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In-hospital resuscitation: opioids and other factors influencing survival
Karamarie Fecho1, Freeman Jackson, Frances Smith
1Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina, USA.
Insights
Survival rates after a Code Blue event requiring cardiopulmonary resuscitation (CPR) were 26.4% to discharge. Opioid use was linked to lower survival in non-CPR events, highlighting potential risks.
Area of Science:
- Emergency Medicine
- Critical Care Medicine
- Clinical Outcomes Research
Background:
- Code Blue events signify a critical need for immediate resuscitation in hospitals.
- Understanding survival rates and influencing factors is crucial for improving patient outcomes.
- Previous research has not fully elucidated the impact of specific interventions and patient characteristics on Code Blue survival.
Purpose of the Study:
- To determine survival rates for Code Blue events.
- To investigate the influence of opioids and other factors on patient survival during and after resuscitation events.
- To differentiate survival based on the need for cardiopulmonary resuscitation (CPR).
Main Methods:
- Retrospective analysis of medical records, Code Blue, and Pharmacy databases.
- Data collected for Code Blue events occurring in 2006.
- Statistical analysis to identify factors associated with survival to discharge.
Main Results:
- Survival to discharge after Code Blue events involving CPR was 26.4%.
- Survival to discharge for non-CPR events was significantly higher at 62.3%.
- For CPR events, survival correlated inversely with time to interventions and patient acuity; opioid use did not significantly impact survival. For non-CPR events, opioid use (continuous infusions or IV boluses) was associated with decreased survival.
Conclusions:
- Approximately one-quarter of patients survive to discharge following a CPR-requiring Code Blue event.
- A higher proportion, two-thirds, survive to discharge after non-CPR Code Blue events.
- Opioid administration may negatively affect survival in non-CPR Code Blue scenarios.
Purpose:
"Code Blue" is a standard term used to alertt hospital staff that a patient requires resuscitation. This study determined rates of survival from Code Blue events and the role of opioids and other factors on survival.
Methods:
Data derived from medical records and the Code Blue and Pharmacy databases were analyzed for factors affecting survival.
Results:
During 2006, rates of survival from the code only and to discharge were 25.9% and 26.4%, respectively, for Code Blue events involving cardiopulmonary resuscitation (CPR; N = 216). Survival rates for events not ultimately requiring CPR (N = 77) were higher, with 32.5% surviving the code only and 62.3% surviving to discharge. For CPR events, rates of survival to discharge correlated inversely with time to chest compressions and defibrillation, precipitating event, need for airway management, location and age. Time of week, witnessing, postoperative status, gender and opioid use did not influence survival rates. For non-CPR events, opioid use was associated with decreased survival. Survival rates were lowest for patients receiving continuous infusions (P < 0.01) or iv boluses of opioids (P < 0.05).
Conclusions:
One-quarter of patients survive to discharge after a CPR Code Blue event and two-thirds survive to discharge after a non-CPR event. Opioids may influence survival from non-CPR events.
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