Longitudinal exploration of in situ mock code events and the performance of cardiac arrest skills

Abstract

IntroductionIn-hospital cardiac arrest (IHCA) affects 200 000 adults in the USA each year, and resuscitative efforts are often suboptimal. The objective of this study was to determine whether a programme of ‘mock codes’ improves group-level performance of IHCA skills. Our primary outcome of interest was change in cardiopulmonary resuscitation (CPR) fraction, and the secondary outcomes of interest were time to first dose of epinephrine and time to first defibrillation. We hypothesised that a sustained programme of mock codes would translate to greater than 10% improvement in each of these core metrics over the first 3 years of the programme.MethodsWe conducted mock codes in an urban teaching hospital between August 2012 and October 2015. Mock codes occurred on Telemetry and Medical/Surgical units on day and night shifts. Codes were managed by unit staff and members of the hospital’s ‘Code Blue’ team, and data were recorded by trained observers. Data were summarised using descriptive statistics, and repeated measures outcomes were calculated using a mixed effects model.ResultsFifty-seven mock codes were included in the analysis: 42 on Medical/Surgical units and 15 on Telemetry units. CPR fraction increased by 2.9% per 6-month time interval on Telemetry units, and 1.3% per time interval on Medical/Surgical units. Neither time to first epinephrine dosing nor time to defibrillation changed significantly.ConclusionsWhile we observed a significant improvement in CPR fraction over the course of this programme of mock codes, similar improvements were not observed for other key measures of cardiac arrest performance.