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Published on: March 29, 2019
Factors associated with non-arrest events triggering code blue alerts: a retrospective cohort study in a tertiary
Mohamad A Nashtar1, Patrick H Nekarda1, Michael Steckstor1
1Ruhr University Bochum, Knappschaft Kliniken University Hospital Bochum, Department of Medicine, Bochum, Germany.
Insights
Over half of cardiopulmonary resuscitation (CPR) alerts are for non-arrest events (IHNA), often involving younger patients in non-clinical areas. These findings highlight the need for targeted training and awareness for IHNA situations.
Area of Science:
- Emergency Medicine
- Cardiology
- Healthcare Operations
Background:
- In-hospital non-arrest (IHNA) cardiopulmonary resuscitation (CPR) alerts consume significant resources but are poorly understood.
- Characterizing IHNA events is crucial for optimizing resource allocation and patient care.
Purpose of the Study:
- To quantify the burden of IHNA events.
- To identify clinical and operational factors differentiating IHNA from true in-hospital cardiac arrests (IHCA).
Main Methods:
- Retrospective cohort study of adult CPR-team alerts at a German tertiary center (2011-2015).
- CPR-positive (CPR+) events defined as IHCA; CPR-negative (CPR-) events as IHNA.
- Multivariable logistic regression with bootstrap validation analyzed factors associated with IHNA.
Main Results:
- 53.5% of 288 CPR alerts were IHNA (CPR-), 46.5% were IHCA (CPR+).
- IHNA patients were younger, predominantly female, and occurred more during morning shifts in non-clinical locations.
- Older age, inpatient status, witnessed events, and ICU/telemetry locations reduced IHNA odds; morning shifts increased them (AUC 0.84).
Conclusions:
- Over half of CPR alerts are IHNA, associated with younger patients, unwitnessed events, non-inpatient status, and non-clinical locations.
- Findings identify high-risk contexts for IHNA, suggesting a need for targeted training and early assessment strategies.
- Observational design necessitates cautious interpretation; prospective evaluation is needed for resource utilization impact.
Objectives:
In-hospital non-arrest (IHNA) cardiopulmonary resuscitation (CPR) alerts, while consuming substantial resources, are poorly characterized. We quantified the burden of IHNA and identified clinical and operational factors that differentiate them from true in-hospital cardiac arrests (IHCA).
Methods:
A retrospective cohort of adult CPR-team alerts at a German tertiary center between January 2011 and February 2015 was conducted. CPR-positive (CPR+) events were confirmed IHCA requiring chest compressions; others, i.e., IHNA, were CPR-negative (CPR-). Demographic, clinical and workflow data were abstracted from hospital records. Factors associated with CPR-/IHNA were analyzed using multivariable logistic regression with non-parametric bootstrap validation.
Results:
Among 288 CPR-team deployments, 154 (53.5%) were CPR-/IHNA and 134 (46.5%) CPR+/IHCA. Patients experiencing CPR-/IHNA were younger (51.5 ± 20.7 vs. 64.1 ± 13.9 years) and predominantly female (57.2% vs. 32.1%). CPR-/IHNA occurred more frequently during morning shifts and in non-clinical on-campus locations, whereas CPR+/IHCA clustered in monitored wards and among inpatients. In multivariable analysis, older age, inpatient status, witnessed events and location in Intermediate Care/Intensive Care Unit (IMC/ICU)/telemetry wards independently reduced the odds of CPR-/IHNA, while morning shift timing increased them; model discrimination was good (AUC 0.84).
Conclusions:
Over half of CPR-team alerts were CPR-/IHNA and were associated with younger age, unwitnessed collapse, non-inpatient status and non-clinical locations. These findings delineate contexts in which non-arrest emergencies are more frequently encountered and may inform targeted training and early assessment strategies, while underscoring the need for cautious interpretation given the observational design.
Implications For Clinical Practice:
High-risk contexts for CPR-/IHNA, such as morning shifts, non-clinical campus areas and events involving non-hospitalized individuals, highlight settings in which enhanced staff awareness, early clinical assessment, and education on non-arrest emergencies may be particularly relevant. Potential effects on alarm burden or resource utilization require prospective evaluation.
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