Can I get a witness?

Abstract

Background The effect of family presence during cardiopulmonary resuscitation (CPR) on family members and the medical team remains controversial. Methods The authors enrolled 570 relatives of active cardiac arrest patients receiving CPR by 15 pre-hospital emergency medical service units. The units were randomly assigned either to systematically offer the family member the opportunity to observe CPR (intervention group) or to follow standard practice regarding family presence (control group). Objective: The primary end point was the proportion of relatives with post-traumatic stress disorder (PTSD)-related symptoms at 90 days. Secondary end points included the presence of anxiety and depression symptoms and the effect of family presence on medical efforts at resuscitation, the well being of the healthcare team, and the occurrence of medicolegal claims. Design: Prospective cluster-randomized controlled trial. Setting: Emergency medical service units were deployed to areas of the city across all socioeconomic groups in France from November 2009 to October 2011. Subjects: Adult family members of adult patients in cardiac arrest occurring at home. Only one first-degree relative per patient was evaluated. The relative was chosen in accordance with the legislation on hospitalization at the request of a third party in the following order of preference: spouse, parent, offspring, sibling. Exclusion criteria were communication barriers with the relative and cardiac arrest cases in which resuscitation was not attempted. Intervention: 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. A communication guide helped introduce the relative to the resuscitation scene and, when required, to help with the announcement of the death. Results In the intervention group, 211 of 266 relatives (79%) witnessed CPR, compared with 131 of 304 relatives (43%) in the control group. In the intention-to-treat analysis, the frequency of PTSD-related symptoms was significantly higher in the control group than in the intervention group (adjusted odds ratio, 1.7; 95% confidence interval (CI), 1.2 to 2.5; P =0.004) and among family members who did not witness CPR than among those who did (adjusted odds ratio, 1.6; 95% CI, 1.1 to 2.5; P =0.02). Relatives who did not witness CPR had symptoms of anxiety and depression more frequently than those who did witness CPR. Family-witnessed CPR did not affect resuscitation characteristics, patient survival, the level of emotional stress in the medical team, and did not result in medicolegal claims. Conclusions Family presence during CPR was associated with positive results on psychological variables of family members and did not interfere with medical efforts, cause increased stress in the healthcare team or result in medicolegal conflicts.