CPRanimationFamily presence in the ED resuscitation of a dying patient is a controversial topic. Some surveys suggest that families favor this practice and would repeat it again in a similar situation.

An article in Critical Care Medicine examines the impact of family presence on the ED personnel’s actions, rather than the impact on the families themselves. Second and third-year EM residents were randomized into paired teams in simulation exercises. All resuscitations involved a cardiac arrest patient. Each team was exposed to one of three types of resuscitation groups:

  1. No family witness
  2. Non-obstructive family witness (quiet person) – quiet crying and conversation with social worker
  3. Overtly grieving family witness – loud crying, attempts to hug patient during resuscitation

Outcome measures

  1. Length of resuscitation attempt
  2. Time to critical events (eg. intubation)
  3. Recognition of potential drug administration error

Results

  • n = 60 residents
  • The timed outcomes were compared across the 3 groups using a one-way analysis of variance.
  • There was no difference across the 3 groups when comparing # of minutes to CPR, to intubate the patient, and to making a death pronouncement.
  • “Overt reaction witness” group: Residents took longer to deliver the first defibrillation shock than the other 2 groups. Also residents delivered fewer shocks overall than other 2 groups.

Bottom line

Mortality improves with PROMPT defibrillation for ventricular fibrillation patients. Delays contribute to worse outcome. This study suggests that overtly-grieving family witnesses during the resuscitation may negatively impact process outcomes of the actual resuscitation.

Of course because this study was conducted on residents (not attendings) and on a human simulation (not on actual patients), more studies need to confirm these preliminary findings.

 
Reference

Fernandez R, Compton S, Jones KA, & Velilla MA (2009). The presence of a family witness impacts physician performance during simulated medical codes. Critical care medicine, 37 (6), 1956-60 PMID: 19384215

 

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD

@M_Lin

Professor of Emerg Med at UCSF-Zuckerberg San Francisco General. Founder of ALiEM @aliemteam #PostitPearls https://t.co/7v7cgJqNEn
Michelle Lin, MD