Should families be allowed to witness CPR?

This is a topic that comes up from time to time for often spirited discussion. The most recent example comes in a a couple of articles in the New England Journal of Medicine. One was a research paper; the other was a pro and con discussion.

The research paper studied cardiac arrests that happened outside the hospital. The authors tested the premise that allowing families to watch the efforts of the medical team reduce their psychic distress later. One group of patients received usual care, which meant keeping the families away from what was going on. Families of patients in the other group were asked if they would like to observe the resuscitation up close: 79% chose to watch. A medical team member was assigned to be with them and explain everything that was going on. The researchers then followed up with the families 90 days later to determine how many had symptoms of anxiety, depression, or actual post-traumatic stress disorder.

The investigators found a significant reduction in psychological symptoms among family members who had watched the CPR. Also important is that there was no problem with family members interfering with the medical team.

Now comes the controversy. Family observation of CPR is a hot topic among critical care and emergency physicians, and opinions are strong both for and against. This is shown in the next article. It is short — a case scenario of a cardiac arrest, and is well worth reading if you don’t know what we actually do in those situations. Two experts then wrote brief pro and con statements about allowing families to watch. But it is in the comments where things really heated up. Here are some examples:

Being present is more harm to the family

A genie that should not have been let out of the bottle

No family presence for me!

Absolutely no — apart from the chaotic scenes of CPR, I don’t want to be accused by the family bystander that I killed their loved on, do you?

Don’t deny families who choose to be present –support them

Being present far more important for all.

Yes, I support family presence at the bedside during a code situation

And so on, for nearly a hundred comments. Scanning them over, they seem pretty equally divided. I assume the commenters were talking about adults, but this issue always comes up when we have a CPR event in the PICU. For pediatric intensivists, the question of parents observing is I think less devisive. I always ask families if they wish to leave or would like to stay with their child. Nearly all choose to stay. I have heard many times afterwards that they were glad they had the opportunity to participate in some small way. Nearly all the pediatric intensivists I know feel the same way.

I have never had a problem with parents interfering with care in any way. But the demeanor of the team members, especially the physician directing the resuscitation, is key. Resuscitations are stressful — and messy, too. But shouting never helps anything. A calm, firm demeanor is what parents need to see, especially in the doctor. So do the other team members. I’ve been doing this for 30 years and have seen my share of chaos. The way to control that is practice, practice, practice: mock codes keep everybody sharp.

It is crucial, however, that someone be delegated to stay right by the parents and explain what is happening. Usually I designate an experienced PICU nurse, who needs to be ready to support the parents emotionally — physically, too, which means finding chairs or stools as needed. Every parent I have ever dealt with in this way has been grateful afterwards for being allowed to stay.

Maybe adult patients are different; I have no experience with that. But I think parents of a child should always be given the option. If the resuscitation is unsuccessful, it is a good way to assure them that everything possible was done to save their child.

Christopher Johnson is a pediatric intensive care physician and author of Your Critically Ill Child: Life and Death Choices Parents Must Face, How to Talk to Your Child’s Doctor: A Handbook for Parents, and How Your Child Heals: An Inside Look At Common Childhood Ailments.  He blogs at his self-titled site, Christopher Johnson, MD.

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