Tandem Codes: A Novel Cardiac Arrest Care Model in COVID-19

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Harman Gill
I am a proud Indian by ethnicity and Sikh by religion who lives in the lovely upper valley here in New Hampshire. I love to host, cook and engage in health conversations and loud debates where decibels can be raised but respect is never lost! Talk to you soon!

The Pre-brief

Routine cardiac arrest care involves many procedures such as CPR and intubation that are known to be aerosol-generating procedures. As such and in the COVID-19 era, many institutions have developed modified code blue or cardiac arrest paradigms to better protect healthcare professionals (HCPs) and still provide our patients with the care they need. This post shares key features of one such paradigm called the “Tandem Code”.

Rationale:

  • ACLS guidelines recommend dedicated care teams for cardiac arrests.
  • These teams are usually very large and ascribe focused tasks to each team member.
  • A pandemic behooves us to keep the size of these teams small so as to limit HCPs exposure. The team members must be versatile to help with multiple tasks.
  • So we decided to make our own process and called it the “Tandem Code”.

The Team:

  • In this model, there is a set number of HCPs that enter the room and another set that are outside the room.
  • Conventionally there is a physician or an APP who is the team leader, but in our model…BIG DIFFERENCE: there is TANDEM physician and nursing leadership in running the code.
  • So in an ideal world:
    • a physician is in charge of supervising the physicians, RTs, & APPs on the team and focuses on tasks of airway management, procedures, POCUS usage, and decision to terminate/continue resuscitative efforts.
    • a nurse code leader is in charge of managing nursing and licensed nursing assistant (LNA) personnel and focuses on the algorithmic components of ACLS, timely rotation of personnel in and out of the room, and ensuring PPE compliance.

Tasks:

  • If the physician team leader is busy with airway management and/or procedures, the entire resuscitation can be run algorithmically by the nurse team leader…that’s right…all of it!!!
  • Tasks are shared: For example, CPR is done in rotation by LNA, RN1, RN2 and potentially even RT if available.
  • Everything from transition of care from EMS to what equipment goes in the room and what stays outside the room to when new sets of meds & personnel enter the room is modelled and practiced in in-situ simulations.

Have something like this at your own shop? If so, then that’s great! If not, then try this out and if you have any questions, please ask in the comments below! We are doing it, practicing it, and even about to publish it!

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