Code teams and the review of cardiac arrests

Follow the protocol and kickstart the heart-Intensive care nurses' reflections on being part of rescue situations in interdisciplinary teams

Aim

To describe intensive care nurses' reflections on being part of interdisciplinary emergency teams involved in in‐hospital cardiopulmonary resuscitation.

Design

A qualitative descriptive design. Methods: Eighteen intensive care nurses from two regions and three hospitals in Sweden were interviewed. The data were analysed with General Inductive Analysis.

Results

The work for intensive care nurses in the emergency team was reflected in three phases: prevention, intervention and mitigation—referred as before, during and after the CPR situation.

Conclusions

The findings describe the complexity of being an intensive care nurse in an interdisciplinary emergency team, which entails managing advanced care with limited and unknown resources in a non‐familiar environment. The present findings have important clinical implications concerning the value of having debriefing sessions to reflect on and to talk about obstacles to and prerequisites for performing successful resuscitation.

Emergency medicine residents effectively direct inhospital cardiac arrest teams

STUDY OBJECTIVE

We compared 2 models of physician leadership for inhospital cardiac arrest teams (CATs): emergency medicine (EM) residents and staff hospitalist physicians.

METHODS

A before-after study was conducted on all adult inhospital CAT activations over a 2-year period. The primary outcome was return of spontaneous circulation (ROSC).

RESULTS

There were 749 total code blues during the 2-year study period. Ninety-one were excluded by protocol. EM residents directed 288 codes, hospitalists directed 248 codes, and other specialties directed the remaining 62. There was no statistically significant difference in percent ROSC or survival to hospital discharge. EM residents responded first for 59.2% of the codes compared with a first response rate of 28% for hospitalists (P<.05). Time to achieve ROSC was quicker in the EM resident cohort.

CONCLUSION

Our findings validate the use of a 24-hour EM resident staffing model for CAT response to inhospital cardiac arrests.

Advanced cardiac life support events in a community hospital and their outcome: evaluation of actual arrests

To evaluate resuscitation efforts for patients with cardiac and/or pulmonary arrest in our hospital a retrospective study was conducted and compared with available data from other community teaching hospitals. Records of 131 consecutive patients of ages 16-98 who received resuscitation according to Advanced Cardiac Life Support protocols were reviewed. Short-term survival (return of spontaneous circulation) and discharge-from-the hospital survival were measured. Nineteen patients (15%) were excluded from the study because the information recorded on the code record sheet was insufficient. Overall short-term survival rate was 34.8%. Resuscitations in the Emergency Room were evaluated separately, because most of them were initiated outside of the hospital. Their short-term survival was 14%, but none of them survived to be discharged. Out of 69 inpatient resuscitative efforts, 33 were successful (47.8%). Of these 33 nine (13.0%) left the hospital. The rest expired during the same hospitalization. Short-term survival for patients after coronary artery bypass graft surgery was 60% (6 of 10) and 30% (3 of 10) were discharged home. Forty percent of official code records were incomplete. We concluded that better education and more emphasis on record-keeping are mandatory, with the main burden falling upon the nurse in charge to have received more precise instruction. Contrary to published data, women did not have a better survival than men (P > 0.05). There was no difference in outcomes between resident physician directed codes compared to attending physician directed codes (P > 0.05). The mean age of inpatient short-term survivors was 69.0 (+/- 13.2) years and that of non-survivors 69.8 (+/- 15.7) years (P > 0.05). Post-bypass surgery patients had a better survival than non-surgical patients, but the difference was significant (P > 0.05). Survival in our hospital was comparable to one hospital and worse than another (34.8% vs. 39.6% or 63.0%). Despite success, prognosis after arrest remain poor.