Cardiac arrest is common in critically-ill patients with coronavirus disease 2019 (COVID-19) and is associated with poor survival. Simulation is frequently used to evaluate and train code teams with the goal of improving outcomes. All participants engaged in a training on personal protective equipment donning and doffing for suspected or confirmed COVID-19 cases. Thereafter, simulations of in-hospital cardiac-arrest of COVID-19 patients, so-called "protected code blue", were conducted at a quaternary academic center. The primary endpoint was the mean time-to-defibrillation. A total of 114 individuals participated in 33 "protected code blue" simulations over 8 weeks: 10 were senior residents, 17 were attending physicians, 86 were nurses and 5 were respiratory therapists. Mean time-to defibrillation was 4.38 minutes. Mean time-to-room-entry, time-to-intubation, time-to-first-chest-compression and time-to-epinephrine were 2.77, 5.74, 6.31 and 6.20 minutes respectively. 92.84% of the 16 criteria evaluating the proper management of a COVID-19 cardiac arrest patient were met. Mean time-to-defibrillation was longer than guidelines-expected time during "protected code blue" simulations. While adherence to the modified advanced cardiovascular life support protocol was high, breaches that carry an additional infectious risk and reduce the efficacy of the resuscitation team were observed.
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