Correlations between first documented cardiac rhythms and preceding telemetry in patients with code blue events

• Published in: Journal of hospital medicine 2013-04, Vol.8 (4), p.225-228
• Main Authors: Bhalala, Utpal S., Bonafide, Christopher P., Coletti, Christian M., Rathmanner, Penny E., Nadkarni, Vinay M., Berg, Robert A., Witzke, Anita K., Kasprzak, Melody S., Zubrow, Marc T.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cardiopulmonary Resuscitation - methods; Cardiopulmonary Resuscitation - trends; Cross-Sectional Studies; Female; Heart Arrest - diagnosis; Heart Arrest - epidemiology; Heart Arrest - therapy; Heart Rate - physiology; Humans; Male; Middle Aged; Telemetry - methods; Telemetry - trends
• ISSN: 1553-5592; 1553-5606
• DOI: 10.1002/jhm.2028

BACKGROUND Among in‐hospital cardiac arrest (IHCA) patients, the first cardiac rhythm documented on resuscitation records (FDR) is often used as a surrogate for arrest etiology. Although the FDR generally represents the electrical activity at the time of cardiopulmonary resuscitation initiation, it may not be the ideal rhythm to infer the arrest etiology. We hypothesized that a rhythm present earlier—at the time of the code blue call—would frequently differ from the FDR, because the FDR might represent the later stage of a progressive cardiopulmonary process. OBJECTIVE To evaluate agreement between FDR and telemetry rhythm at the time of code blue call. DESIGN Cross‐sectional study. SETTING A 750‐bed adult tertiary care hospital and a 240‐bed adult inner city community hospital. PATIENTS Adult general ward patients monitored on the hospital's telemetry system during the 2 minutes prior to a code blue call for IHCA. INTERVENTION None. MEASUREMENTS Agreement between FDR and telemetry rhythm. RESULTS Among 69 IHCAs, agreement between FDR and telemetry was 65% (kappa = 0.37). Among 17 events with FDRs of ventricular tachyarrhythmia (VTA), telemetry showed VTA in 12 (71%) and other organized rhythms in 5 (29%). Among 12 events with first documented rhythms of asystole, telemetry showed asystole in 3 (25%), VTA in 1 (8%), and other organized rhythms in 8 (67%). CONCLUSIONS The FDR had only fair agreement with the telemetry rhythm at the time of code blue call. The telemetry rhythm may be a useful adjunct to the FDR when investigating arrest etiology. Journal of Hospital Medicine 2013;8:225–228. © 2013 Society of Hospital Medicine.