Impact of a COVID-19 code blue protocol on resuscitation care and CPR quality during in-hospital cardiac arrest

Christian Vaillancourt; Manya Charette; Soha Khorsand; Erica Shligold; Chelsea Lanos; Jennifer Dale-Tam; Alexandre Tran; Loree Boyle; Sylvie Aucoin; Jerry Maniate; Hilary Meggison; Michael Hartwick; Glenn Posner

doi:10.1016/j.resuscitation.2024.110172

Impact of a COVID-19 code blue protocol on resuscitation care and CPR quality during in-hospital cardiac arrest

Resuscitation. 2024 May:198:110172. doi: 10.1016/j.resuscitation.2024.110172. Epub 2024 Mar 9.

Authors

Affiliations

¹ Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada. Electronic address: cvaillancourt@ohri.ca.
² Ottawa Hospital Research Institute, Ottawa, ON, Canada.
³ The Ottawa Hospital, Ottawa, ON, Canada.
⁴ Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, University of Ottawa, ON, Canada; Division of Critical Care Medicine, University of Ottawa, ON, Canada.
⁵ Department of Medicine, University of Ottawa, ON, Canada.
⁶ Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada.
⁷ Department of Medicine, University of Ottawa, ON, Canada; Bruyère Research Institute, Ottawa, ON, Canada.
⁸ Division of Critical Care Medicine, University of Ottawa, ON, Canada.
⁹ Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Obstetrics and Gynecology, University of Ottawa, ON, Canada.

PMID: 38461888
DOI: 10.1016/j.resuscitation.2024.110172

Abstract

Objective: We sought to evaluate the impact of a COVID-19 Code Blue policy on in-hospital cardiac arrest (IHCA) processes of care, cardiopulmonary resuscitation (CPR) quality metrics, and survival to hospital discharge.

Methods: We completed a health record review of consecutive IHCA for which resuscitation was attempted. We report Utstein outcomes and CPR quality metrics 33 months before (July,2017-March,2020) and after (April,2020-December,2022) the implementation of a COVID-19 Code Blue policy requiring all team members to don personal protective equipment including gown, gloves, mask, and eye protection for all IHCA.

Results: There were 800 IHCA with the following characteristics (Before n = 396; After n = 404): mean age 66, 62.9% male, 81.3% witnessed, 31.3% in the emergency department, 25.6% cardiac cause, and initial shockable rhythm in 16.7%. Among all 404 patients screened for COVID-19, 25 of 288 available test results before IHCA occurred were positive. Comparing the before and after periods: there were relevant time delays (min:sec) in start of chest compressions (0:17vs.0:37;p = 0.005), team arrival (0:43vs.1:21;p = 0.002), 1st rhythm analysis (1:15vs.3:16;p < 0.0001), 1st epinephrine (3:44vs.4:34;p = 0.02), and airway insertion (8:38vs. 10:18;p = 0.02). Resuscitation duration was similar (18:28vs.19:35;p = 0.34). Exception of peri-shock pause which appeared longer (0:06vs.0:14;p = 0.07), chest compression fraction, rate and depth were identical and good. Factors independently associated with survival were age (adjOR 0.98;p < 0.001), male sex (adjOR 1.51;p = 0.048), witnessed (adjOR 2.35;p = 0.02), shockable rhythm (adjOR 3.31;p < 0.0001), hospital location (p = 0.0002), and COVID-19 period (adjOR 0.68;p = 0.052).

Conclusions: The COVID-19 Code Blue policy was associated with delayed processes of care but similarly good CPR quality. The COVID-19 period appeared associated with decreased survival.

Keywords: COVID-19 pandemic; Cardiopulmonary resuscitation quality metrics; In-hospital cardiac arrest; Personal protective equipment.

MeSH terms

Aged
COVID-19* / epidemiology
COVID-19* / therapy
Cardiopulmonary Resuscitation* / methods
Cardiopulmonary Resuscitation* / standards
Clinical Protocols
Female
Heart Arrest* / therapy
Humans
Male
Middle Aged
Personal Protective Equipment
Retrospective Studies
SARS-CoV-2
Time-to-Treatment