Psychologic benefits for relatives witnessing CPR
medwireNews: People given the option to witness the cardiopulmonary resuscitation (CPR) of close relatives are less likely to suffer post-traumatic stress disorder (PTSD) symptoms than those who are not, French research shows.
Study findings published in TheNew England Journal of Medicine also indicate that family members who are actually present during CPR are less likely to have PTSD-related symptoms than those who are not present, regardless of whether the healthcare team actively invited the relatives to witness the resuscitation.
Crucially, the effectiveness of the resuscitation efforts was not affected by the presence of family members, nor did family presence cause stress to the healthcare team or result in more medicolegal claims.
These findings "bolster the current international recommendations regarding family presence during CPR," say Frederic Adnet (Hôpital Avicenne, Bobigny, France) and colleagues.
The study, which was carried out between November 2009 and October 2011, included 570 relatives of patients having a sudden cardiac arrest in the home. Prehospital emergency medical service units were randomly assigned to follow standard practice with regard to family presence during CPR or to always give family members the opportunity to be present.
Of the 266 relatives who were given the choice to be present, 211 (79%) witnessed the resuscitation, whereas only 131 (43%) of the 304 relatives in the standard-practice group were present.
The primary endpoint, the presence of PTSD-related symptoms 90 days after the event, was measured through a questionnaire answered by the family members. Symptoms assessed included feelings of anxiety, depression, anger, and stress.
Relatives given the choice to be present during CPR were significantly less likely to suffer from PTSD-related symptoms than relatives in the control group, at 27% versus 37%.
Regardless of study-group assignment, family members who witnessed the resuscitation attempt had fewer symptoms of anxiety and depression than those who were not present.
Importantly, the emergency service units in the intervention group had a dedicated support assistant who followed a scripted protocol and gave the family members support and guidance before, during, and after the resuscitation event. This is not the current standard procedure for out-of-hospital resuscitation of people suffering sudden cardiac arrest, explain the authors
Writing in an accompanying editorial, Daniel Kramer and Susan Mitchell (both from the Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA) say that a strict protocol may be key to the efficacy observed in the study.
"Thus, it would be imprudent to adopt this strategy into clinical practice without a similar commitment to training and staffing emergency response teams," they advise.
By Christopher Walsh, medwireNews Reporter