Inoue Youichi, Okamura Keisuke, Shimada Hideaki, Watakabe Shinobu, Hirayama Shiori, Hirata Machiko, Kusuda Ayaka, Matsumoto Arisa, Inoue Miki, Matsuishi Emi, Yamada Mizuki, Iwanaga Sachiko, Narumi Shogo, Nakayama Shiki, Sako Hideto, Udo Akihiro, Taniguchi Kenichiro, Morisaki Shogo, Ide Souichiro, Nomoto Yasuyuki, Miura Shin-Ichiro, Imakyure Osamu, Imamura Ichiro
Emergency Room, Imamura Hospital, Tosu, Saga, Japan.
These authors contributed equally to this work.
J Clin Med Res. 2024 Dec;16(12):578-588. doi: 10.14740/jocmr6111. Epub 2024 Dec 20.
Our hospital is a designated emergency hospital and accepts many patients with out-of-hospital cardiac arrest (OHCA). Previously, after receiving a direct call from emergency services to request acceptance of an OHCA patient, the emergency room (ER) chief nurse notified medical staff. However, this method delayed ER preparations, so a Code Blue system (CB) was introduced in which the pending arrival of an OHCA patient was broadcast throughout the hospital.
In this study, we retrospectively analyzed the impact of introducing CB at our hospital on OHCA patient prognosis to examine whether the introduction of CB is clinically meaningful. We compared consecutive cases treated before introduction of the CB (March 3, 2022, to March 22, 2023) with those treated afterwards (March 23, 2023, to July 23, 2024).
A total of 30 cases per group were included. The mean number of medical staff present at admissions increased significantly from 5.4 ± 0.6 to 15.0 ± 3.0 (P < 0.001). Although not statistically significant, the introduction of the CB increased the return of spontaneous circulation (ROSC) rate from 20% to 30%, survival to discharge rate from 3% to 10%, and social reintegration rate from 0% to 3%. ROSC occurred in 15 patients. Among OHCA patients with cardiac disease, the ROSC rate tended to increase from 0% to 43% (P = 0.055). In addition, in OHCA patients with cardiac disease whose electrocardiogram initially showed ventricular fibrillation or pulseless electrical activity, the ROSC rate increased from 0% to 100%. ROSC tended to be influenced by the total number of staff and physicians present and the number of staff such as medical clerks, clinical engineers, and radiology technicians (P = 0.095, 0.076, 0.088, respectively).
Introduction of a CB may increase the ROSC rate and the number of patients surviving to discharge. It also appears to improve the quality of medical care by quickly gathering all necessary medical staff so that they can perform their predefined roles.
我院是一家指定的急诊医院，接收许多院外心脏骤停（OHCA）患者。此前，在接到急救服务的直接电话请求接收OHCA患者后，急诊室（ER）护士长会通知医务人员。然而，这种方法延迟了急诊室的准备工作，因此引入了蓝色代码系统（CB），在该系统中，OHCA患者即将到达的消息会在全院广播。
在本研究中，我们回顾性分析了我院引入CB对OHCA患者预后的影响，以检验引入CB是否具有临床意义。我们将CB引入前（2022年3月3日至2023年3月22日）治疗的连续病例与引入后（2023年3月23日至2024年7月23日）治疗的病例进行了比较。
每组共纳入30例病例。入院时在场的医务人员平均人数从5.4±0.6显著增加到15.0±3.0（P<0.001）。虽然无统计学意义，但引入CB使自主循环恢复（ROSC）率从20%提高到30%，出院生存率从3%提高到10%，社会重新融入率从0%提高到3%。15例患者出现ROSC。在患有心脏病的OHCA患者中，ROSC率倾向于从0%提高到43%（P=0.055）。此外，在最初心电图显示心室颤动或无脉电活动的患有心脏病的OHCA患者中，ROSC率从0%提高到100%。ROSC倾向于受在场的工作人员和医生总数以及诸如医疗办事员、临床工程师和放射技师等工作人员数量的影响（分别为P=0.095、0.076、0.088）。
引入CB可能会提高ROSC率和出院存活患者数量。它似乎还通过迅速召集所有必要的医务人员以便他们能够履行其预定义的职责来提高医疗质量。
