213 Family Presence During Cardiopulmonary Resuscitation

Abstract

Study Objectives: Family presence during cardiopulmonary resuscitation (CPR) of a loved one remains controversial. The principal aim of this trial was to determine if offering a relative the choice to observe CPR of a family member might reduce his or her psychological impact 90 days later. We also assessed the impact of family presence on medical efforts at resuscitation, the wellbeing of the health care team, and on the occurrence of medicolegal claims. Methods: This study was a multicenter prospective, cluster randomized, controlled trial. We enrolled 570 relatives of patients who were in cardiac arrest in 17 out-of-hospital emergency medical services. Centers were randomized either to 1) systematically offer the family member the opportunity to observe CPR (intervention group), or 2) to a habitual practice regarding family presence (control group). The primary endpoint was the proportion of relatives having post-traumatic stress disorder (PTSD)-related symptoms by an Impact of Event Scale (IES) >30 at 90 days. Secondary endpoints included the presence of anxiety and depression symptoms by the Hospital Anxiety and Depression Scale (HADS) and the impact of family presence on medical efforts at resuscitation, the wellbeing of the health care team, and on the occurrence of medicolegal claims. For pyschological assessment analyses, inorder to take into account the cluster structure of the design, Generalized Estimating Equations (GEE) were used. Results: In the intervention group, 211/266 (79%) relatives witnessed CPR compared to 131/304 (43%) relatives in the control group. In the intention-to-treat analysis, family members had PTSD-related symptoms significantly more frequently in the control group (adjusted odds ratio, 1.7; 95% confidence interval [CI], 1.2 to 2.5; P=0.004) and when they did not witness CPR (adjusted odds ratio, 1.6; 95% CI, 1.1 to 2.5; P=0.02). According to family presence, relatives who did not witness CPR had more frequently symptoms of anxiety and depression. Family-witnessed CPR did not affect resuscitation characteristics, patient survival, medical team stress or result in medicolegal claims. Conclusion: Our results promote family presence during CPR. This experience was associated with positive results on psychological parameters and neither interfered with medical efforts or health care team stress nor resulted in medicolegal conflicts.