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Updated: Feb 5, 2026

A Piglet Perinatal Asphyxia Model to Study Cardiac Injury and Hemodynamics after Cardiac Arrest, Resuscitation, and the Return of Spontaneous Circulation

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Code Blue blindspots: mapping nursing exposure to cardiac arrests.

Devin Walker¹, Daniah Allali², Adam Szulewski³

¹MD Candidate, School of Medicine, Queen's University, Kingston, Ontario, Canada.

|February 3, 2026

Summary

Nurses face infrequent and unpredictable exposure to in-hospital cardiac arrests (IHCA). This variability challenges skill maintenance, highlighting the need for targeted training to improve response readiness.

Keywords:

Code Blue In-hospital cardiac arrest Nursing exposure Resuscitation Simulation training Skill decay

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Area of Science:

Emergency Medicine
Healthcare Workforce Management
Clinical Skills Training

Background:

In-hospital cardiac arrest (IHCA) necessitates rapid team response.
The rarity of IHCA poses challenges for maintaining nurse competence.
Understanding nurse exposure to IHCA is crucial for effective training.

Purpose of the Study:

To analyze spatial-temporal patterns of IHCA events.
To model nursing exposure to IHCA based on various work schedules.
To identify gaps in exposure that may affect skill retention.

Main Methods:

Analysis of Code Blue activations over two years at a tertiary hospital.
Modeling nursing exposure using 10,000 work schedule variants.
Calculation of IHCA event frequency and intervals between exposures per schedule.

Main Results:

IHCA events were concentrated, with 30% in one unit.
Nurses on standard schedules experienced median gaps of 36 days between events.
Nearly all modeled schedules included gaps longer than 90 days between IHCA exposures.

Conclusions:

Most nurses encounter infrequent and irregular intervals between IHCA events.
Prolonged gaps risk decay of critical resuscitation skills.
Targeted simulation or just-in-time training can mitigate skill erosion and enhance IHCA response.