The presence of an Emergency Airway Response Team and its effects on in-hospital Code Blue.
The survival rate from in-hospital cardiac arrest due to pulseless electrical activity (PEA)/asystole in our institution was higher than expected (70%). It was the impression of the Emergency Department-led Code Blue Team (CBT) that many of these patients were actually suffering respiratory arrests before their cardiac events. To address this, the facility developed an early intervention team focused on early airway intervention-the Emergency Airway Response Team (EART). The objective of this study was to assess the effect of early intervention in patients during the "pre-Code Blue" period, specifically with regard to airway stabilization. Our hypothesis was that there would be fewer CBT calls (cardiac arrests) due to PEA and asystole and that the survival from these events would decrease. This was a retrospective review of all cardiac arrests responded to by the CBT and EART for a period of 2 years. Charts were reviewed for the initial presenting rhythm (as defined by the Utstein Format) and event survival for the 12-month period immediately before and immediately after the establishment of the EART (Time Periods 1 and 2, respectively). The total number of CBT calls decreased by 15%, return of spontaneous circulation from any rhythm decreased by 9%, and survival to discharge decreased by 8% (p = non-significant). The number of CBT calls specifically for asystole/PEA decreased by 8%. Deaths in hospital were significantly associated with Period 2 (odds ratio 1.84; 95% confidence interval 1.03-3.28) after adjusting for age, gender, and presenting rhythms. The total number of CBT calls decreased slightly with the creation of the Emergency Airway Response Team. Return of spontaneous circulation and survival to hospital discharge after cardiac arrest due to asystole/PEA were significantly decreased, suggesting early intervention may have benefit.
Henderson
Sean O
SO
Department of Emergency Medicine, Keck/USC School of Medicine, Los Angeles, California, USA.
McClung
Christian D
CD
Sintuu
Chanida
C
Swadron
Stuart P
SP
D000293:Adolescent; D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D004636:Emergency Service, Hospital; D005260:Female; D006323:Heart Arrest / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010348:Patient Care Team; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D055815:Young Adult