Family Presence During CPR

If you needed to call 911 because your loved one had an apparent heart attack and required immediate intervention, would you want to stay in the room while emergency personnel attempted resuscitation?  That was the choice given to several hundred people in a study reported in this week's New England Journal of Medicine, and as Rick and I discuss on PodMed this week, we are both in favor of the practice, a standpoint borne out by the data and conclusions of this study.

The study took place in France, where there is admittedly much less lawsuit-filing behavior alleging medical malpractice than in this country, and where another potentially critical difference in emergency responders also exists: the presence of a "senior emergency physician' as well as a nurse and a driver is found on each team. Fifteen prehospital emergency medicine service teams participated in the study, and enrolled adult family members of adult patients experiencing cardiac arrest at home. 

A total of 570 relatives of persons experiencing cardiac arrest at home were enrolled in the study and were randomly assigned to either be asked if they would like to observe CPR and resuscitation efforts, or were assigned to standard practice.  In the group queried about observing CPR, 211 of 266 chose to observe (79%), while in the control group 131 of 304 (43%) witnessed resuscitation attempts.

The main outcome measure in this study was the presence of post-traumatic stress disorder (PTSD) on day 90 following the CPR attempt. This was assessed using a standardized questionnaire administered via telephone by a trained psychologist. In addition to the Impact of Event Scale, used to assess how traumatic the event was, a depression and anxiety scale was also employed.  An additional measure of the family member's reaction included whether medicolegal actions were undertaken. Secondary endpoints included an assessment of the wellbeing of the  medical response team and the impact of family members on their resuscitation efforts.  Exactly which interventions each family member observed was recorded.

The study found that PTSD was significantly higher in the control group than in the invention group and among those family members who did not witness resuscitation efforts than among those who did. Anxiety and depression were reported more often among those who did not observe CPR than among those who did. No legal actions were undertaken by anyone participating in this study and one note of thanks was sent to responders.

Teams who had responded to 911 calls and undertaken CPR did not report any interference by observers, nor did they report higher stress or emotional reactions relative to the presence of family members.  Outcomes (4% survival) among CPR recipients were not affected.  Rick and I agree that the positive results of this study argue in favor of allowing family members to remain during CPR attempts if they choose to do so.  We agree with the researchers that such observations most likely offer loved ones the assurance that all measures likely to avert death were attempted.

Other topics this week include MRI follow-up of sciatica, also in NEJM, waning immunity following the last dose of pertussis vaccine in Pediatrics, and sildenafil in one type of heart failure in JAMA.  Until next week,y'all live well.

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Betsey April 5, 2014 at 1:29 am

A motivating discussion is worth comment. I do think that you need to publish more
on this topic, it may not be a taboo matter but usually people
do not discuss these issues. To the next! Many thanks!!

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Gerald J. Anthony April 25, 2013 at 5:06 am

Fortunately i haven't been in that situation, i'm not actually asking to be in a situation like that though. I wouldn't know what to do, but i think i would like to be by my loved one's side. I think it would be a difficult thing to see but i would regret it if something bad happens and i'm not by her side.

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Dana M. Underwood April 11, 2013 at 9:04 pm

I think it is a difficult situation to be in but personally, i would want to be with my loved one. I would want to see my loved one and assure the person that no matter what happens, i will always be by his or her side.

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