Understanding Code Blue Activations: Insights From Early Warning and Palliative Scores in a Tertiary Hospital

Abstract

Gezy Weita Giwangkancana,1 Yani Gezy Setiasih,2 Anisa Hasanah,2 Yunita Persiyawati,2 Wawan2 1Department of Anesthesia and Intensive Care, Faculty of Medicine Universitas Padjadjaran / Dr. Hasan Sadikin National Referral and Teaching Hospital, Bandung, Indonesia; 2Department of Nursing Dr. Hasan Sadikin National Referral and Teaching Hospital, Bandung, IndonesiaCorrespondence: Gezy Weita Giwangkancana, Department of Anesthesia and Intensive Care, Faculty of Medicine Universitas Padjadjaran / Dr. Hasan Sadikin National Referral and Teaching Hospital Bandung, Bandung, 40161, Indonesia, Tel [phone], Email [email protected]: In-hospital cardiac arrest (IHCA) is a critical emergency, occurring at rates of 1– 6 events per 1000 hospital admissions, necessitating immediate and efficient resuscitation efforts. This study aims to determine the frequency, demographic characteristics, and outcomes of Code Blue activations in a tertiary teaching hospital in a low-middle-income country.Methods: This retrospective observational study was conducted at in National Referral and Teaching Hospital in a middle income country in Asia, covering data from January 1, 2017, to December 31, 2023. The study included 2184 Code Blue activations, with data on Early Warning Scores (EWS) and palliative scores available from 2021 onwards. Statistical analyses were performed to evaluate the relationship between these scores and patient outcomes.Results: Out of 2184 Code Blue activations, 713 cases included both EWS and palliative scores. The highest number of activations was recorded in 2019 (535 cases), and the lowest in 2021 (152 cases). Calculated incidence where 5.46 per 1000 visits. The return of spontaneous circulation (ROSC) rates ranged from 11% to 27.6%, with an average of 17.7% per year. The mean EWS and palliative scores for Code Blue activations were 9.2 (SD ± 2.3) and 7.8 (SD ± 1.9), respectively.Discussion: The findings highlight trends in IHCA incidence, causes, and outcomes, emphasizing the importance of early identification and management of patients at risk. The study underscores the need for continuous monitoring and early intervention, particularly for patients with high EWS. Additionally, the integration of palliative care considerations into hospital protocols is crucial for improving patient outcomes and resource allocation.Conclusion: Early warning system and palliative care scoring may predict code blue activation and if managed can reduce its number.Keywords: In-hospital cardiac arrest, code blue, early warning score, palliative care, emergency response, resuscitation

Keywords

• in-hospital cardiac arrest
• code blue
• early warning score
• palliative care
• emergency response
• resuscitation