MAY 2025
A “code blue” is a well- recognised and universally used broadcast call for medical assistance in the event of a cardiac or cardiorespiratory arrest in the hospital setting. A designated team of medical and nursing clinicians will attend immediately with the expectation of performing advanced cardiopulmonary resuscitation.
Intraoperatively, in the theatre suite, a code blue or audible emergency buzzer will be called by an anaesthetist or other member of the team when assistance is required for management of cardiac arrest, anaphylaxis or airway compromise. In the latter situation and in particular if the airway is lost and the patient cannot be ventilated there is the real prospect of the requirement for an urgent tracheostomy. The most skilled clinician in this scenario would be a surgeon, preferably an ENT surgeon. A “code airway” in the operating suite would be useful to alert to the urgent requirement of surgical attendance.
In the postoperative setting, when a “code blue” is called the cause of arrest is often assumed to be cardiac but may in fact be airway compromise. Examples include neck haematoma following thyroid surgery, carotid surgery or an anterior cervical discectomy, swelling following head and neck or ear, nose and throat surgery and tracheostomy complications. The code blue team may not necessarily include a clinician with advanced airway skills such as an anaesthetist. In situations of airway compromise attendance by any available anaesthetist would be helpful. A broadcast of “code airway” or “code blue - airway” would alert all personnel to the nature of the clinical situation with the aim of attracting those with the most appropriate skill set and the rapid provision of specialised airway equipment.
It is suggested that:
- In theatre suites consideration should be given to implementing a “code airway” for episodes of airway compromise where practitioners with advanced airway or neck surgery skills can be alerted to a critical event that may benefit from their immediate attendance.
- Future consideration be given to enabling specific ward emergency calls for medical emergency situations where airway compromise is the primary concern. This may take the form of targeted personal paging in public hospitals, contacting the operating theatre anaesthesia team, or a modified type of overhead paging method (e.g. “MET – airway”, or “code blue – airway”) being announced so that advanced equipment and clinical skills are likely to be able to be more rapidly provided. It is expected that individual sites will have individual approaches to this suggestion.
- Whilst every inpatient healthcare facility has a code blue or medical emergency call team, implementation would have to include an education package raising awareness of the new code structure, targeted at appropriate clinicians.