Code Blue Calls: Role of Respiratory Therapist

Cardiopulmonary Resuscitation (CPR) is a life saving measure provided for victims of cardiac arrest inside the hospital or for patients in the out of hospital areas. CPR is the most frequently performed medical treatment after the rediscovery of closed chest compression and its significant effect in 1960 [1]. CPR is provided for victims of cardiac arrest without a palpable pulse or with a feeble pulse.


Editorial
Cardiopulmonary Resuscitation (CPR) is a life saving measure provided for victims of cardiac arrest inside the hospital or for patients in the out of hospital areas. CPR is the most frequently performed medical treatment after the rediscovery of closed chest compression and its significant effect in 1960 [1]. CPR is provided for victims of cardiac arrest without a palpable pulse or with a feeble pulse.
Hospitals typically have a Code Blue Team (CBT) or a Rapid Response Team (RRT) who are usually placed in the main emergency triage or in the major Intensive care unit. The Code blue team consists of Medical practitioner (Anaesthesiologist, Intensivist or a Physician), Respiratory Therapist (RT) and a nurse. Code blue team members are well trained in providing Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) and they need to carry the AHA provider cards with them while they are on duty at the hospital. The medical practitioner, the doctor becomes the team leader and the rest of the code blue members are assigned different roles such as compression, ventilation, medications and defibrillation by the team leader. Respiratory Therapist in the code blue team needs to be well trained and confident in managing the airway and optimizing the ventilation through bag -mask unit.
Education and training of an RT focuses on the airway adjuncts, mechanical ventilation and cardiopulmonary resuscitation. This foundation creates a platform for RTs to gain confidence and be skilled in the area of CPR and practice it well for the patient care when he/she encounters with the cardiac arrest event. The education also emphasizes one to be well trained in BLS and ACLS and obtain the provider certification from American Heart Association (AHA). Respiratory Therapists mandatorily need to renew the certification by attending the AHA programme on BLS and ACLS to continue the practice as an RT in the hospital. Although there are training facilities and enough training provided to health care professionals in CPR, the outcome of patients who sustain cardiac arrest is not optimal. The survival rate vary across the globe and it ranges between 0-42% [2].
Survival rates are associated with the rapid response, early CPR and early defibrillation. Bloom et al in their study reported that these factors also determine short term and long term survival [3]. Resuscitation skills of the code blue team needs to be good as the team takes over the resuscitation from the first responders and provides advanced care to the patient. Presence of an RT in the team helps the team to optimize ventilation, airway and any other skills like defibrillation and administration of medications. The role of an RT is vital in the post resuscitation period as well. Once the patient has return of spontaneous circulation, advanced airway needs to be inserted; if already got intubated during CPR then the position and patency of the tube needs to be checked, hemodynamics needs to be stabilized and patient needs to be shifted to an intensive care unit for further monitoring and care.
Intensive Care Unit can provide good patient care and improve the outcome only with the team work of all the medical professionals. Code blue is a part of Intensive care unit services in most of the hospitals and the involvement of competent respiratory therapists in the team can improve the skills of the team and also the patient outcome.