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Should Relatives Be Witnesses to Resuscitation Attempts?
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Am Fam Physician. 1998 Dec 1;58(9):2122-2127.
Family members are usually excluded from resuscitation attempts because it is believed that witnessing invasive procedures and aggressive interventions would be distressing to them. In addition, the presence of family members is thought to impair the performance of clinical staff. Robinson and colleagues conducted a pilot study to see if witnessing a resuscitation attempt had an adverse effect on family members who remained with the patient during the attempt.
During a 15-month period, relatives of patients undergoing resuscitation following cardiac arrest or multiple trauma at a British hospital were included in the study. A sealed envelope was used to randomize relatives who would be eligible to remain with the patient during resuscitation attempts. However, those randomized to the control group were not given this option. Both groups of relatives were accompanied at all times by an experienced staff member who explained the resuscitation procedures according to standardized protocols.
Bereaved relatives were interviewed at one and six months after the resuscitation attempt, and their psychological status was established using five questionnaires. The results of the questionnaires were available, on average, three and nine months after the event.
Of the 25 patients resuscitated, 13 were in the witnessed resuscitation group and 12 were in the control group. All of the patients in the control group died, but three of the patients in the witnessed resuscitation group survived. Thirty-four relatives were present in the witnessed resuscitation group, but only the person most closely related to the patient was included in the analysis. Full psychologic testing at six months was obtained for eight bereaved relatives who witnessed resuscitation attempts and for 10 relatives from the control group. At three and nine months, the median scores for the witnessed resuscitation group were lower than those of the control group, suggesting decreased levels of anxiety, depression, intrusive imagery, grief and post-traumatic avoidance behavior. All of the relatives who remained with the patient during the resuscitation attempt expressed satisfaction with the decision.
The trial was terminated early because the randomization process was at risk of being compromised when the clinical team became convinced that allowing relatives to remain during resuscitation was beneficial. The authors emphasize that relatives should be offered the choice to remain with the patient and that if they choose to remain, they must be supported and offered explanations throughout the procedure.
The authors conclude that routine exclusion of relatives from resuscitation is no longer appropriate.
Robinson SM, et al. Psychological effect of witnessed resuscitation on bereaved relatives. Lancet. August 22, 1998;352:614–7.
Copyright © 1998 by the American Academy of Family Physicians.
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