Code Blue-a misapplied procedure

  1. I'm sure that many of you remember hearing that report of research that showed that on TV, the code blue save rate is something like 90%, but in real life it is much lower than that. TV contributes to a misapprehension that the Code Blue is a universally successful procedure.

    Now, the Code Blue procedure was primarily developed to resuscitate dysrhythmia in the setting of acute myocardial ischemia. As most cardiac nurses know, when you do a code blue on a patient like this promptly in the ICU (or the field), the procedure works well. It doesn't work as well when their are complicating factors such as congestive heart failure, multiple system failure, infection, and just being old.

    Here's my thesis: I feel that all too often coding is proffered as a solution to a problem that it is actually poorly suited to and unlikely to solve. Coding is actually unlikely to solve cardiac arrest in multiple system failure, old age; tired, multiply infarcted hearts, etc. (And I think research could be done to support this contention based on retrospective research.)

    Anyhow, do you think the general public needs to be more aware of this? people, I'm not saying "never" code an old person BUT if families were aware that a code procedure was unlikely to successful and was more likely to de-humanize people in their last moments of life, don't you think they could do more realistic planning and decision-making?

    I'm a big believer in CARE not CURE approach for MANY of the souls we see repeatedly in the hospital. Thoughts?
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    About MollyJ, MSN, RN

    Joined: Jun '99; Posts: 748; Likes: 68
    school nurse
    Specialty: 36 year(s) of experience


  3. by   VickyRN
    I coudn't agree more.
  4. by   4XNURSE

    Unfortunately, the TV reporters are related closely to the lawyers. They have to sell themselves with what the public wants to hear. Their claims are so people will like them and give them their money.

    The real numbers are more like 13 - 30 % save rate, s/p code. If you are a lawyer or reporter you need to have someone to blame when something goes wrong, so you say that there should be a 90% save rate. Now you can blame the doctors, nurses, and other healthcare providers, thereby giving a good reason to file a big $$$ lawsuit.

    You are right. The public should know that there aren't any quick, easy fixes. The people we "code" are dead to start with. We only do CPR on people who are not breathing and who have no pulse. - That translates to dead. A few of those we are able to bring back to life. Good Lord willing. Trick is, how do you get that message out. The press and the lawyers have a vested interest in keeping the public believing the other way.

    Good luck finding a solution.

    just my $ .02

  5. by   MollyJ
    Hey, Ken, this study reflected the Code Blue save rate in TV dramas, TV movies, soaps, etc NOT anything factual. But the fact is, this soaks into the popular consciousness and people actually THINK codes work 90% of the time. (I know--you and I don't get our medical info from "general hospital", but some folks do...).
  6. by   NurseDennie
    I agree SO much with what you've written. I actually have a whole page on this subject in my web page. People not only think that codes are going to WORK, but they have no idea of what the person is put through.

    On TV when somebody codes, they are brought right back, no blood, no bones broken, no teeth broken or Anything like that. Also, the person who was coded then wakes up and is able to converse and carry on like normal.

    And you're also right that this is something that the public needs to be educated about. It's not pleasant, though, and it's not (necessarily) uplifting, and I don't see any emphasis on this anytime soon!


  7. by   4XNURSE
    Right you are, Molly.

    Unfortunately way too many of the people who watch these programs, actually can't differentiate the real from the scripted. If it works for "Dr. Green" it ought to work for everyone else, right?

    As I said, Getting the real numbers out is near impossible.

  8. by   cbs3143

    Your statistics are right on. The survival to discharge rates at my facility are between 15 and 25%. That is still breathing when they left the acute care level of care. Some of those were discharged to a SNF to "let their ship sail", some were transferred to another facility, but the ones who still have any meaningful quality of life are much lowere than that.

    One scenario that seemed to pop up was the old "Grandpa was fine when we went to the mall." Who knows how long he was down. Short of rigor or livor mortis giving the paramedics the wave off, he's coming to the ER for a visit.

    We work hard enough to get a response from their myocardium, forget about their brain. Almost every "out-of-the-hospital" code eventually dies of severe anoxic encephalopathy if we can get their heart going again. Even the codes in the ICU or the cath lab have a less than 50% chance of survival to discharge due to the severity of their disease processes.

    I agree completely with this thread, Hollywood paints a very inaccurate picture of the outcome. One of the very few episodes that I watched of "ER" had the patient pass a kidney stone into his foley bag on the way to emergency abdominal surgery. Then he was all better. Who writes this stuff?
  9. by   catlady
    The myth is even endemic in so-called "educational" programs. I happened to catch an episode on the Discovery channel this morning about MIs, and the protagonist had a v-fib arrest, got shocked in two attempts into sinus rhythm, didn't even get intubated, and in the next scene was laughing and joking with his buddies. That was a relief to my child who was watching and kept asking me if the guy was going to die, but not very realistic.

    I don't recall any time in my ICU days where someone experienced a full-blown code and survived at baseline. There was always at least some residual damagel
  10. by   micro
    and the answer to the ????? is hollywood and others that have not been there done that and think it would be way too shocking to show the whole truth, nothing but the truth, ma'am.
  11. by   nursnancy
    Working in a LTC facility, I am often frustrated when we get an admission w/CHF, CVD, CAD, hx of CVA, s/p hip fx, dementia, etc, etc, etc, weighing in at 80 lbs and find out he/she is a full code! One of my first agendas when I get a pt like this is to educate the person's family on what exactly happens when a person is coded. I've never had one family member tell me I was out of line. Most of the time they are very gracious and thank me for informing them, stating that they had no idea. So far, every single one has changed their loved one's status to DNR. This is just a start, but if all nurses educated family members of elderly people on this subject, I think it would help. Thoughts?
  12. by   JWRN
    One important aspect of codes I think is that the latest research is not being utilized. Specifically, End-tidal CO2 levels. This is pretty prognostic sign of survival to discharge. But very few doctors utilize it. The studies have shown that if after 15 minutes of CPR, ACLS, etc...If the EtCO2 is < 10 mmHg then the chance of survival to discharge is <1% pretty much zero.....I feel that if the new research were to be utilized then there would be many less needless codes that go on for an 1/2 hour or more...Of course I do not think that this research included pedi's, hypothermia or other oddities. Pretty much in hospital adult arrests were looked at. Hopeful one day the public and the media will learn to look at this aspect of healthcare with more respect and with a different perspective...
    While working in the cath lab, I had a patient arrest (VF), we defibrillated her 16 times out of VF and every shock except the last one, hurt her, this I know because she kept saying "that hurts, stop it", the last shock she was pretty much out of it, so for airway safety she was intubated and sedated. During all of these shocks she had little or no BP, so the doctors said no sedation for fear worsening her hemodynamic status.
    It is funny I can remember every code that I was involved in or every patient that coded on me, can't remember names of all, but can remember circumstances around them....I too believe that is family members were educated about what goes on in a code this would only help matters in my opinion. I truly believe in family presence during resuscitation or invasive procedures the research shows a great deal of support for allowing famliy members in during a resuscitation attempt....Though that is another issue all .02 worth........
  13. by   Nittlebug
    I heard from a doctor that a study done on thrombolytics was skewed to make it look like it was more successful than it really was. You have to read how the study was done before you accept the results as fact and alter your practice.

    Questions to ask: Who did the study and do they have anything to gain by skewing the results to make themselves or their product look good?
  14. by   aimeee
    You hit upon one of my favorite soapboxes, but talking about it here is pretty much preaching to the choir! I deal exclusively with folks who have a terminal diagnosis and you would be surprised how many of them still find it hard to sign a DNR form. One of the hardest things is presenting this realistically while still being gentle.