Code Blue Applications in COVID-19 Pandemic Hospital

Objective: Code Blue (CB) is one of the important practices for preventing mortality and morbidity and increasing the quality of care in hospitals. The aim of this study was to evaluate the Code Blue notifications and their results, their importance, and determine the effectiveness and deficiencies of the applications in a pandemic hospital.

Materials and Methods: In this study, CB forms of our hospital were reviewed retrospectively. By looking at the forms, results such as demographic data, diagnosis, cardiac arrest, time and place of CB administration, time of team reaching the patient after CB administration, heart rhythm of the patient, respiratory rhythm, duration of Cardio-Pulmonary Resuscitation (CPR) applied to the patient, Endotracheal Intubation status, whether defibrillation was performed, and transfer to the intensive care unit were recorded.

Results: In the study, it was found that there were a total of 650 CB calls (2020-2022). The mean age of the patients was 60.00 (±28.51) years. The mean time to reach calls was 1.26 (1-7) minutes (min), and the mean CPR time was 15.40 ± 20.30 minutes. Looking at the units where CB calls were given, it was found that 300 (46.15%) of the calls were made from the COVID-19 service, 150 (23.07%) from the palliative care unit, and 140 (21.54%) from the neurology intensive care unit. When the appropriateness of the CB was evaluated, it was found that 585 (90%) of 650 patients were correct and 65 (10%) were incorrect CB calls. It was observed that 44% of CB was given due to cardiac arrest. CPR was performed in 286 (44%) of the patients, it was found that 364 (56%) were given advanced respiratory support without cardiac massage. In our study, the survival rate was 50% and the transfer rate to the intensive care unit was 85%.

Conclusion: It has been determined that the vital CB system is realized at an appropriate time, but the rates of incorrect CB rates are still high. It was found that the unit with the highest number of CBs was the COVID-19 Ward and the second was the Palliative Care Ward. COVID-19 infection has increased CB rates and intensive care death rates. Awareness of healthcare professionals about the indications for CB administration must be increased and they must be trained on how to approach the patient with which indication.

Keywords: Code Blue, Cardio Pulmonary Resuscitation, COVID-19, Death.