A “code status” is a formal medical designation determining the extent of life-saving treatment a patient receives if their heart or breathing stops. This decision guides the immediate actions of the medical team during an emergency. The default status for every patient admitted to a hospital, unless explicitly stated otherwise, is “full code,” which communicates the patient’s wish for the maximum possible intervention to reverse a life-threatening event.
Defining the Full Code Status
The status of “full code” is a standing physician’s order requiring all available medical efforts to be employed to sustain a patient’s life during cardiopulmonary arrest. If the patient’s heart stops or they stop breathing, the medical team initiates a full-scale response. The alert for this emergency is commonly called a “Code Blue,” an immediate, overhead announcement that mobilizes a specialized team to the patient’s location. The intent of the full code status is the complete restoration of the patient’s spontaneous circulation and breathing.
Components of a Full Code Response
The activation of a full code triggers a rapid, coordinated response involving multiple medical professionals and specific, standardized procedures. The most recognizable component is Cardiopulmonary Resuscitation (CPR), which involves repeated chest compressions to manually circulate blood and oxygen. High-quality chest compressions are performed at a rate of 100 to 120 compressions per minute and a depth of at least two inches in adults.
Simultaneously, the team follows Advanced Cardiac Life Support (ACLS) protocols, including the administration of emergency cardiac drugs like epinephrine to stimulate the heart. If the patient’s heart rhythm is shockable, electrical defibrillation is used to deliver a controlled shock aimed at resetting the rhythm. Additionally, the team may perform intubation to secure the patient’s airway, placing a breathing tube into the trachea and connecting it to a mechanical ventilator. The combined goal of these procedures is the immediate reversal of the cardiac or respiratory arrest and the return of a pulse.
Alternative Levels of Care
In contrast to the full code status, patients can choose alternative levels of care that limit or withhold specific life-sustaining interventions. The most common is a Do Not Resuscitate (DNR) order, a medical instruction to withhold CPR during cardiopulmonary arrest. A DNR order is specific to resuscitation attempts and does not mean that all other medical treatments are stopped.
A related order is Do Not Intubate (DNI), which instructs the medical team not to place a breathing tube or connect the patient to a mechanical ventilator. Patients may also choose Comfort Measures Only, sometimes referred to as Allow Natural Death. This choice focuses solely on providing pain relief and symptom management, withholding all treatments intended to prolong life, including medications, intubation, and CPR.
Decision-Making and Documentation
The decision regarding a patient’s code status requires a thorough discussion with their physician, centering on the patient’s medical condition, prognosis, and the potential benefits and burdens of resuscitation. If patients are unable to communicate their wishes, the decision falls to a legally designated healthcare agent, often named in an Advance Directive.
Advance Directives are legal documents, such as a Living Will or a Health Care Power of Attorney, that articulate a patient’s preferences for future medical treatment. The chosen code status is formally documented as a physician’s order within the medical record, ensuring all healthcare providers are aware of the patient’s wishes. Standardized forms like Physician Orders for Life-Sustaining Treatment (POLST) or Medical Orders for Life-Sustaining Treatment (MOLST) are often used to communicate these orders across various healthcare settings. The patient retains the right to change their code status at any point during their care, requiring a new physician’s order to be documented.