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


  • 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.


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


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at https://t.co/50EapJORCa Bio: https://t.co/7v7cgJqNEn
Michelle Lin, MD