Code Blue Training: Life Support Challenges

Cardiac arrest affects over 600,000 people per year in North America alone. Depending on the circumstances of arrest, 20 to 40 percent of adults who survive to hospital care after resuscitation from cardiac arrest are discharged alive, the majority of whom enjoy favorable functional recovery. Advances in cardiopulmonary resuscitation (CPR) and post-cardiac arrest care delivery have improved outcomes over time. 

The most immediate threat to survival during the first minutes to hours is cardiovascular collapse. Interventions to optimize blood pressure and maintain brain and other end-organ perfusion (e.g., boluses of intravenous [IV] fluid, vasopressors, and inotropes) can help prevent secondary injury from hypotension.  Additional short-term goals during the first hours of care include optimizing oxygenation and ventilation and correcting electrolyte abnormalities.  

If the person survives the cardiac arrest, management of the post-cardiac arrest patient is also complex and must address multiple major problems simultaneously: 

• Initial cardiopulmonary stabilization and prevention of rearrest 
• Identification and treatment of reversible causes of cardiac arrest 
• Ongoing stabilization and prevention of brain injury 
• Early risk stratification 

Immediately following resuscitation from cardiac arrest, the patient can develop severe problems due to medical comorbidities, the underlying cause of arrest, and sequelae of global ischemia-reperfusion injury.  

In this presentation, you will hear about real-world code blue events.  You will learn about the management of both adult- and pediatric-code blue scenarios.  Highlights will include pharmacology, advanced interventions (extracorporeal membrane oxygenation, ECMO; intra-arterial fibrinolytics) and case studies.