Smartphone Code Blue Alerts Boost Response to In-Hospital Cardiac Arrest

The smartphone code blue notification system accelerated the hospital code team's response to a patient in cardiac arrest by 1 minute.

A system linking hospital code blue buttons with electronic medical records and staff smartphone text messaging was found to decrease the time to code team response to inpatient cardiac arrest events, according to study results presented at the American Heart Association (AHA) Scientific Sessions held from November 5th through 7th, in Chicago, Illinois.

In the past decade, in-hospital cardiac arrest mortality rates have modestly improved. Some studies have suggested that earlier defibrillation and administration of epinephrine may more effectively improve inpatient cardiac arrest outcomes.

Researchers from the University of Maryland Medical Center sought to decrease the time to code team activation by mapping code blue buttons to patient data and code team smartphones. When the code blue button was pressed, a simultaneous secure text message was sent to the smartphones of the code blue team members with relevant patient information, such as admitting diagnosis, recent procedural and therapeutic history, and biomarker levels. At the same time, the hospital operator was contacted to activate the team using the standard protocol by overhead page and pager alert.

This pilot system was tested in 4 inpatient units between November 2019 and May 2022. The primary outcomes for this study were time from button press to smartphone message receipt, time to epinephrine administration, and patient survival.

Implementation of a smartphone-based code button activated notification system reduced the time to code team activation by over one minute.

During the pilot program, a total of 35 inpatient cardiac arrest events occurred. In a third of these events (34.3%), the code blue button was the primary mode of team activation.

The team received a smartphone notification a median of 78 (interquartile range [IQR], 47-127) seconds prior to traditional prepilot study protocol notification rates.

Most patients with cardiac arrest had an initial rhythm that was nonshockable (97.1%). The median time to epinephrine administration was 2:57 (IQR, 0:34-6:07) during events involving blue button activation and 4:00 (IQR, 2:07-4:30; P =.89) for nonbutton events.

Survival to discharge occurred among 25.0% of patients who had a button-activated responding code team and 17.4% of patients without a button-activated code team (P =.61).

The results of this pilot program may not be generalizable for other sites.

“Implementation of a smartphone-based code button activated notification system reduced the time to code team activation by over one minute,” the researchers stated. They acknowledged that this protocol should be evaluated on a larger scale to better assess the effect on patient outcomes.


Couperus C, Dezman Z, Friedrich R, et al. Feasibility of accelerated code team activation with code button triggered smartphone notifications. Presented at AHA Scientific Sessions 2022; November 5-7; Chicago, IL. Abstract #6.