‘Code blue button’ may improve care of in-hospital cardiac arrest
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CHICAGO — A “code blue button” to activate code teams via text message may expedite epinephrine administration and increase survival to discharge vs. code activation by overhead page or pager alerts, a speaker reported.
However, Cody Couperus, MD, resident physician in the emergency medicine and internal medicine program at University of Maryland Medical Center in Baltimore, Maryland, told Healio that due to the small study size, these findings are not statistically significant and require verification in a larger cohort.
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The data were presented at the Resuscitation Science Symposium of the American Heart Association Scientific Sessions.
“Use of a smartphone code blue notification system significantly reduced the time to code team notification,” Couperus told Healio. “The notification also delivered critical, need-to-know, information for doctors and nurses who will immediately be working to save the patient's life. We feel that this study helps show the way towards innovative strategies to improve the care of our patients.”
Utilizing patient electronic health record data, Couperus and colleagues mapped code blue buttons behind each hospital bed in four inpatient units. In the event of an in-hospital cardiac arrest, pressing the code blue button sent patient-specific data including admitting diagnosis, recent procedural history, presence of difficult airway and most recent potassium, bicarbonate, troponin and hemoglobin levels via secure text messaging system to the code teams’ smartphones. At the same time, the code blue button also contacted the hospital operator who activated the code blue team via traditional methods such as overhead page and pager alerts.
“The cost of implementation would depend upon a hospital’s current technical infrastructure. Our methods utilized systems that were already active and in use,” Couperus told Healio. “The main cost was the time investment from our physician builder and technical teams.”
The code blue button was tested from November 2019 through May 2022.
The primary outcomes were time from code blue button press to smartphone message receipt compared with overhead page; time to epinephrine administration; and survival to discharge.
A total of 35 cardiac arrests occurred during the study period, of which 12 had code team activation via code blue button press.
On average, the code team received smartphone notifications a median of 78 seconds (interquartile range, 47-127) before they were notified via overhead page and pager alerts.
Researchers reported that the median time to epinephrine administration was 2 minutes and 57 seconds for codes activated via button push compared with 4 minutes for codes activated via traditional methods (P = .89).
Survival to hospital discharge was 25% for codes activated with the button and 17.4% for codes activated by traditional methods (P = .61).
“With regards to reduced time until epinephrine, it makes good sense that getting the code team to the patient faster should help them get the best care,” Couperus told Healio. “Due to the small number of patients in the study, though, these findings are not statistically significant. Larger studies are needed to help elucidate other outcomes, such as time to epinephrine, time to defibrillation, survival and neurologic outcomes.”
Reference:
- Smartphone alerts may lead to faster response to in-hospital cardiac arrest, “code blue”. newsroom.heart.org/news/smartphone-alerts-may-lead-to-faster-response-to-in-hospital-cardiac-arrest-code-blue. Published on Oct. 31, 2022. Accessed on Nov. 4, 2022.
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Couperus C, et al. Abstract 6. Presented at: American Heart Association Resuscitation Science Symposium; Nov. 5-7, 2022; Chicago (hybrid meeting).
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