Family Presence During Cardiopulmonary Resuscitation
What is the impact of family presence during cardiopulmonary resuscitation (CPR) on the family members themselves and the medical team?
This was a prospective, cluster-randomized, controlled trial of 15 prehospital French emergency medical service units. Participants were adult family members of adult patients in cardiac arrest occurring at home. For emergency medical service units assigned to the intervention, a medical team member systematically asked family members whether they wished to be present during the resuscitation. For units assigned to the control, family members were not routinely given the option to be present during CPR. The primary endpoint was the proportion of relatives with post-traumatic stress disorder (PTSD)-related symptoms on day 90 (as determined by an interview conducted by a trained psychologist blinded to study-group assignments). Secondary endpoints included the presence of anxiety and depression symptoms and the effects of family presence on medical efforts at resuscitation, the well-being of the health care team, and the occurrence of medicolegal claims.
The frequency of PTSD-related symptoms was significantly higher in the control group than in the intervention group (adjusted odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2-2.5; p = 0.004) and among family members who did not witness CPR than among those who did (adjusted OR, 1.6; 95% CI, 1.1-2.5; p = 0.02). Family-witnessed CPR did not affect the duration of resuscitation, patient survival, medicolegal claims, or the level of emotional stress in the medical team.
Offering family members of patients undergoing CPR at home the option of witnessing the resuscitation efforts was associated with a significantly lower incidence of PTSD-related symptoms, compared to standard practice.
The practice of routinely offering family members the opportunity to stay with the patient during CPR is a controversial issue. While this randomized trial would suggest the positive impact of this intervention, the limitations of this study should be kept in mind before implementing changes in clinical practice. In particular, this trial took place in patients’ homes. The results would need to be confirmed in the hospital setting.
Keywords: Depression, Odds Ratio, Patient Care Team, Cardiopulmonary Resuscitation, Heart Arrest, Stress, Psychological, Visitors to Patients, Heart Diseases, Stress Disorders, Post-Traumatic, Heart Failure, Confidence Intervals
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