Introduction: Institut Jantung Negara is a 461-bedded cardiac hospital that provides a 24-hour multidisciplinary Code Blue resuscitation team. The team consists of a Cardiologist/Cardiothoracic Surgeon, Anesthetist, Senior Nurse and Coronary Care Unit nurse with a pediatric equivalent for pediatric cases.
Materials & Methods: Details of all Code Blue activation from 1/1/2017 to 31/12/2017 were analyzed using a Resuscitation Feedback Form. Data collected include time and location of incident, time of Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) by resuscitation team arrival, initial cardiac rhythm and other demographic information.
Results: A total of 331 Code Blue announcements were made in 2017. A total of 207 forms (63%) were received for analysis. The majority of cases (61%) occurred out of office hours. 93% occurred in adults while 3% occurred in pediatric age. 87% of cases were inpatients whereas 13% were outpatients in public areas such as the lobby, pharmacy and prayer room. There was male predominance (68%) compared to females (32%). Unsurprisingly, 39% of patients had Acute Coronary Syndrome and 38% had Congestive Cardiac Failure. The most common initial cardiac rhythm was Pulseless Electrical Activity (21%) followed by Asystole (11%) and shockable rhythms - Ventricular Fibrillation and Ventricular Tachycardia (11%). Immediate BLS (within 2 minutes) was achieved in 94% and ACLS within 5 minutes was achieved in 89% of cases. Overall survival rate to ROSC was 62%.
Discussion: A multidisciplinary team of BLS and ACLS trained professionals is ideal in management cardiac arrest. The study showed that cardiac arrest often occurred out of office hours with reduced manpower and may occur in obscure places involving patients and non-patients. Thus, all staff should be trained to perform BLS and strategically placed public access defibrillators is important in shockable rhythms. Periodical data analysis of outcomes is vital in planning for improvement.
Code Blue, cardiac arrest