Code Blue Outcomes of CPR and Post-ICU Admissions from a Major Tertiary Care Center in Northern India: A Retrospective Cohort Study

Introduction:Code Blue events denote critical emergencies within hospital settings that frequently signify life-threatening situations necessitating immediate interventions such as cardiopulmonary resuscitation (CPR). The outcomes of these pivotal incidents in a large tertiary care hospital are crucial for refining hospital protocols, enhancing overall patient care, and improving survival rates through efficient resource management. This study presents a unique perspective on Code Blue activations and their outcomes, including the return of spontaneous circulation (ROSC) and the impact of post-ICU admissions on patient survival rates. The potential to optimize hospital protocols based on these findings should inspire confidence and optimism among clinicians, thereby supporting a more promising future in emergency medical care. Materials and Methods : The study included code blue activations from January 2023 to June 2024 at a 1,250-bed tertiary care hospital in Northern India, involving CPR, defibrillation, intubation, venous access, and medication administration. Patients were divided into two groups: those who received CPR (Group I) and those who did not (Group II). The outcomes analyzed were: a) survival status during code blue alerts and b) survival after ICU admission. Results showed 288 (0.029%) code blue events from 964,923 unique patient entries, including inpatients and outpatients. Males, with an average age of 57.9 years, comprised 64.2% (n = 185), while females, with a mean age of 57.1 years, accounted for 35.8% (n = 103). Most patients had at least one comorbidity, affecting 42.4% (n = 122) of the sample. The highest number of codes occurred in the Accident and Emergency (A&E) department (n = 139; 48.3%), followed by oncology and daycare chemotherapy centers (11.5%, n = 33). Comorbidities significantly influenced survival; patients with fewer comorbidities (n = 122; 59.1%) had better outcomes than those with five or more (n = 35; 37.9%). The cardiac rhythm at arrest was critical; shockable rhythms (ventricular tachycardia and fibrillation) had a higher rate of ROSC, whereas non-shockable rhythms (asystole and pulseless electrical activity) had only a 10% chance of ROSC. Patients receiving CPR for less than 30 minutes had a ROSC rate of 92.5% and a survival rate of 35%. Conversely, those receiving CPR for 30 minutes or longer had an ROSC rate of 8.6% and a survival rate of 4.3% (p < 0.000). Of the 288 patients, 164 (56.9%) were admitted to the ICU, and 134 (46.5%) were discharged alive with good neurological recovery. Conclusion : The study underscores the urgent and essential need for the prompt commencement of cardiopulmonary resuscitation (CPR) and resuscitative efforts to attain return of spontaneous circulation (ROSC). Effective post-ICU care significantly impacts the survival prospects of these patients. The prevention of cardiac arrest is crucial for improving neurological outcomes, which can be achieved through increasing staffing levels and monitoring during non-operational hours.