Prospective Study of Functioning and Outcomes of Code Blue System in an Indian Tertiary Care Center: An Observational Study

Abstract

Background: Code blue (CB) is a well-established and common emergency code used in hospitals to summon specialized medical personnel and equipment to resuscitate a patient in the event of cardiac arrest. Albeit, there are not many studies done in the Indian setup, especially in a government institution setting to assess the effectiveness of timely implementation of CB. In our study, we evaluated the effectiveness of CB system (CBS) in an Indian Armed Forces tertiary care hospital. Materials and Methods: A prospective observational study was conducted over 18 months which included all patients who were resuscitated by the CB team (CBT). A CB audit form (CBAF) was formulated through a questionnaire. CBAFs were filled and endorsed by the doctors who attended CB. The audit forms were compiled and analyzed using SPSS, version 21 software. Results: A total of 66 CB calls were initiated during the study period. While 23 patients (34.8%) had a successful return of spontaneous circulation (ROSC), 43 patients (65.2%) were declared dead at the end of initial resuscitation and 10 patients (15.2%) survived to be discharged from the hospital. The average time taken by the CBT to arrive at the scene was 3.1 min. Maximum number (n = 30, 45.4%) of CB calls were received from 1200 h to 1800 h IST. While 63 cases (95.5%) had nonshockable cardiac rhythm, only 3 cases (4.5%) had shockable rhythm on initial assessment. Forty-three patients (65.1%) had either diabetes or hypertension or both and only 4 patients (6.1%) had prior known cardiac illness. Conclusion: The availability of CBS increased the chance of survival and about 35% of cardiac-arrested patients had successful ROSC. Since majority of the cardiac arrest patients had a nonshockable rhythm (about 95%), nonavailability of a defibrillator is not a limiting factor in providing effective resuscitation.