Ending Code Blue Considerations

Slides by Sumit Patel, Alex Ryden, Brian Locke, and collaborators

Ending Code Blue Considerations

Learners will practice:

  1. How long to code?
  2. Bring families back.
  3. End with team check, family plan, and debrief.

How long to continue CPR

Probability of favorable functional status at discharge decreases as CPR duration increases, stratified by witnessed versus unwitnessed arrest.

BMJ IHCA cohort: favorable functional status by CPR duration.

30-minute anchor: stop/continue huddle, not a rule.

Longer: witnessed/monitored, shockable/improving, reversible cause/bridge, ROSC signs.

Shorter: unwitnessed/unmonitored, unchanged asystole/PEA, no target/ROSC/bridge.

Guardrail: OHCA TOR rules do not automatically apply to IHCA.

Family presence

NEJM RCT on family presence during resuscitation

Use judgment.

Delegate attention.

Try to include when possible and safe.

Jabre et al., NEJM 2013.

How to stop ACLS

  1. Summarize: “[duration] CPR, persistent [rhythm], no ROSC, no remaining reversible intervention.”

  2. Ask: “Anything we have not tried?”

  3. Announce: “One final rhythm/pulse check; if unchanged, we stop CPR.”

After the event

  • Family update
  • Primary team/attending
  • Debrief: [time/place]

What went well/not? What could we do differently? Does anyone need support?

Summary

  • Bring family back.
  • Customize duration from 30 minutes (no slow code).
  • Ending: summarize, ask, do not resume.

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