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

Christian Vaillancourt1, Manya Charette2, Soha Khorsand2

  • 1Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada.

Resuscitation
|March 10, 2024
PubMed

Insights

The COVID-19 Code Blue policy led to delays in in-hospital cardiac arrest care but maintained cardiopulmonary resuscitation quality. The pandemic period was associated with decreased survival rates.

Area of Science:

  • Emergency Medicine
  • Critical Care Medicine
  • Public Health

Background:

  • The COVID-19 pandemic necessitated new protocols, including enhanced personal protective equipment (PPE) use during resuscitation events.
  • Code Blue policies were adapted to mitigate viral transmission risks during in-hospital cardiac arrests (IHCA).

Purpose of the Study:

  • To evaluate the impact of a COVID-19 Code Blue policy on IHCA processes of care.
  • To assess changes in cardiopulmonary resuscitation (CPR) quality metrics and survival to hospital discharge.
  • To analyze the association between the COVID-19 period and IHCA outcomes.

Main Methods:

  • A health record review of consecutive IHCA cases was conducted.
  • Data were collected for 33 months before (July 2017-March 2020) and after (April 2020-December 2022) policy implementation.
  • Utstein outcomes and CPR quality metrics were compared between the two periods.

Main Results:

  • Significant time delays were observed in chest compressions, team arrival, rhythm analysis, epinephrine administration, and airway insertion post-policy implementation.
  • Chest compression fraction, rate, and depth remained consistently good, with a notable increase in peri-shock pause.
  • Factors associated with survival included younger age, male sex, witnessed arrest, shockable rhythm, and hospital location; the COVID-19 period was associated with decreased survival (adjOR 0.68, p=0.052).

Conclusions:

  • The COVID-19 Code Blue policy, while associated with delayed care processes, did not compromise CPR quality.
  • The implementation of enhanced PPE requirements during IHCA correlated with a potential decrease in survival rates during the COVID-19 period.
Abstract

Keywords:
COVID-19 pandemicCardiopulmonary resuscitation quality metricsIn-hospital cardiac arrestPersonal protective equipment

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