcomes of In-Hospital Cardiac Arrest Events During the COVID-19 Pandemic: A Single-Center Experience From a New York City Public Hospital. Circ Cardiovasc Qual Outcomes. 2020 Nov;13(11):e007303.
• Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CV, Carson AP., et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019 Mar 5;139(10):e56-e528.
• Shao F, Li CS, Liang LR, Qin J, Ding N, Fu Y., et al. Incidence and outcome of adult in-hospital cardiac arrest in Beijing, China. Resuscitation. 2016 May;102:51-6.
• Nallamothu BK, Guetterman TC, Harrod M, et al. Kellenberg JE, Lehrich JE, Kronick SL., How do resuscitation teams at top-performing hospitals for in-hospital cardiac arrest succeed? A qualitative study. Circulation. 2018;138:154–163.