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protocol of responding to a ‘Code Blue’ situation. Any health staff (doctor, nurse or auxiliary staff like patient transporters, paramedics) can activate the Code Blue from any area of the hospital through the nearest telephone extension. As per protocol of the hospital, Code Blue is activated across the hospital outside Emergency, Critical Care units and Operation theatre which have dedicated stationed Advanced Cardiac Life Support (ACLS) providers. There is a dedicated hotline number through which all ‘Code Blue’ calls are handled followed by subsequent alert of the respective Code Blue team members as per duty roster. The ‘Code Blue’ team consists of ACLS trained doctors from the department of anesthesiology, emergency medicine and critical care units along with nursing staffs, pharmacists and allied personnel. The team leader from the physician pool of the Code Blue team is responsible for directing the resuscitation services. As per protocol if arrest is detected, resuscitation will begin immediately by the local care providers and continue as per Basic Life Support (BLS) Guidelines till the Blue Bode team arrives to the particular unit and takes charge of the resuscitation services. Resuscitation Services were provided as per AHA Guidelines 2015. The immediate success of ‘Code Blue’ was considered as Return of Spontaneous Circulation (ROSC) and sustainability beyond 4 hours; survival beyond 24 hours and till discharge was also considered. Code Blue cases who did not have ROSC or where ROSC was not sustained beyond 4 hours was considered as unsuccessful. The study protocol was approved by the Institutional Ethics Committee before the start of the study. Review of Code Blue Report forms revealed a sample size of 111 after considering the exclusion criteria. Code Blue calls below 18 years were excluded. 10 cases were excluded as those were not true cardiac arrest situations. The data was entered and recorded in a Microsoft Excel 2013 file and analyzed using the SPSS version 21. Descriptive statistics and Chi-square test were used to the data. RESULTS Immediate success of resuscitation services for Code Blue calls was 63.06%, beyond 24 hours this was 27.03% and at discharge this was just 9.01%. The sex distribution of Code Blue cases reveals males 72.1% and females 27.9% (Figure 1). The outcome of resuscitation services in terms of immediate success of Code Blue cases was more in males (48, 68.57%) vis a vis (22, 31.43%) in females and this difference was statistically significant (p value=0.000). This outcome however got reversed at discharge. The survival rate at discharge was more in females 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% Male Female 72.1% 27.9% 5.4% 48.6% 45.9% 18-40 years 41-65 years >65 years 12.6% 18.0% 16.2% 14.4% 19.8% 18.9% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 8am-12 noon 12noon-4pm 4pm-8pm 8pm-12 midnight 12 midnight-4am 4m-8am Figure-1: Sex Distribution of Code Blue Cases Figure-2: Age wise Distribution of Code Blue cases Figure-3: Time Distribution of Code Blue Calls Mitra, et al. Success and Other Correlates of Code Blue Cases International Journal of Contemporary Medical Research Section: Anesthesiology ISSN (Online): 2393-915X; (Print): 2454-7379 | ICV: 98.46 | Volume 7 | Issue 1 | January 2020 A3 (6, 60%) vis a vis males (4, 40%) (p value=0.000<0.05). The mean age of the patients for Code Blue was 64.06 years (± 9.96 Standard Deviation), range 18 -90 years. The Age Distribution of Code Blue cases was 5.4% in the age group of 18-40 years, 48.6% in the age group of 41-65 years and 45.9% in the age group of >65 years (Figure 2). The success of resuscitation depended on the age of the patients with immediate success rates declining in the age group of >65 years (30, 42.86%) against that in the age group ≤ 65 years (40, 57.14%) and this difference was statistically significant. (p value=0.000<0.05). This difference was more evident in the survival rate at discharge. In the age group ≤ 65 years, it was (8, 80%) against those with age > 65 years being (2, 20%). This difference was also statistically significant (p value=0.000<0.05). Logistic Regression Analysis substantiated the same. The odds of the immediate success rate of resuscitation was 1.5 times more in the age group ≤ 65 years. This difference was more evident in the survival rate at discharge where the odds of survival at discharge being 4 times more in patients in the age group ≤ 65 years. The time Distribution of Code Blue Calls was 12.6% between 8AM to 12 noon, 18% between 12 noon to 4 PM, 16.2% between 4PM to 8 PM, 14.4% between 8PM to 12 midnight, 19.8% between 12 midnight to 4AM and 18.9% between 4AM to 8AM (Figure 3). The outcome of resuscitation in terms of immediate success was dependent on the time of occurrence of Code Blue with unsuccessful immediate resuscitation being (11, 27.5%) during the routine hospital working hours of 8AM to 8PM vis a vis that (30, 72.5%) after hospital working hours of 8PM to 8AM. This difference was also statistically significant. (p value=0.000><0.05). The success rate was better in terms of discharge in patients who had Code Blue during routine hospital working hours of 8AM to 8PM (7, 70%) against those who had Code Blue after hospital working hours of 8PM to 8 AM (3,30%). This difference was statistically significant (p value=0.000><0.05). This could be due to delayed communication and response to Code Blue calls, team efficiency and competence beyond routine hospital working hours which could have affected the quality of resuscitation services. The department wise distribution of Code Blue calls is depicted in the Figure 4. Initial Rhythm at the time of Code Blue is depicted in the Figure 5. Rate of immediate success of resuscitation services was more where initial rhythm was Asystole (39, 55.71%), followed by Pulseless Electrical Activity (PEA) (20, 28.57%), VT/VF (6, 8.57%) and Bradycardia (5, 7.14%) but this difference did not turn out to be statistically significant in our study (p value= 0.495><0.05) The immediate success of resuscitation was better in patients without comorbidities (42, 60%) against that in patients with comorbidities (28, 40%) and this difference was statistically significant (p value=0.000><0.05). This was also evident at discharge with the success rate at discharge in patients without comorbidities (8, 80%) vis a vis those with comorbidities (2, 20%) and this was statistically significant (p value=0.000><0.05). Logistic Regression Analysis, revealed a similar picture. The odds of the immediate success of resuscitation was 1.75 times more in patients without comorbidities. This was also evident on survival at discharge. The odds of survival at discharge was 2.5 times more in patients without comorbidities. The immediate success of resuscitation was more where response time by Code Blue team was within 3 mins (44,62.86%) against the response time of > 3 mins (26, 37.14%) but this difference was not statistically significant (p value=0.46<0.05) though. This could be due to the well established process of first response in the hospital where all the staffs are Basic Life Support (BLS) trained. The success of resuscitation was better in terms of survival at discharge in cases where response time was within 3 mins (10, 9.01%) vis a vis those with response time >3mins having nil survival at discharge (0,0%). This difference however was statistically significant. (p value=0.006<0.05). The outcome of resuscitation in terms of immediate success was better in patients who did not have any procedure like dialysis or Operation or Chemotherapy within the last 24 hours of resuscitation (60, 85.71%) against patients who had a procedure like dialysis or Operation or Chemotherapy in the last 24 hours (10, 14.29%) and this difference was statistically significant. (p value=0.000><0.05). The outcome of resuscitation in terms of immediate success was better in patients where the doctors attended the patient within last 4 hours (50, 71.43%) vis a vis those patients where the doctor did not attend in the last 4 hours (20, 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 37.84% 19.82% 16.22% 10.81% 4.50% 5.40% 2.70% 2.71% Department wise Distribution of Code Blue Calls Asystole, 62.16% PEA, 28.83% VT/VF, 9.01% Figure-4: Department wise Distribution of Code Blue Calls Figure-5: Initial Rhythm Mitra, et al. Success and Other Correlates of Code Blue Cases Section: Anesthesiology International Journal of Contemporary Medical Research Volume 7 | Issue 1 | January 2020 | ICV: 98.46 | ISSN (Online): 2393-915X; (Print): 2454-7379 A4 28.57%). This difference was statistically significant. (p value=0.000><0.05). Duration of resuscitation was > 20 mins in all the cases in consonance with the established guidelines. DISCUSSION Factors such as age, time of Code Blue during or outside routine hospital working hours, associated comorbidities, procedures like dialysis, operation or chemotherapy done in the last 24 hours preceding the Code Blue and duration of CPR were found to have a significant effect on the success rate. Immediate success of resuscitation services for Code Blue calls was 63.06%, beyond 24 hours this was 27.03% and at discharge this was just 9.01%. Our study is also consistent with the findings from other studies which reported that survival rate after cardiac arrest declined significantly with increase in age.13,14 There is a scope of improvement on the quality of resuscitation services beyond routine working hours of the hospital from 8 PM to 8 AM. This finding points out to a very important aspect which requires further in depth analysis to find out the root cause for targeted interventions. Asystole was the predominant rhythm at the time of ‘Code Blue’ which was consistent with other studies.15 Though studies pointed out that presenting rhythm significantly affected the survival of the patient after cardiopulmonary arrest,16,17 our findings deviated from the same. Unlike studies which did not find any significant effect of gender on the success rate, our findings were consistent with the findings of studies which reported that gender was a predictor of survival after cardiac 

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