Family Presence in Cardiac Arrest Resuscitations

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Jabre P, Belpomme V, Azoulay E, et al. Family Presence during Cardiopulmonary Resuscitation. New Engl J Medicine 2013;368(11):1008–18. 10.1056/nejmoa1203366

P – Relatives of patients undergoing cardiopulmonary resuscitation (CPR) in the out-of-hospital setting

I – Offering family members ability to witness CPR with designated family liaison and script

C – Standard practice regarding family presence

O – Primary: Post-traumatic stress disorder (PTSD) related symptoms of relatives 90 days after CPR; Secondary: Effect of family presence on medical resuscitation efforts, well-being of health care team

Background

Cardiac arrests are an inevitable reality for emergency medicine providers. There is often a debate on whether family members presence during CPR will lead to more emotional burdens on the family members who witnessed these resuscitations. This study aimed to determine if there are increased rates of PTSD-related symptoms of close relatives who witnessed CPR of a family member.

Methods

This was a prospective, cluster-randomized, controlled trial that involved fifteen emergency medical service agencies in France. Eight of the agencies were randomly selected into the intervention group, which meant they were instructed to offer family members the opportunity to witness CPR during resuscitations. If those family members agreed there was a specific script that a designated family liaison followed. The seven agencies randomly selected into the control group would not stop a family member from witnessing CPR, but it was not regularly offered, and they followed standard protocols of the agency. The designated family member for this study then underwent psychiatric evaluation 90 days after the event to determine likely PTSD-related, anxiety, and depression symptoms. The psychiatric professional was blinded to which study group the family member was enrolled. For secondary outcomes, the resuscitations were reviewed to determine if family member presence affected resuscitation efforts. Additionally, the emotional stress level of the medical team was evaluated after each resuscitation by a nine-item questionnaire.

Results

A total of 570 relatives of patients undergoing CPR were enrolled in this study. In regards to the primary outcome

  • 79% (211 of 266) of family members in the intervention group witnessed CPR compared to 43% (131 of 304) of family members in the control group.

  • For study participants in the intervention group, and for those who witnessed CPR in both the intervention and control group, there was a significantly decreased likelihood of developing PTSD-related symptoms 90 days after the resuscitation event

  • Family members who did not witness CPR, both in the control and intervention group, had increased symptoms of anxiety and depression.

  • Those that did not witness CPR were more likely to say they regretted their decision compared to those who did witness the resuscitation.

For the secondary outcomes, there were no statistically significant differences in resuscitation efforts when family members were present during CPR, and there was no change in medical practitioner emotional stress with family members were absent or present during resuscitations.

Limitations

One of the main study limitations is the generalizability to emergency departments, considering all cardiac arrests and resuscitations that were witnessed occurred out of hospital, and often in the patient’s and relatives’ homes. Additionally, this study only occurred in France, which may reduce it’s generalizability to different countries that may have different cultural values and beliefs on end-of-life care. Finally, the script and family liaison of the intervention group could be a confounding variable comparing those who witnessed CPR in the intervention group and the control group.

Conclusion

This study showed that family member presence during CPR was associated with a decreased likelihood of PTSD-related symptoms several months after the event. Family members witnessing CPR also did not affect the resuscitative efforts of the medical team or affect their emotional well-being.

Authorship

  • Written by Melanie Yates, MD, PGY-3 University of Cincinnati Department of Emergency Medicine

  • Peer Review and Editing by Jeffery Hill, MD MEd, Associate Professor of Emergency Medicine University of Cincinnati Department of Emergency Medicine.

Cite As

Yates, M. Hill, J. (November 11, 2022). Family Presence in Cardiac Arrest Resuscitations. TamingtheSRU. https://www.tamingthesru.com/blog/journal-club/family-presence-in-cardiac-arrest-resuscitations