Leman ACUN DELEN, Zeliha KORKMAZ DİŞLİ

Evaluation of Code Blue activations in Covid 19 Patients and non-COVID-19 patients: A retrospective research review

We aimed to contribute to increase the efficiency of the Cardiopulmonary Resusitation (CPR) interventions by comparing the code blue applications activated for patients with and without COVID 19 during the pandemic process. The code blue registration forms who were diagnosed with and without COVID-19 and underwent resuscitation, between March 15-November 30, 2020 were examined retrospectively through the hospital information processing system. Demographic data, time of code blue activation, COVID-19 status, call accuracy, initial heart rhythm, respiratory arrest, survival in the first 24 hours, 30-day survival, discharge, time to reach unit. CPR durations were recorded. 79% of patients with code blue were covid-19. İnitial asystolic rhythm was present 16.7%, VF arrest was present in 34.8% and respiratory arrest was present in 71.7% patients and 53.6% of the patients died in the first 24 hours. The average time the team reaches the unit was aproximately 3 minutes, and the mean CPR duration was apoximately 30 minute. The rate initial asystolic rhythm was found higher in COVID- patients . The rate being declared exitus was higher in COVID-19 patients. The time to reach the place of activation and the duration of CPR were found higher in COVID-19 patients. The time to reach the place was found to be delayed for about 1 minute in our study. To develop strategies for minimizing the time between wearing the protective equipment properly and the response to the blue code without delay should be our first goal for the success of resuscitation.

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1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506.

2. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Jama. 2020;323:1061-9.

3. T. Guo, Y. Fan, M. Chen, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol, 2020;811-8.

4. Bhatraju PK, Ghassemieh BJ, Nichols M, et al. Covid-19 in critically ill patients in the Seattle Region — Case series. N Engl J Med. 2020;382:2012-22.

5. Mercuro NJ, Yen CF, Shim DJ, et al. Risk of QT interval prolongation associated with use of hydroxychloroquine with or without concomitant azithromycin among hospitalized patients testing positive for coronavirus disease-2019 (COVID-19). JAMA Cardiol. 2020;5:1036-41.

6. Shao F, Xu S, Ma X, et al. In-hospital cardiac arrest outcomes among patients with COVID-19 pneumonia in Wuhan, China. Resuscitation. 2020;151:18–23.

7. Nolan JP, Monsieurs KG, Bossaert L, et al. European resuscitation council COVID-19 guidelines executive summary. Resuscitation. 2020;153:45-55.

8. Chan PS, Berg RA, Nadkarni VM. Code blue during the COVID-19 pandemic. Circ Cardiovasc Qual Outcomes. 2020;13:e006779.

9. Perkins GD, Handley AJ, Koster RW, et al. European resuscitation council guidelines for resuscitation 2015. Section 2. Adult basic life support and automated external defibrillation. Resuscitation. 2015;95:81-99.

10. Hayek, SS, Brenner, SK, Azam, TU, et al. In-hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study. BMJ (Clinical Research Ed) 2020;371:m3513

11. V. Sheth, I Chishti, A Rothman, et al. Outcomes of in-hospital cardiac arrest in patients with COVID-19 in New York City. Resuscitation. 2020;3-5.

12. Baldi E. Sechi G.M. Mare C. et al. Out-of-hospital cardiac arrest during the Covid-19 outbreak in Italy. New Engl J Med. 2020;383:496-8.

13. Murat E, Toprak S, Buğur Doğan D, et al. The code blue experiences: gains, problems and troubleshooting. Medicine Science. 2014;1:1002-12