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Table 1 Sample quotations for the compiled themes

From: Perceptions of resuscitation care among in-hospital cardiac arrest responders: a qualitative analysis

Timeline of arrest

Themes

Sample Quotations

Pre-Arrest

Code Activation

(A) While an ICU bed was being prepared, the patient ended up coding on the floor.

(B) This arrest happened close to shift change in an ICU setting. The ICU staff required assistance from the floor code teams.

Code Status Issues

(C) The patient was DNI but not DNR making resuscitation efforts difficult.

(D) When the patient lost BP (blood pressure), MD confirmed with the wife we weren’t doing chest compressions per his code status (he was intubation only).

(E) Alert the family sooner that death of the patient is imminent and attempt to change the code status from full to DNR (do not resuscitate). The patient was reintubated for the second time on the unit in less than 12 h.

Arrest

Team Interactions

(F) We identified the loss of pulse immediately, started CPR (cardiopulmonary resuscitation) while the patient was in the chair, and delivered the first shock before the code team arrived and the patient regained consciousness.

(G) The MD in charge did a wonderful job, very clear with his directions, wore the yellow sign. He came back to our unit to assure that we didn’t need anything else after the code.

(H) The team leader was not initially evident. Orders were coming from many different people.

(I) The code ran very smoothly. The only complaint I heard was that there were too many people in the room. Some of the ICU nursing staff suggested that [these people] leave the room.

Supplies and Equipment

(J) The supplies on the cart were quickly used up.

(K) …The drugs that anesthesia usually brings, such as phenylephrine, were not available.

Post-Arrest

Code Cessation

(L) The length of time and amount of medication we used in this code was unacceptable. I strongly feel that this code should not have lasted as long as it did.

(M) The team’s ability to “let go” was an issue. The patient was gone at least an hour before we stopped coding her.

Transitions of Care

(N) Floor nurses need to have their code documentation done when or shortly after the patient transfers to an ICU. So if the patient arrests again (like this patient did), the ICU can start and document the code in real time instead of putting together the variables later.

(O) The ICU fellow was called, but did not enter the room to assess the situation. She should have found me as the team leader before deciding not to accept the patient, especially since this patient had been in the unit 4 days prior.

Holistic

Attentiveness to Patient Comfort

(P) Dr. X cannulated this patient for ECMO (extracorporeal membrane oxygenation) during CPR…It was very upsetting.

(Q) Unsure as to why the RN placed intraosseous access when he had two functioning lines. The patient was awake at the time it was placed, and found it to be very painful.

Family

(R) We had taken the step to involve ethics as the patient had a terminal illness, and yet the wife (who did not fully understand the code process and would hang up when discussions were initiated) wanted everything done.

(S) During the code, a family member barged in the room, hysterical, and demanded that we stop. The entire team actually stopped compressions and intubation. As the code leader, I asked them to resume CPR, which they did. The family member was not the DPOA.