Code Blue Teams in general hospital. Guidelines and best practices

National & Kapodistrian University of Athens
MEDICAL SCHOOL
POST-GRADUATE PROGRAMME
«International Medicine – Health Crisis Management»
ESSAY
SUBJECT:
« Code Blue Teams in general hospital. Guidelines and best practices»
POST-GRADUATE STUDENT:
THEONI ZOUGOU
ATHENS
May, 2012

CONTENTS
ENGLISH ABSTRACT -4-
GREEK ABSTRACT -4-
INTRODUCTION -5-
CHAPTER 1 CARDIOPULMUNARY RESUSCITATION (CPR) -7-
1.1 General Information - Definitions -7-
1.2 Cardiac Arrest Epidemiology -7-
1.3 Predisposing Factors of Cardiac Arrest -8-
CHAPTER 2 FUNCTIONAL PRINCIPLES & AIMS OF CODE BLUE TEAM (CBT) IN
HOSPITAL
2.1 Activation and Calling Criteria of CBT -9-
2.2 Structure and roles in CBT -11-
2.3 Assessment of CPR from CBT -11-
2.4 Data Documentation and Record Keeping -12-
CHAPTER 3 STAFF TRAINING FOR IMMEDIATE CALL OF CBT -13-
3.1 Training on CPR and Affecting Factors -13-
3.2 Aggravating and Supporting Factors for early call of CBT -14-
CHAPTER 4 LITERATURE REVIEW FOR CBT IN HOSPITALS -15-
4.1 International Data -15-
4.2 National Data -19-
CONCLUSIONS -20-
APPENDIX -21-
BIBLIOGRAPHY -32-
-9-
2

ACKNOWLEDGMENTS
I am particularly grateful to my colleaques Karapanou Amalia, Sampani Michael, Hatzopoulou Maria,
Hatzopoulou Eirini, who was so supportive by providing valuable data and information, during the writing of
these essay.
3

ABSTRACT
It has been estimated that the incidence of in-hospital arrests is about 1-5/1000 admissions. The health care
team has to deal with cardiac arrest in minutes. If CPR is not implemented within 3-4 minutes, brain disorder
starts and leads to irreversible brain damage.
The term Code Blue is used to indicate that a patient has an immediate need for resuscitation in order to
prevent an arrest and call Code Blue Team through telephone.
The code blue team is consisted of specific professionals, each professional knows his role, responds to
every call and applies international protocols.
In Europe, America, Canada, Australia, the blue code is implemented successfully. In Greece, public
hospitals are not implementing the blue code only a few private hospitals do.
KEYWORDS: Blue Code, cardiac arrest, cardiopulmonary resuscitation, resuscitation team
ΠΕΡΙΛΗΨΗ
Έχει υπολογιστεί ότι η συχνότητα των ενδονοσοκομειακών ανακοπών είναι περίπου 1-5/1000 εισαγωγές .
Για να αντιμετωπισθεί η Καρδιακή Ανακοπή ο χρόνος κυμαίνεται σε ελάχιστα λεπτά. Αν δεν εφαρμοστεί
Καρδιοαναπνευστική Αναζωογόνηση μέσα στα 3-4 λεπτά αρχίζει εγκεφαλική διαταραχή η οποία καταλήγει
σε μη αναστρέψιμη εγκεφαλική βλάβη.
Ο όρος Μπλε Κωδικός χρησιμοποιείται για να δείξει ότι ένας ασθενής έχει άμεση ανάγκη για αναζωογόνηση
με σκοπό την πρόληψη μιας ανακοπής και κλήση της ομάδας του μπλε κωδικού μέσω δεκτών ειδοποίησης.
Η ομάδα του μπλε κωδικού αποτελείται από συγκεκριμένα άτομα , το κάθε άτομο γνωρίζει το ρόλο του ,
απάντά σε κάθε κλήση και εφαρμόζει τα διεθνή πρωτόκολλα.
Στην Ευρώπη, στην Αμερική, στον Καναδά ,στην Αυστραλία ο μπλε κωδικός εφαρμόζεται με μεγάλη
επιτυχία.
Στην Ελλάδα στα δημόσια νοσοκομεία δεν γίνεται εφαρμογή του μπλε κωδικού παρά μόνο σε ελάχιστα
ιδιωτικά νοσοκομεία .
ΛΕΞΕΙΣ ΚΛΕΙΔΙΑ: Μπλε Κωδικός, Καρδιακή Ανακοπή, Καρδιοαναπνευστική Αναζωογόνηση, ομάδα
αναζωογόνησης
4

INTRODUCTION
Ischemic heart disease is the leading cause of death worldwide. In Europe, cardiovascular diseases account
for 40% of deaths in age groups up to 75 years. The sudden cardiac death is responsible for over 60% of
adult deaths from coronary heart disease. Data from 37 European countries suggest that the annual incidence
of outpatient cardiac arrests treated by pre-hospital systems of immediate aid amounting to 38 cases per
100,000 inhabitants. On the same basis, the annual incidence of ventricular fibrillation (VF) treated by pre-
hospital immediate aid systems is about 17 per 100,000 inhabitants.
The survival rate and discharge from the hospital is 10.7% for cardiac arrest from all cardiac rhythms
and 21.2% for cardiac arrest from VF. These rates vary across continents. On the other hand, the incidence
of hospital cardiac arrest is estimated with difficulty, because it is heavily influenced by factors such as: the
criteria for hospital admission and the current policy of Do Not Attempt Resuscitation (DNAR).
The definition of in-hospital arrest is the disruption of heart mechanical activity as confirmed by the
absence of palpable pulse, no response and apnea or presence of ante mortem rhonchus. This definition
separates the heart from respiratory arrest, characterized by apnea with a palpable pulse. Cardiac arrest is
classified as in-hospital when it happens in a hospitalized patient who had pulse on admission to the hospital.
The reported incidence of in-hospital arrest ranges between one to five cases per thousand admissions.
Preliminary data from the UK National Cardiac Arrest Audit (NCAA) suggest that the survival and hospital
discharge after in-hospital arrest is 13.5% (all cardiac rates). The initial rhythm is VF or pulseless ventricular
tachycardia in 18% and 44% of them survive and exit from the hospital. After pulseless electrical activity
(PEA) or asystole only 7% are survived.
Similar data from the National Registry of Cardiopulmonary Resuscitation (NRCPR) of the United
States reported 14,720 arrests in 287 U.S.A. hospitals. According to these data, 25 to 67% successfully
resuscitated patients (regained spontaneous circulation) died the first 24 hours after resuscitation. Most
studies report that 20% of the patients survived and exit from the hospital and a year after the arrest, a rate
between 53% and 86% of patients were still alive. While another study reported that 53% of patients who
survived the arrest and left the hospital were alive five years later. 1
The in-hospital arrest is often the last event of patient’s progressive deterioration that may have
pathological vital signs for hours or days before the arrest. These precursor elements are recorded but
appropriate actions which could possibly prevent the arrest aren’t implemented timely. 2
Moreover, for every minute that passes without applying CPR, the survival of patients with ventricular
fibrillation (AF) is reduced by 7-10% . 3 If the CPR applied immediately, the decrease of survival rate ranges
between 3-4%. 3,4,5 Generally, the immediate implementation of CPR can double the survival of cardiac arrest
victims. 3,4,6
According to the above data there is an urgent need for Resuscitation Team operating in the hospital,
which will consist from trained and qualified staff. This team will be on duty 24 hours a day throughout the
year. 7
5

All the hospital staff can call the Resuscitation Team, either through a button visible and easily
accessible throughout the hospital or through a simple telephone number. These teams in the literature are
referred as Code Blue Teams (CBT) or Rapid Response Teams (RRT) or Medical Emergency Teams
(MET). 8
The aim of this essay is to study of the implementation of Code blue team to Greek hospitals, the evidence
from hospitals abroad and to document the need for a manual of good practice.
6

CHAPTER 1
CARDIOPULMONARY RESUSCITATION
1.1 General Information – Definitions
Cardiac arrest (CA) is the leading cause of death worldwide and the most frequent cause of death in
persons over 40 years old. 9 The first heart rate analysis shows ventricular fibrillation (VF) in approximately
40% of victims. 10-13 It is likely that more victims have VF or ventricular tachycardia (VT) at the time of
14, 15
collapse, which has turned into asystole by the time first ECG rhythm was recorded.
The guidelines for the treatment of VF have been developed by international organizations with aim to
optimize the outcomes. These guidelines are reviewed every five years through reviewing of publications
with keywords “Arrest – Resuscitation”. 16, 17 Main objective of these guidelines are the survival of CA
victims.
The steps which should be followed during the CPR are described at the chain of survival (Figure 1).
This chain had been proposed 40 years ago by F. Ahnefeld and since then it has been established as the
symbol for setting the priority sequence of actions for CPR. The chain is composed of 4 rings and the
important element of each ring is the word “early”. The first ring describes the early recognition and early
call for specialized help to prevent the cardiac arrest, the second ring represents the early CPR to buy time,
the third ring shows the early defibrillation to restart the heart and the fourth ring symbolizes the early
specialized hospital care to store quality of life. The rings are correlative and equally important, so this
sequence should always be followed. “Cardiac Arrest (CA)” is as the disruption of cardiac and respiratory
function, which is not accompanied by symptoms, or accompanied by symptoms less than 1 hour . 18
“Cardiopulmonary resuscitation (CPR)” is the sequence of actions aimed to rebound in life the cardiac arrest
victim and the gradual recovery of vital functions. The CPR intended to improve the transfer of O2 to tissues,
to determine the specific causes of CA and to maintain the rescued functions. 19
1.2 Epidemiology of CA
The incidence of CA is calculated with difficulty. In Europe, each year the victims of CA are
approximately 700.000. 20 the prevalence of coronary heart disease varies in different countries. Although in
Greece there are no sufficient epidemiological data, the victims of CA are estimated from 5000 to 6000 per
year. The large number of CA victims includes patients with coronary disease as first symptom and patients
who belong to high risk groups and the likelihood of having CA can be predicted more accurately.
21, 22
7

1.3 Predisposing Factors CA*
Practically, any heart pathology can lead to a variety of fatal arrhythmias with consequence the CA.
Multivariate analysis of selected risk factors (age, systolic blood pressure, heart rate, smoking, diabetes
mellitus, hyperlipidemia) has shown that about half of the CA victims have at least one of these factors.
The overall risk for CA is not simply the numerical sum of the above risk factors. Another important factor
that is associated and affected the rate of sudden heart events, mainly in Greece, is obesity. 24
Epidemiological observations in the past have shown a correlation between low physical activity and
risk for sudden death. Moreover, obesity is the cause of many aggravating factors such as
hypercholesterolemia and hyperlipidemia, diabetes mellitus. Finally, obesity contributes as an independent
factor to the risk of atherosclerosis.
25, 26
Nowadays, CA is a common event, so CPR should be developed and continually redesigned in order to
rescue more and more CA victims. The guidelines should be consistent with updated scientific data. The
instructions should be as simple as possible and easy to learn for implementation by unqualified staff.
20, 23
27, 28, 29
8

CHAPTER 2
FUCTIONAL PRINCIPLES AND OBJECTIVES OF THE CODE BLUE TEAM (CBT) IN
HOSPITAL
The need for a CBT in the hospital is recognized in recent years more and more because the team
addresses to life - threatening situations of hospitalized patients and provides specialized CPR as indicated.
In hospitals with organized CBT, there is a reduction in the frequency of in-hospital arrest. Also, the early
30, 31, 32
CPR by the specialized team increases survival and improves the prognosis of CA victims.
The aims of this group are:
� Early recognition of respiratory, cardiac and neurological deterioration of the patient, according
to the ABCDE approach as defined by the guidelines of international organizations, American
Heart Association (AHA) and European Resuscitation Council (ERC), to reduce the number of
cardiac arrests.
� Early initiation of CPR in case of CA.
� Early defibrillation if indicated.
� Early care after successful CPR.
2.1 Activation and Calling Criteria of CBT
The hospital has to establish objective, reproducible and easily measurable criteria for the activation of
CBT. The existence of these predefined criteria increases the reliability of team calls and prevents delays.
The criteria are routine vital signs recorded by the staff in an objective, non-invasive manner. When any
member of the staff, medical or nursing, recognizes one or more criteria in a patient which suggests acute
deterioration of his condition, he/she is obliged to call directly the CBT. These criteria are described at the
table below.
9

Table 1. Medical Emergency Team Calling Criteria 33
The call of a specialized team is made through a simple telephone number, usually consisting of 3-4 digits
equal to easily memorized by all personnel. It is also clearly visible in apparent points throughout the
hospital. 33
In the case of CBT call, the following should be referred:
� Brief and accurate description of the emergency situation, whether it is cardiac arrest or another
type of emergency
� Exact location (floor, clinic, ward)
� Attending Physician
10

2.2 Structure and roles of CBT
The exact composition of the team (CBT) varies and depends on the needs of each hospital. Usually,
includes a doctor and a nurse specialized in intensive care, the attending doctor and the ward nurse. 2
Both the doctor and the nurse, who are specialized in intensive care, have knowledge and skills for
airway management. The management includes maintaining a patent airway, suctioning, use of appropriate
aids, adequate and effective ventilation, advanced airway placement with intubation or other invasive means.
They can practice the algorithms BLS, ALS, ACLS, ATLS (Appendix) which apply to specific CPR, deal
with life-threatening tachyarrhythmias or bradyarrhythmias, trauma, burn, obstetric emergency, poisoning
etc.
In case of CPR, either the specialized doctor or the nurse take the leading role, specifies the exact role
and responsibilities of other team members and facilitates the communication between them in order to
achieve appropriate functioning and effectiveness.
During CPR, the assigned roles to the team members are:
� airway management and ventilation of the patient (one member)
� performing effective chest compressions (two members alternative every two minutes)
� providing safe defibrillation if it is indicated and ensuring intravascular route and the
preparation and administration of drugs (one member)
� clear and concise documentation of code events (one member)
When the CPR is completed successfully, the team is responsible for the safe transportation of the patient in
the intensive care unit. Instead, if the patient died, the team leader should be responsible for family
information. 34
2.3 Assessment of the CPR from the team
After completing each resuscitation effort, the members of the team should meet in order to evaluate
what could be improved in patient’s care. The process of evaluation by the team provides feedback to
members and the capability to address with weaknesses or mistakes. Moreover, through reviewing their
actions, the novice members of the team are trained.
35, 36
11

2.4 Data Documentation - Record Keeping
It is essential for the team to keep a detailed record of all actions taken during an emergency response or
CPR. The data archiving has control, research, education and legal purposes. Most hospitals have a
preprinted form (Figures 2-3) for recording the data of in-hospital resuscitation.
This form is necessary in order to achieve uniformity of records and to facilitate communication
between departments in terms of patient care. In this form, data of the hospital, the patient, the circumstances
of the arrest or emergency, therapeutic interventions and outcome are recorded. The head nurse of the
department is responsible for the proper completion of the form. This form is duplicated, the original is kept
in the patient file and a copy is filed and sent to the Quality Assurance Office of the hospital. 37
12

CHAPTER 3
STAFF TRAINING FOR IMMEDIATE CALL OF CBT
3.1 Training on CCA and affecting factors
Training in CPR is urgent need, because the Greek Health System requires specialized resuscitators.
The effective teaching in candidate resuscitators will ensure the quality of the given CPR to victims of
cardiac arrest. Therefore, it is important to find new ways of training which will familiarize trainees with the
CPR and maintain knowledge and skills during time.
The National Cardiopulmonary Resuscitation (EEKAN) of the Central Council of Health (ΚΕΣΥ) of
Ministry of Health and Social Welfare made compulsory the training of all health personnel in Greece (ΦΕΚ
219/τ.B/22-02-2007).
The CPR boards of many countries have adopted or have developed training courses for citizens and
health professionals in the native language of trainees. It is should be mentioned that in the U.S., UK and
other countries, the attendance of these seminars is essential for health professionals in order to be employed
in a hospital. 38
A small number of trainees (4-6 persons) should attend this kind of seminars. The trainers use
interactive discussions, skill exercises and solving clinical problems in different scenarios. The trainees are
divided in groups with hierarchical distribution and leader presence 39 and the trainer to trainee ratio should
range from 1:3 to 1:6. The aim of the seminars is to improve the skills of the trainee for treating with
seriously ill patients. Sophisticated models, simulators and virtual reality techniques are now included in
educational diadikasia. 40
There are several factors affecting the training in CPR.
The group of trainees is mixed in age and educational status 41 that’s why the seminars are different
according to the group of trainees. The seminars BLS, ACLS, ALS, and ATLS address at citizens and
professionals such as GPs, dentists, medical and nursing students, paramedics, rescuers and those who work
in specific population groups.
The trainers are chosen according to their performance as students in CPR seminars, their theoretical
training, and their ability as leader, their educational skills and their motivation. The trainers should
encourage the trainees with positive feedback and reinforcement of their skills. 42
The educational material should be characterized by clarity and completeness and the trainees should be
able to understand it. It should be based on the latest guidelines, formulated in algorithms in order to
facilitate learning. 43
The importance of training in CPR has been recognized and many efforts have been made to improve
the training conditions and the overall educational process. Although there aren’t enough evidence that
13

training in CPR improves survival and discharge rates for victims of cardiac arrest, 44,45 it is required for
43, 46
skills acquisition and retention during time and the better care of patients.
Findings from a recent randomized prospective study demonstrated that students participating in a 2-
hour seminar for Basic CSD (CSD-B) and Automated External defibrillator (AEA) can acquire and maintain
skills over an extended period of time. The overall results were comparable with studies based on courses
lasting 4 and 7 hours. 47
Other studies have shown that nurses are more effective than doctors in teaching CPR to other nurses.
This excellence is achieved not only by establishing a complete theoretical background to the students but
also by disseminating the necessary skills for a dynamic, effective and efficient CPR implementation. 42
3.2 Aggravating and Supporting Factors for early call of CBT
According to international literature, findings demonstrated that despite the existence of a resuscitation
team in some hospitals, the team wasn’t called timely in critically ill patients. 48 This delay could have
adverse effects on the patient such as cardiac arrest, multi-organ failure, even death. The final outcome for
these patients often depends on the ability of medical and nursing staff to recognize early signs of clinical
deterioration of patients and to call the CBT. 49
The key factor, which is responsible for this delay, is the inadequate staff training. The lack of
knowledge may concern to the role of resuscitation team and the criteria of the calling. Specifically, research
findings had shown that staff often is not familiar with the functional principles, the role of the team and the
effectiveness of the team. 50
Other studies had demonstrated that nursing staff don’t call proper CBT appropriately, due to ignorance
of CBT activation criteria and lack of experience in dealing with emergency events (i.e. not familiar with the
equipment, do not recognize the extreme abnormal vital signs, etc.) .51 The more theoretical training and
clinical experience has a nurse, the more confident he/she feels for the decision to call the resuscitation team
52, 53
for critically ill patient.
One of the major factors, which promote the appropriate calling of CBT, is the smooth cooperation
among nurses and medical staff. On the other hand, aggravating factors for early call of CBT are inadequacy
feelings for patient care and the belief of hierarchy elimination, when the CBT is responsible of the patient
care. 54 Finally, the workload of nursing staff is a controversial factor, which may support or suspend the early
call of CBT. The continuing training of the staff in regular manner could prevent the delay in calling CBT. 34,
55
14

CHAPTER 4
LITERATURE REVIEW FOR CBT IN HOSPITALS
The objective of CPR is the survival of the patient and the assurance of high quality of life. In the
international literature, studies demonstrated that the development of CBT leads to a decrease in the number
of cardiac arrests and the mortality in hospital. 56
4.1 International Data
In a prospective study conducted in Carolinska University hospital (Stockholm, Sweden), in hospital
mortality decreased by 10% after the development of CBT. Mortality was reduced by 12% in patients
hospitalized in a medical clinic and 28% in patients hospitalized before an operation in a surgical clinic. The
number of arrests decreased from 1.12 to 0.83 per 1000 admissions. The calling frequency of CBT was 9.3
per 1000 admissions. 57
A similar study was conducted in the U.S. and demonstrated that the call of the CBT increased from
13.7 to 25.8 per 1000 admissions after the introduction of objective calling criteria. At the same time, the
incidence of cardiac arrests decreased 17%, from 6.5 to 5.4 per 1000 admissions. Cardiac arrests, deaths and
unplanned ICU admission decreased due to the development of CBT, as it is supported by numerous other
studies.
In 2000 a CBT was developed at Keck / USC School of Medicine (Los Angeles, California). The
findings of the study were similar with the above. An increase of survival after a CA was noticed regardless
of the initial cardiac rate of arrest. The findings of the study showed 58% survival rate after CA however the
average for the country was 44%. Particularly, the survival after asystole reaches 48% compared with
country average 35%. 58
A survey conducted also in the U.S.A. and evaluated data from 507 hospitals from January 2000 until
February 2007. They studied 58,543 CA in relation with successful CPR, 24-hour survival, hospital
discharge and neurological picture of all the CA victims. Then these data were correlated with the day and
time arrest was happened (within the week or weekend and hour of the day). The study findings showed that
survival rates 24 hours after CPR (28.9% vs. 35.4%), until the hospital discharge (14.7% vs. 19.8%) and the
better neurologic function (11% versus 15.2%) were significantly lower during the night than morning -
afternoon. Also among the CA that occurred during morning-afternoon, the survival was higher on weekdays
than on weekends (20.6% vs. 17.4%) however the night survival was similar between weekdays and
weekends (14.6% and 14.8%). 59 The conclusion of the study was that CBT should be adequately staffed 24
hours every day of the year.
15

In St Cloud Hospital (Minnesota) and St Dominic Hospital (Mississippi) the survival of CA victims was
studied before and after the training of their staff in CPR according to AHA guidelines. The survival was
increased by 60% from 17.5% to 28%. 60 This study demonstrated that the CPR should be done by
appropriately qualified staffed, trained through CPR guidelines from international organizations.
At the Austin Hospital (Melbourne, Australia), the incidence of in-hospital arrests was studied before
and after the establishment of criteria for early calling of CBT. The findings demonstrated a gradual decline
during the 4 years of study. Before the implementation of specific criteria there were 4,06 arrests per 1000
admissions, 2,45 during the introductory training and awareness of staff with the criteria of early call CBT
and 1,90 after the complete implementation of the criteria. It is noteworthy that 17 calls to CBT correspond
to the avoidance of one CA. 61
In a recently published study (March-April 2012) qualitative and quantitative measures of resuscitation
team were evaluated in a California hospital for five years period (2005-2010). The team was consisted from
specialized nurses, responsible for assessing and monitoring the critically ill patients in the hospital. The
team purpose is to recognize early signs of deterioration to prevent CA in direct cooperation with the rest of
the nursing and medical staff. The following diagrams showed all the statistics related to the study. 62
Figure 1: Frequency of calls at CBT
16

Figure 2: Indicators of mortality before and after the introduction of CBT
Figure 3: Frequency of CPR in all calls of CBT
17

Figure 4: Survival rates after early intervention of CBT
Figure 5: Percentages of survival until hospital discharge after CA
Calzavacca et al studied the features of patients for whom the CBT was called. They found that 22.5%
of the patients were evaluated by the team more than once. These patients were hospitalized in surgical
wards, stayed longer at the hospital by 50% and increased mortality by 34,6%, compared to patients who
need one evaluation by the CBT. 63
18

Finally, another survey was conducted by the Ottawa Hospital (Canada) and showed that 27% of
patients, for whom the CBT were called, needed constantly ICU admission. Also, they found that the first 2
years of implementation of CBT the rate decreased from 2, 53 CA patients to 1, 3 per 1000 admissions. 64
Although, the international literature is full of studies about the value of a resuscitation team, there is a
need for more investigation concerning patient outcomes. Moreover, the effectiveness of a CBT requires
constant training, permanent recording of interventions and feedback to improve quality of given care.
A common basis for evaluating the data from CPR was published after a session in 2006 with
International Liaison Committee on Resuscitation (AHA, ARC, ERC, HSFC, IHF, RCSA, and NZRC), the
American Heart Association Emergency, Cardiovascular Care Committee, Council on Cardiopulmonary,
Perioperative, and Critical Care and Interdisciplinary Working Group on Quality of Care and Outcomes
Research. The produced guidelines concerned the collection and recording of data and studies in relation to
resuscitation teams. 37 By using a specific form (Figure 4), it is easier to record the frequency, type and
outcome of hospital events.
The processing of data ensures better planning of the intervention system. At the same time, data can be used
to develop guidelines for better treatment of hospitalized patients and prevention of medical errors.
4.2 National Data
According to the literature, there are no published data concerning the development and function of
resuscitation teams in Greek hospitals. In public hospitals, there is no evidence for existence CBT. Cardiac
arrest and threaten-life emergencies treated by ICU doctors, anesthesiologists, cardiologists, who are trying
to coordinate the CPR. Therefore, several times difficulties were presented during the CPR process such as
there is no specialized staff, there is no staff available to the ward, they aren’t aware of the emergency
equipment etc. The result of the above difficulties is the valuable time loss; there is no coordination at
interventions with adverse consequences in care of the patient. Moreover, no record of the arrests was kept
and the needs and problems arising are not documented, so the need for developing CBT is not recognized.
Exceptions are some private hospitals which have adopted the function of such teams operating in
accordance with international guidelines. There is an easy telephone number for calling the team. The team
composition is fixed for all the hours and days of a year. The team is coordinated and the role of each
member is distinct. At the end of each intervention the data are collected and documented at a predetermined
form (Figure 5) which is sent to the quality assurance office.
19

CONCLUSIONS
The number of CA victims out-hospital and in-hospital is very large, in Europe and worldwide. CA is
the leading cause of death worldwide and the most frequent cause of death in people over 40 years old. The
early CPR by qualified personnel increases the survival and improves the final neurological outcome
contributing to a better quality of life.
According to the literature, hospitals with CBT have significantly reduced the number of CA victims
and CA mortality. In these hospitals there is complete recording of the frequency, nature and outcome of
events they faced. The processing of these data ensures better planning of the intervention system. Also, data
can be used to develop guidelines for better care of hospitalized patients and prevention of medical errors.
Therefore, the need for the development of CBT in Greek hospital is urgent. This team should consist
from trained and qualified staff. This team will be on call 24 hours a day throughout the year. The CBT is
called for the early care of CA victims and other life -threatening situations according to international
guidelines.
The obligatory training of all health professionals in CPR will ensure the achievement of successful
CBT function. The training programs should follow guidelines and be developed by international
organizations. The training should be continuous in order to guarantee the maintenance of theoretical
knowledge and practical skills during time. Moreover, in many countries the attendance of CPR seminars is
necessary to health professionals for being employed in the hospital.
20

Figure 1.
APPENDIX
21

Figure 2
22

Figure 3.
23

Figure 4.
24

Figure 5
26

ALGORITHMS OF IN-HOSPITAL CARDIAC ARREST
27

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