Abstract 259: Characteristics of Patients With Sudden in Hospital Cardiac Arrest With a Shockable Initial Rhythm in a System With Mature Rapid Response and Code Blue Teams

Abstract

Study Objectives: Every year 33,000 people suffer an IHCA with an initial shockable rhythm in the US. Rapid Response Teams may increase time to defibrillation and are not associated with lower in-hospital mortality. We sought to describe characteristics of sudden IHCAs with a shockable initial rhythm in a system with mature Rapid Response and Code Blue teams, in particular, time to defibrillation. Methods: Retrospective chart review at a large, urban teaching hospital with mature Rapid Response and Code Blue teams. Adults in whom a “Code Blue” was called with confirmed cardiac arrest between Jan 2017 and Mar 2018 were included. Codes with incomplete data or that occurred in the ED or ICU were excluded. The “Code Blue” team consists of 1-3 Nurse Responders, a nursing supervisor, a respiratory therapist, Anesthesiology, a critical care resident, and a surgical resident. Each ward has a defibrillator and standardized code cart. Trained and supervised research assistants used a standardized data collection tool to extract demographic information, comorbidities and event related data from code sheets, history and physical, progress notes, discharge and death summaries. Events were categorized by initial rhythm as shockable or non-shockable. Time to defibrillation was defined as the interval from reported time of initial recognition of cardiac arrest to the reported time of first attempted defibrillation. Fisher’s exact testing was used to test for statistical significance. Results: A total of 183 “Code Blues” met criteria. Demographics: 71% black; mean age 65; and 46% women. Fifty-five (30%) survived to hospital discharge. Forty (21.3%) had an initial shockable rhythm of whom 21 (52.5%) survived to hospital discharge. Of the 40 patients that had an initial shockable rhythm, 36 were defibrillated. Median time to defibrillation was 2 minutes [IQR = 1-4]. Of those defibrillated within 2 minutes, survival was 64% vs 33% (P = 0.102) among those defibrillated in > 2 minutes. Of the 143 patients that had a nonshockable initial rhythm, 34 (23.8%) survived to hospital discharge. Conclusion: In a system with mature Rapid Response and Code Blue teams, time to defibrillation among IHCA patients with a shockable initial rhythm is 2 minutes.