TDNet Discover

Background: Cardiac arrest is a common medical event that more than five-hundred thousand patients suffer from each year in the United States. The procedure seen most commonly in the American healthcare system includes ushering any present family members away from the resuscitation effort and only allowing them back once the patient is either stabilized or deceased. However, emerging research has shown significant benefits to the psychological health of family members who are offered the opportunity to witness cardiopulmonary resuscitation. Objective: To evaluate the existing data on family presence during resuscitation (FPDR) and its effect on family members’ psychological outcomes including rates of anxiety, depression, and PTSD. Methods: An evidence-based medicine systematic review of the literature was performed by searching databases such as PubMed, Mendeley, Google Scholar, and Discover Search using phrases including “family presence during resuscitation,” “cardiopulmonary resuscitation family,” and “CPR family stress anxiety depression.” The following limits were used: last ten years (2010-2020), peer-reviewed, journal, humans, free full text, clinical trial, meta-analysis, randomized controlled trial, and systematic review. Inclusion criteria included the following: family members must be adults (aged 18 years or older), exposure to CPR effort regardless of outcome, direct comparison of family presence to no family presence, article publication of “good” quality, in a first world country with modernized medicine, and availability in English language. Exclusion criteria included simulated learning scenarios and primary emphasis on nonCPR interventions, patient outcomes, or subjective attitudes of providers. The selection of studies was done using an in duplicate search and review process. Data extraction and quality assessment were completed for each chosen study. Results: This review included one systematic review/meta-analysis, one systematic review, and one quasi-experimental interventional study. iv Each of the chosen articles compared the systemic offering of FPDR to usual care. The largest study evaluated found rates of depression and anxiety to be significantly higher in the control group than intervention group. The study also found significantly lower incidence of PTSD intrusion symptoms in the intervention group, but not avoidance symptoms. The interventional study that was assessed found that at 90 days after witnessing CPR, the intervention group that was offered the chance to be present during CPR had significantly lower rates of depression, anxiety, and PTSD. Another systematic review found that routine offering of FPDR helped to facilitate coping, grieving, and understanding among family members as well as lessen symptoms of anxiety, depression, and PTSD. Conclusion: Offering family members the option to be present during cardiopulmonary resuscitation of their loved one appears to be beneficial to their psychological outcomes including levels of stress, anxiety, and PTSD. Evidence explored in this review suggests family members feel that witnessing CPR efforts helps to facilitate the grieving process and provides a sense of closure. While the data surrounding this topic is relatively unanimous that FPDR is beneficial, this practice is not commonly seen in the hospital setting. Further research is needed to determine the most appropriate process for standardization and implementation of FPDR as the standard of care.