How long to run a code?

Specialties Critical

Published

I work in long term hospital in ccu, we are all acls certified how long do we have to run a code before we can call it when no doctor is going to come in to see pt.. some of out soctors are at least 45 mins away and refuse to come in when the pt has expired.

0 Votes

That seems fishy, no doctors are around? Is this a rehab hospital or is this a hospital staffed with doctors and an emergency room? I would think by the sounds of it you’d call emergency services if someone was to code while doing CPR. Even if your floor isn’t staffed with a doctor 24/7, there should always be a hospitalist and code team within the hospital.

2 Votes

by Joseph Esherick, M.D., FAAFP, FHM

February 20th, 2017

The Universal Termination of Resuscitation Guidelines suggest that resuscitation should be terminated if at least four rounds of CPR have occurred and the following three criteria are met:

The arrest was NOT witnessed by emergency medical services (EMS)

There has been NO return of spontaneous circulation (ROSC)

No shocks were delivered.

This study used data from a large prospective database of adult patients with OHCA of presumed cardiac origin to test the performance of these Universal Termination criteria. In the study, 9467 patients did not achieve pre-hospital ROSC and were transported. The following are results of the study:

1.1% of these patients had survival with a good neurological outcome.

Patients who had a shock delivered or arrest witnessed by EMS had significantly higher survival (3.0% vs. 0.7%) and higher survival with good neurological function (1.7% vs. 0.3%) than those who met all three criteria for termination.

Among survivors with good neurological outcome, 90% had ROSC by 20 minutes and 99% by 37 minutes.

Based on this study, patients with OHCA should be transported to the hospital if they have ROSC, if they receive any shocks, or if the arrest is witnessed by EMS. Resuscitation should be terminated in OHCA in all other patients, especially if there is no ROSC within 30-35 minutes.

Citation(s):

Drennan IR et al. A comparison of the universal TOR Guideline to the absence of prehospital ROSC and duration of resuscitation in predicting futility from out-of-hospital cardiac arrest.

I am not Joseph Esherick...?... I can never figure out how to "insert other media"....?.

And your post smells fishy to be honest.

2 Votes

As I read the OP he/she appears to be talking about in-hospital cardiac arrest not out-of-hospital cardiac arrest.

0 Votes
4 hours ago, Susie2310 said:

As I read the OP he/she appears to be talking about in-hospital cardiac arrest not out-of-hospital cardiac arrest.

Maybe, but an inhospitable unit with no doctor available for 45 minutes, I've never heard of such a facility????

1 Votes

I’m hung up on how it can be a “ccu” in a long term hospital w no doctor on site. I think by definition that is not critical care ?

5 Votes

every word is true, no doctors, pa or np, in house at night only on call, pts or families sigh a paper acknowledging this at admission. stand alone, speciality , ltac and rehab hospital. Its called CCU, we do vents, gtts, everything. I know of other such hospitals that operate like this also!!! Ihave worked acute care ICU. this place in a real hospital would be like a step down unit. most doctors on staff, live at least 40 miles away, by the way I am RN with 25 years experience in ICU,

0 Votes

Thanks for clarifying. Are you in the USA?

0 Votes

It really doesn't matter what anyone on Allnurses tells you. It certainly would NOT protect your license.

You need to have a written protocol signed by the medical director on what to do when a patient codes at night and there is no doctor.

I'm sorry you're put in such a difficult situation.

1 Votes

I am in USA, Texas to be exact. written protocol is ACLS, so my question is how long to run a code that is unsuccessful before we can call it. ACLS instructor 25 min. and like any other hosp. we are not staffed for emergencies. I cant find it written anywhere.

0 Votes
35 minutes ago, smary8055 said:

... I cant find it written anywhere.

It needs to be, these are not questions you should be asking anonymous posters on an internet forum.. If your are running a resuscitation without a physician present you need protocols or guidelines that address when to discontinue the resuscitation, what treatments and interventions can be initiated, and when to call EMS for continues resuscitation or transfer to an acute care facility.

Best wishes.

ETA: Nor does it matter what the ACLS instructor has to say.

1 Votes
Specializes in Progressive Care, Sub-Acute, Hospice, Geriatrics.

At my facility, you do a code (CPR) while calling 911. Then, they handle it from there and take the patient to a nearby ER

2 Votes
+ Add a Comment