UMEM Educational Pearls

Category: Critical Care

Title: Benefits of Family Presence During CPR

Keywords: Resuscitation, CPR, family, policy (PubMed Search)

Posted: 7/17/2017 by Kami Hu, MD
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Takeaways

When surveyed, half of general medicine patients interviewed stated that they would prefer to have a loved one present if they were to develop cardiac arrest and require CPR. So far, studies have demonstrated that…

Allowing family presence during CPR is associated with the following benefits to family members:

  • Decreased rates of PTSD-related symptoms
  • Decreased scores on anxiety and depression scales
  • Decreased incidence of complicated grief
  • Decreased incidence of family member regret (at having been present vs absent during CPR)

And is NOT associated with a difference in:

  • Survival rate
  • Duration of resuscitation efforts
  • Type or dose of administered medications
  • Number of shocks delivered
  • Emotional stress level of medical providers
  • Occurrence of medicolegal conflict

In-Depth

Several studies have demonstrated benefits to patient family members who are offered the opportunity to witness ongoing CPR when their loved one develops cardiac arrest.  These benefits--decreased rates of PTSD-related symptoms, anxiety, depression (including need for medication, professional treatment, and suicide attempts), and complicated grief--have been shown to persist at 1 year post-resuscitation event.

Themes that arise when discussing the resuscitations with family members afterward include:

1. The feeling of active involvement in the resuscitation process

  • The importance of being emotionally present for their loved one
  • The ability to see the efforts of the resuscitation team

2. Communication with the resuscitation team

  • Providing medical information on the loved one’s behalf
  • Explanation from the team of what was happening

3. Perception of the reality of death

  • Understanding actual death as the cause for CPR
  • Seeing the failure of CPR and even nonverbal communication between participants of the team

4. Experience of and reaction to witnessing (or not witnessing) the resuscitation

  • Examples given when witnessed:
  1. Relief that the patient did not or would not suffer
  2. Feeling that there was even excessively heroic treatment
  • Examples given when not witnessed:
  1. Feeling of brutality and dehumanization
  2. The inability to say goodbye

Twelve percent of family members who chose to NOT be present during CPR expressed regret at their choice, versus three percent of relatives who chose to be present.

Negative outcomes cited by family members who witnessed CPR involved feeling like they were not being communicated with, or that their loved one was being over-zealously resuscitated. 

References

  1. Bradley C, Keithline M, Petrocelli M, et al. Perceptions of adult hospitalized patients on family presence during cardiopulmonary resuscitation. Am J Crit Care. 2017;26(2):103-110.
  2. Jabre P, Belpomme V, Azoluay E, et al. Family presence during cardiopulmonary resuscitation. N Engl J Med. 2013;368(11):1008-18.
  3. Jabre P, Tazarourte K, Azoulay E, et al. Offering the opportunity for family to be present during cardiopulmonary resuscitation: 1-year assessment. Intensive Care Med. 2014;40(7):981-7.
  4. Goldberger Z, Nallamothu B, Nichol G, et al.  Policies allowing family presence during resuscitation and patterns of care during in-hospital cardiac arrest. Circ Cardiovasc Qual Outcomes. 2015;8(3):226-34.
  5. De Stefano C, Normand D, Jabre P, et al. Family presence during resuscitation: A qualitative analysis from a national multicenter randomized clinical trial. PLoS ONE.  2016;11(6): e0156100.