Roles of anesthesia assistants within the code blue team at in-hospital cardiopulmonary arrests: A retrospective analysis.

Introduction: Anesthesia assistants (AAs) are respiratory therapists or nurses who have additional sub-specialty training in the provision and maintenance of anesthesia. Their skill set includes advanced airway management, vascular access, and knowledge of vasoactive medications and resuscitative protocols. AAs function as non-physician members of the anesthesia team and can act as physician extenders to help offset the current shortage of anesthesiologists. Methods: This study was a retrospective analysis of AA roles at code blue events at an adult academic teaching centre. Data was extracted from administrative data collection forms completed by AAs at adult code blue events between 2017 and 2022. The data elements that each form captured included time and location of event, presumed cause of the code, airway management details, vascular access provision, medication preparation or administration, human factors and cognitive supports provided to the team by the AAs. Results: Administrative data collection forms from 320 code blue events were analyzed in this study. The most common primary causes of the code blue events were "arrest" (39%) and "respiratory failure" (26%). Regular floor beds (47%) and the intermediate care units (18%) were the most common locations of code blue events. Airway support was required in 77% of the codes, and in 50% of the cases requiring intubation, it was performed by the AAs. The first pass success rate for AA intubations was 83%, and overall success rate was 96%. In addition to airway management at codes, the AAs also reported providing numerous other valuable contributions to the team. The most reported supports provided to the team included cognitive support regarding resuscitation (49% of cases), intravenous access (19% of cases), and medication preparation or administration (9% of cases). Other roles included placement of arterial lines and drawing blood gases, obtaining interosseous vascular access, and assisting with patient transport to critical care units after resuscitation. Conclusions: Our study characterizes the supporting roles that AAs can provide as members of the code blue team and demonstrates their contributions to management of critically ill patients. The AAs' airway management, vascular access skillsets, and knowledge of vasoactive and resuscitative medications and protocols make them well-suited to the code blue team. In addition to assisting within the operating room team, AAs can also provide valuable support in non-operating room environments such as cardiopulmonary arrests.