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

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.