Student Dissertation

Agency : Code Blue Cases; Disaster management; CPR; Survival Rates

Objective : ï‚· To analyze the code blue process. ï‚· To find out the survival rate of the patients suffering from Code Blue. ï‚· To analyze and recommend changes if any loopholes are present.

Methodology : • Study type – The study is non-experimental evidence based that is a Retrospective and analytical study. • Area of study- Study is conducted in the Indraprastha Apollo Hospital, New Delhi. • Data Collection method Data is collected from the Code Blue Sheets that are filled and sent to the department by staff of the respective areas of the hospital and also by the monthly Code Blue Announcements given by the telephone exchange and training cell. • Inclusion/Exclusion criteria – All the patients suffering from any emergency that leads to a Code Blue are included in the study. • Sample Size – 365 cases of code blue that occurred in the hospital • Study Period – 4months, December 2015 to March 2016 • Sampling Technique- Purposive sampling

Findings : According to the data and its analysis, the maximum no. of code blue cases has occurred in the month of February. The area with the maximum no. of Code Blue cases is ICU followed by emergency and then wards. Although ICU has maximum no. of Code Blue, it has got least survival rate that is only 4%. On the other hand, dialysis, physician office, diagnostic areas etc have 100% immediate survival rate. When we compared the cases on the basis of age of the patient, most successful age group that is with best survival rate has been found to be the young age group, 16-30 years. The worst survival rate has been found for the children aged 15 years. The survival rate has been found to be just 6% i.e. out of 30 code blues, only 2 have survived and out of those two, only 1 has successfully discharged. Most of the children amongst them have suffered from respiratory causes and as per a study most often, cardiac arrest in children is the result of a primary respiratory cause. Breathing conditions such as anaphylaxis, apnea, aspiration, asthma, bronchiolitis, epiglottitis, drowning, pneumonia, respiratory syncytial virus, smoke inhalation, and suffocation can quickly deteriorate into respiratory failure. Variable periods of systemic hypoxemia, hypercapnea, and acidosis occur, with progression to bradycardia and hypotension, terminating in cardiac arrest. The overall Immediate Survival Rate has been found out to be 22% and if we exclude ICU &Emergency from the Total Cases, the Immediate Survival Rate has drastically improved to 84% We have also analyzed the twenty-four-hour survival rate in these cases. As far as twenty-four hours survival rate is concerned, the overall rate has been found out to be 10% with maximum no. of cases in Wards. The Overall Survival Rate to discharge has also been analysed and has come out to be 4.11% with maximum no. of cases in wards.

Recommendations : From the study, it is concluded that the Overall Code Blue Survival Rate has definitely improved as compared to the previous quadrimester. Previously, it was 19% but has improved to 22% for this period. It has also been concluded from the above study that the hospital also includes the cases of ICU as Code Blue Cases in the study following the usual protocols. But, it actually should not be included in the study as they are not the code blue cases that are announced. The survival rate including the cases of ICU and emergency comes out to be 22% but when we exclude the cases of ICU & Emergency, the survival rate gets improved to 84% and these are the actual code blue cases that are announced. So, it has been recommended to the management to exclude these cases from their quarterly study of Code Blue. The Survival Rate to discharge is also very less i.e. 4.11%. For this, the management has decided to look in to the diagnostic details of such cases. For the declining survival rate of pediatric patients: ï‚· Training and maintaining skills. Enrollment in lifesaving courses such as pediatric basic life support (BLS) and PALS is recommended once every year. The frequency with which a professional is required to use resuscitation skills also have an impact on the frequency with which training is needed in order to prevent the degradation of knowledge and skills. ï‚· Follow 2010 AHA Guidelines for CPR Chest compressions first, followed by airway, and then breathing/ventilations