Abstract P72: Code Blue and Hospitalized Patients With Implantable Cardiac Defibrillators
BACKGROUND: Since 2002 the annual number of patients receiving implantable cardiac defibrillators (ICDs) grew almost 5-fold, with over 137,000 devices implanted in 2006 in the United States. Hospitals are expected to see more patients with ICDs as the overall prevalence increases. We anticipate that the chances of encountering an ICD during in-hospital resuscitative efforts are also growing. Unfortunately, there is a paucity of information on this subject. The goal of this research is to establish objective data characterizing trends in hospitalized patients with ICDs with special attention to code blue.
METHODS: We reviewed all medical records of hospitalized patients at our facility from 2002–2007 to identify patents with ICDs, events related to ICD discharge, and code blue. We interviewed physicians involved in the resuscitative efforts of these patients and summarized their experiences. Poisson regression was used to estimate the change in rates of these events over the six years considered.
RESULTS: Approximately 3% (n=1,933) of total hospital admissions (n=62,863/six years) involved patients with ICDs. On average the annual admission rates changed little (n=10,477 +/−585) per year. However, the number of admissions involving patients with ICDs nearly doubled in the same period (28% increase annually, p<0.0001), making up 4.7% (n=510) of the 2007 admissions. The rate of total annual code blue events decreased slightly 11% yearly, p=0.024; (n=143 +/−21 per year on average). Of these, very few events involved patients with ICDs (n=21); on average an ICD was implicated in 4.0+/−1.6% code blue events per year. Physician experiences varied. Questions arose, whether timing of external defibrillator shocks should be modified to account for potential conflicts with internal defibrillation and/or anti-tachycardia pacing functionalities.
CONCLUSIONS: The number of patients with ICDs grew significantly since 2002 at our facility. Approximately 4% of our in-hospital code blue events involve a patient with an ICD. The clinical implications for managing patients with ICDs during code blue efforts remain murky. Future studies should evaluate the role, if any, for integrating ICD functionality into code blue algorithms.