Code blue in OR

[icu2crna]

When a code happens in OR who leads the code, the surgeon or the anesthesia team.

[Mully]

Anesthesia. The surgeons rarely have any clue what the patient's vital signs are unless we tell them (not talking down, simply because they're performing surgery). Certainly it's a team effort, but who decides what drugs to give, when, and how? Anesthesia. Who gives the drugs? Anesthesia. Most OR nurses that I've worked with aren't ACLS trained. Their roll is more r/t calling the code/anesthesia stat, and other things that I'm not sure of lol. I've experienced one almost code in anesthesia during a craniotomy. We directed the OR nurse to call anesthesia stat which resulted in an MDA and 3 CRNAs in our room in about 3 seconds. Someone along the way brought the crash cart in. Myself and my CRNA gave what drugs we decided and directed the other CRNAs as to what help we needed. The surgeon did end up re-opening the head to make sure nothing funny was going on. Patient survived, anyway.

Hope this helps.

[Rose_Queen, BSN, MSN, RN]

I would bet that your facility has a policy that likely delineates who is responsible for what. Mine does:

Circulator overhead pages for anesthesia stat or in the rooms with code blue buttons activates the button. Gets the crash cart if responding staff doesn't already have it en route (mostly off shifts with decreased staffing). Circulator is also responsible for documentation.

Scrub person (handling instruments) is responsible for maintaining the sterile field when possible/doesn't further jeopardize patient.

Assistant (whether ST/PA/RNFA/etc) is responsible for initial round of compressions

Surgeon is responsible for either emergent completion of surgery/closure of incision (mostly for those in positions we need to get out of for effective compressions) if there's time (no need for compressions at that point), preparing for further surgical intervention(s), assisting with compressions

Anesthesia gives medications

Anyone may run the defibrillator at the direction of anesthesia or the surgeon (cardiac surgeons take a much more involved role in defibrillation decisions as we may emergently go on bypass rather than defibrillate)

Responding staff are responsible for retrieving the crash cart, relieving the person doing compressions (will scrub in if there's opportunity and necessary to maintain sterile field), but we do take the stance of infection is treatable, death is not)

All in all, the vast majority of our anesthesia stats are airway issues, not true codes where it's anesthesia's domain anyway. Of those that aren't airways, we've called enough in advance that it's more pressure support or other pre-CPR-necessity interventions than true cardiac arrest- anesthesia is proactive about the need for assistance.

[jdsmom, RN]

I currently work in a pediatric OR and have worked in adult OR as well. The anesthesiologist is the one who runs a code, or even a rapid response. Most times the anesthesiologist will notify the surgeon that something is not right and ask them to stop whatever they are doing and try to correct the situation. Our OR requires all RNs to be ACLS certified (because we are combined with the adult OR as well) and PALS certified for the pediatric side. Any hospital who does not train their RNs to be ACLS or PALS certified is asking for trouble and poor outcomes. I have been in a few codes and felt well-prepared to handle them. Every time the anesthesiologist is the lead and everyone directs their attention to them for instructions. Most of the time the surgeon and surgical team scrubbed in do what they can to keep the sterile field sterile and wait for instructions from the anesthesiologist. Sometimes that means getting prepared to close quickly so they can get the patient off the table, or possibly doing internal compressions depending on how serious the situation is. I have not worked in an environment with CRNAs, but I imagine that if things start looking concerning you would notify your anesthesiologist STAT and get them in there to help. A good anesthesiologist or CRNA is pretty in tune to how the patient is doing and is proactive when warning signs arise.