INDEX
S.NO / Topic / Annexure No. / Page1. / Glossary / 2-3
2. / CPR committee /Code blue team / Emergency codes / Annexure-1 / 4
3. / Crash Cart trolley / Annexure-2 / 5
4. / Standardized List of Crash Cart / Annexure-3 / 6
5. / BLS Training 2015,2016,2017 / Annexure-4a / 7
6. / ACLS Training 2015,2016,2017 / Annexure-4b / 8
7. / Code Blue Performa / Annexure-5 / 9
8. / Six Sigma-DMAIC / Annexure-6 / 10
9. / Cardio Pulmonary Resuscitation Analysis
– Year 2015-2016 / Annexure-7 / 11
10. / Cardio Pulmonary Resuscitation Analysis –
Year 2016-2017 / Annexure-8 / 12
11. / Code Blue activated vs. Cardio Pulmonary Respiratory Arrest -2015/2016/2017 / Annexure-9 / 13
12. / Code Blue team arrive within 3 min (%) / Annexure-10 / 14
13. / Return of Spontaneous Circulation (ROSC)
after CPR (%) / Annexure-11 / 15
14. / Discharged after ROSC (%) / Annexure-12 / 16
15. / Logistic Checklist (Code Blue Performa)- 2015/2016/2017 / Annexure-13a/13b / 17-18
Glossary :
Advanced Cardiovascular Life Support (ACLS): Emergency medical procedure in which basic life support efforts of CPR are supplemented with drug administration, Iv fluids, etc.
Basic Life Support (BLS): Emergency treatment of a victim of cardiac or respiratory arrest through cardiopulmonary resuscitation and emergency cardiovascular care.
Code Blue: A declaration of or a state of medical emergency and call for medical personnel and equipment to attempt to resuscitate a patient especially when in cardiac arrest or respiratory distress or failure.
CPR: A basic emergency procedure for life support, consisting of mainly manual external cardiac massage and some artificial respiration.
Cardiac arrest: Defined as the cessation of cardiac mechanical activity as confirmed by lapse in circulation, which was determined by the absence of a palpable central pulse.
Continual Quality Improvement: CQI is serial experimentation (the scientific method) applied to everyday work to meet the needs of those we serve and improve the services we offer.
Return of Spontaneous Circulation (ROSC): is resumption of sustained perfusing cardiac activity associated with significant respiratory effort aftercardiac arrest
References:
In-hospital cardiac arrest is an emergency situation that requires teamwork and the appropriate sequential actions to rescue the patients.[1]despite considerable efforts to improve the treatment of cardiac arrest, most reported survival outcome figures are poor.[2] Even in the hospitalised patients, the rate of successful CPR has been reported by some studies to be as low as 2–6%, although most studies report successful CPR outcome in the range of 13–59%.[3,4]
Very few studies are available in the literature on comparative CPR outcomes after formal resuscitation training. An in-hospital investigation demonstrated that cardiac arrest detected by an ACLS-trained nurse was strongly associated with a four-fold increase in survival to discharge
(38% vs. 10%) than those detected by a nurse without ACLS training.[5] This indicates that ACLS-trained nurses provided an independent contribution to increased survival rate.
Successful resuscitation after cardiac arrest requires early recognition of cardiac arrest, rapid activation of trained responders, timely initiation of BLS, early defibrillation and early ACLS.[6] In accordance with a few data available in the literature, our study reveals that formal training of the CPR team drastically improves the survival rates and survival to hospital discharge rates following resuscitation of cardiac arrest victims. We conclude that formal certified BLS and ACLS training courses with hands-on practice and their periodic renewal are crucial in improving the outcomes of CPR.
Study by Saket Girotra, forthe American Heart Association Get with the Guidelines–Resuscitation Investigators in “Trends in Survival after In-Hospital Cardiac Arrest “shows that the overall rate of survival to discharge improved significantly from 13.7% in 2000 to 22.3% in 2009. [7]
Biblography
1.Krittayaphong R, Saengsung P, Chawaruechai T, Yindeengam A, Udompunturak S. Factors predicting outcome of cardiopulmonary resuscitation in a developing country: The Siriraj cardiopulmonary resuscitation registry.J Med Assoc Thai.2009;92:618–23.[PubMed]
2.Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation. (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa)Resuscitation.2004;63:233–49.[PubMed]
3.Borimnejad L, Nasrabadi AN, Mohammadi H, Kheirati L. Improving the outcomes of CPR: A report of a reform in the organization of emergency response.Internet J Emer Med.2008;4:2.
4.Berger R, Kelley M. Survival after in-hospital cardiopulmonary arrest of noncritically ill patients.Chest.1994;106:872–9.[PubMed]
5.Dane FC, Russell-Lindgren KS, Parish DC, Durham MD, Brown TD. In-hospital resuscitation: Association between ACLS training and survival to discharge.Resuscitation.2000;47:83–7.[PubMed]
6.Doig CJ, Boiteau PJ, Sandham JD. A 2-year prospective cohort study of cardiac resuscitation in a major Canadian hospital.Clin Invest Med.2000;23:132–43.[PubMed]
7. Saket Girotra, M.D., Brahmajee K. Nallamothu, M.D., M.P.H., John A. Spertus, M.D., M.P.H., Yan Li, Ph.D., Harlan M. Krumholz, M.D., and Paul S. Chan, M.D., forthe American Heart Association Get with the Guidelines–Resuscitation Investigators.
Annexure-1
Cardio Pulmonary Resuscitation Committee-Members / Code Orange-Medical Emergency Paediatric / *5777Dr. B.K. Rao, Chairperson / Chairperson - Deptt. of Critical Care & Emergency Medicine / Paediatric ICU Registrar on Duty
Dr.Reena Kumar / A.D.M.S / Nursing Supervisor
Dr. Ashwini Mehta / Sr. Consultant, Cardiology / Nursing Supervisor
Dr. Suresh Gupta / Sr. Consultant, Paediatrics / DMS on Duty
Dr. Debashish Dhar / Sr. Consultant, Paediatrics / ECG Technician
Dr. Jyoti / DMS & In-charge - Quality / Telephone Exchange
Ms. Usha Pandey / Chief Nursing Officer
Code BLUE-Cardiopulmonary Arrest / *5111 / Code Indigo-Medical Emergency Neonatal / *5999
ICU CONSULTANT / Neonatology ICU Registrar on duty
ICU REGISTRAR / Nursing Supervisor
CARDIOLOGY REGISTRAR / Nursing Supervisor
DMS ON DUTY / DMS on Duty
NURSING SUPERVISOR / ECG Technician
TELEPHONE EXCHANGE / Telephone Exchange
1
Annexure-2
Annexure-3
Standardized List of Crash Cart – Uniform in all locations
Annexure-4a
BLS Training 2015/2016/2017Categories of staff / 2015 / 2016 / 2017 / Total
Doctor / 200 / 440 / 98 / 738
Nurses / 500 / 800 / 210 / 1510
Paramedical Staff / 109 / 150 / 40 / 299
Grand Total / 811 / 1396 / 348 / 2555
Annexure-4b
ACLS Training 2015/2016/2017Categories of staff / 2015 / 2016 / 2017 / Total
Doctor / 102 / 240 / 60 / 402
Nurses / 367 / 605 / 200 / 1172
Grand Total / 471 / 851 / 230 / 1552
Annexure-5
Six Sigma-DMAIC Annexure-6
Annexure-7
CARDIO PULMONARY RESUSCITATION ANALYSIS - YEAR 2015-2016Apr-15 / May-15 / Jun-15 / Jul-15 / Aug-15 / Sep-15 / Oct-15 / Nov-15 / Dec-15 / Jan-16 / Feb-16 / Mar-16
No. of Cases / % of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases
Total no. of Code Blue activated / 14 / 10 / 17 / 12 / 7 / 4 / 9 / 18 / 14 / 23 / 22 / 16
Team arrival time –within 3min / 13 / 92.86 / 10 / 100 / 15 / 88.24 / 12 / 100 / 7 / 100 / 2 / 50 / 6 / 66.67 / 18 / 100 / 13 / 92.86 / 19 / 82.61 / 20 / 90.91 / 14 / 87.50
Cardio Pulmonary Respiratory Arrest / 9 / 64.29 / 7 / 70 / 10 / 58.82 / 6 / 50.00 / 5 / 71.43 / 1 / 25.00 / 4 / 44.44 / 12 / 66.67 / 7 / 50.00 / 21 / 91.30 / 14 / 63.64 / 11 / 68.75
Return of spontaneous circulation (ROSC)after CPR / 4 / 44.44 / 3 / 42.86 / 3 / 30.00 / 2 / 33.33 / 1 / 20.00 / 0 / 0.00 / 0 / 0.00 / 4 / 33.33 / 4 / 57.14 / 7 / 33.33 / 5 / 35.71 / 6 / 54.55
Patients Discharged / 0 / 0.00 / 1 / 14.29 / 2 / 20.00 / 1 / 16.67 / 0 / 0.00 / 0 / 0.00 / 2 / 50.00 / 2 / 16.67 / 1 / 14.29 / 4 / 19.05 / 2 / 14.29 / 1 / 9.09
Annexure-8
CARDIO PULMONARY RESUSCITATION ANALYSIS - YEAR 2016-2017Apr-16 / May-16 / Jun-16 / Jul-16 / Aug-16 / Sep-16 / Oct-16 / Nov-16 / Dec-16 / Jan-17 / Feb-17 / Mar-17
No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases / No. of Cases / %age of cases
Total no. of Code Blue activated / 13 / 16 / 13 / 15 / 14.00 / 16 / 10 / 14 / 12 / 14 / 13 / 16
Team arrival time –within 3min / 11 / 84.62 / 13 / 81.25 / 13 / 100 / 13 / 86.67 / 12 / 85.71 / 15 / 93.75 / 8 / 80.0 / 14 / 100 / 12 / 100 / 14 / 100 / 13 / 100 / 15 / 93.75
Cardio Pulmonary Respiratory Arrest / 11 / 84.62 / 14 / 87.50 / 7 / 53.85 / 12 / 80.00 / 9.00 / 64.29 / 15.00 / 93.75 / 9 / 90.00 / 13 / 92.86 / 12 / 100.00 / 11 / 78.57 / 11 / 84.62 / 15 / 93.75
Return of spontaneous circulation (ROSC)after CPR / 5 / 45.45 / 7 / 50.00 / 1 / 14.29 / 5 / 41.67 / 3.00 / 33.33 / 7.00 / 46.67 / 4 / 44.44 / 4 / 30.77 / 2 / 16.67 / 4 / 36.36 / 7 / 63.64 / 6 / 40.00
Patients Discharged / 3 / 27.27 / 4 / 28.57 / 4 / 57.14 / 2 / 16.67 / 2.00 / 22.22 / 6.00 / 40.00 / 2 / 22.22 / 2 / 15.38 / 6 / 50.00 / 4 / 36.36 / 2 / 18.18 / 5 / 33.33
Annexure-9
Code Blue activated vs. Cardio Pulmonary Respiratory Arrest -2015-2016,2017
Apr-15 / May-15 / Jun-15 / Jul-15 / Aug-15 / Sep-15 / Oct-15 / Nov-15 / Dec-15 / Jan-16 / Feb-16 / Mar-16 / Apr-16 / May-16 / Jun-16 / Jul-16 / Aug-16 / Sep-16 / Oct-16 / Nov-16 / Dec-16 / Jan-17 / Feb-17 / Mar-17
Code Blue activated-2015,16,17 / 14 / 10 / 17 / 12 / 7 / 4 / 9 / 18 / 14 / 23 / 22 / 16 / 13 / 16 / 13 / 15 / 20 / 21 / 13 / 14 / 12 / 17 / 13 / 19
Cardio Pulmonary Respiratory Arrest-2015,16,17 / 9 / 7 / 10 / 6 / 5 / 1 / 4 / 12 / 7 / 21 / 14 / 11 / 11 / 14 / 7 / 12 / 9 / 15 / 9 / 7 / 12 / 11 / 11 / 15
Annexure-10
Code Blue team arrive within 3min(%)April / May / June / July / Aug / Sept / Oct / Nov / Dec / Jan / Feb / March / Average (%)
2015-16 / 92.86% / 100% / 88.24% / 100% / 100% / 50% / 66.67% / 100% / 92.86% / 82.61% / 90.91% / 87.50% / 87.64%
2016-17 / 84.60% / 81.25% / 100% / 86.67% / 85% / 93.75% / 80.00% / 100% / 100% / 100% / 100% / 94% / 92.89%
Annexure-11
Return of spontaneous circulation (ROSC) after CPR (%)April / May / June / July / August / September / October / November / December / January / February / March / Average (%)
2015-16 / 44.4% / 42.9% / 30.0% / 33.3% / 20.0% / 0.0% / 0.0% / 33.3% / 57.1% / 33.3% / 35.7% / 54.5% / 32.10%
2016-17 / 45.5% / 50.0% / 14.3% / 41.7% / 33.3% / 46.7% / 44.4% / 30.8% / 16.7% / 36.4% / 63.6% / 40.0% / 38.60%
Annexure12
Discharged after ROSC(%)Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec / Jan / Feb / Mar / Average (%)
2015-16 / 0.0% / 14.3% / 20.0% / 16.7% / 0.0% / 0.0% / 50.0% / 16.7% / 14.3% / 19.0% / 14.3% / 9.1% / 14.50%
2016-17 / 27.3% / 28.6% / 57.1% / 16.7% / 22.2% / 40.0% / 22.0% / 15.4% / 50.0% / 36.4% / 18.2% / 33.3% / 30.60%
Annexure-13a
Logistic Checklist -Code Blue Performa 2015/2016/2017
13 / Was staff able to readily locate/operate the following: / Available, and was used / Available, but not used on the patient / Available, but defective / Not Availablea) Emergency Medicines
b) Defibrillator
c) Laryngoscope
d) Ambu bag
e) Oxygen Cylinder (filled or not)
f) Suction machine & suction catheter
g) Glucometer
Annexure-13b
Logistic Checklist Code Blue Performa 2015,2016,2017Ambu Bag / Laryngoscope & intubation / Defibrillator / ET tube & Airways / O2 therapy / Emergency Medicines / Others (
Non-compliance (%) / 0.5 / 0.3 / 0.3 / 0.0 / 0.5 / 0.3 / 2.5
Compliance (%) / 99.5 / 99.7 / 99.7 / 100.0 / 99.5 / 99.7 / 97.5
1