We sought to evaluate the impact of a COVID-19 Code Blue policy on in-hospital cardiac arrest (IHCA) processes of care, cardiopulmonary resuscitation (CPR) quality metrics, and survival to hospital discharge. We completed a health record review of consecutive IHCA for which resuscitation was attempted. We report Utstein outcomes and CPR quality metrics 33 months before (July,2017-March,2020) and after (April,2020-December,2022) the implementation of a COVID-19 Code Blue policy requiring all team members to don personal protective equipment including gown, gloves, mask, and eye protection for all IHCA. There were 800 IHCA with the following characteristics (Before n = 396; After n = 404): mean age 66, 62.9% male, 81.3% witnessed, 31.3% in the emergency department, 25.6% cardiac cause, and initial shockable rhythm in 16.7%. Among all 404 patients screened for COVID-19, 25 of 288 available test results before IHCA occurred were positive. Comparing the before and after periods: there were relevant time delays (min:sec) in start of chest compressions (0:17vs.0:37;p = 0.005), team arrival (0:43vs.1:21;p = 0.002), 1st rhythm analysis (1:15vs.3:16;p < 0.0001), 1st epinephrine (3:44vs.4:34;p = 0.02), and airway insertion (8:38vs. 10:18;p = 0.02). Resuscitation duration was similar (18:28vs.19:35;p = 0.34). Exception of peri-shock pause which appeared longer (0:06vs.0:14;p = 0.07), chest compression fraction, rate and depth were identical and good. Factors independently associated with survival were age (adjOR 0.98;p < 0.001), male sex (adjOR 1.51;p = 0.048), witnessed (adjOR 2.35;p = 0.02), shockable rhythm (adjOR 3.31;p < 0.0001), hospital location (p = 0.0002), and COVID-19 period (adjOR 0.68;p = 0.052). The COVID-19 Code Blue policy was associated with delayed processes of care but similarly good CPR quality. The COVID-19 period appeared associated with decreased survival.

中文翻译：

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COVID-19 蓝色代码方案对院内心脏骤停期间复苏护理和心肺复苏质量的影响

我们试图评估 COVID-19 蓝色代码政策对院内心脏骤停 (IHCA) 护理流程、心肺复苏 (CPR) 质量指标以及出院生存率的影响。我们完成了对尝试复苏的连续 IHCA 的健康记录审查。我们报告了要求所有团队成员穿戴个人防护装备的 COVID-19 蓝色代码政策实施前 33 个月（2017 年 7 月至 2020 年 3 月）和实施后（2020 年 4 月至 2022 年 12 月）的 Utstein 结果和心肺复苏质量指标包括所有 IHCA 的长袍、手套、面罩和护目镜。 800 名 IHCA 具有以下特征（之前 n = 396；之后 n = 404）：平均年龄 66，62.9% 为男性，81.3% 有目击者，31.3% 在急诊科，25.6% 为心脏病，初始可电击心律为 16.7% %。在所有 404 名接受 COVID-19 筛查的患者中，IHCA 发生前的 288 项可用检测结果中有 25 例呈阳性。比较前后期间：胸外按压开始（0:17vs.0:37；p = 0.005）、团队到达（0:43vs.1:21；p = 0.002）存在相关时间延迟（分钟：秒） )、第一次心律分析 (1:15vs.3:16;p < 0.0001)、第一次肾上腺素 (3:44vs.4:34;p = 0.02) 和气道插入 (8:38vs.10:18;p = 0.02 ）。复苏持续时间相似（18:28vs.19:35；p = 0.34）。除了电击周暂停时间较长外（0:06 vs.0:14；p = 0.07），胸外按压分数、速率和深度均相同且良好。与生存独立相关的因素包括年龄（adjOR 0.98；p < 0.001）、男性（adjOR 1.51；p = 0.048）、目击者（adjOR 2.35；p = 0.02）、可电击节律（adjOR 3.31；p < 0.0001）、医院地点(p = 0.0002) 和 COVID-19 时期 (adjOR 0.68;p = 0.052)。 COVID-19 蓝色代码政策与护理流程延迟有关，但心肺复苏质量同样良好。 COVID-19 时期似乎与生存率下降有关。