COBRA: COde Blue Retrospective Audit in a metropolitan hospital

Area of Science:

• Cardiology
• Critical Care Medicine
• Hospital Management

Background:

• Inhospital cardiac arrest (IHCA) presents a significant clinical challenge.
• High mortality rates are associated with IHCA.
• Understanding IHCA management and outcomes is crucial for improving patient care.

Purpose of the Study:

• To analyze the management and outcomes of IHCA.
• To evaluate the impact of introducing a Medical Emergency Team (MET) on IHCA prevalence.
• To identify factors influencing survival to hospital discharge after IHCA.

Main Methods:

• Retrospective review of 176 adult IHCA cases over five years.
• Inclusion of patients receiving cardiopulmonary resuscitation across various hospital settings.
• Statistical analysis using average treatment effect (ATE) and control charts to assess outcomes and prevalence over time.

Main Results:

• Inhospital cardiac arrest (IHCA) had a high mortality rate, with 65.3% of patients dying during hospitalization.
• The introduction of a dedicated MET service did not alter IHCA prevalence.
• Survival to discharge was associated with initial rhythms of ventricular tachycardia (VT) or ventricular fibrillation (VF), cardiac monitoring, and shorter times to return of spontaneous circulation.

Conclusions:

• IHCA remains an uncommon but high-mortality event.
• A dedicated MET service did not reduce IHCA prevalence in this study.
• Key factors for improved survival include initial shockable rhythms (VT/VF), continuous cardiac monitoring, and prompt resuscitation efforts.