Elsevier

The Lancet

Volume 352, Issue 9128, 22 August 1998, Pages 614-617
The Lancet

Early Report
Psychological effect of witnessed resuscitation on bereaved relatives

https://doi.org/10.1016/S0140-6736(97)12179-1Get rights and content

Summary

Background

Established practice is for the relatives of critically ill patients to be excluded from the clinical area during resuscitation. We aimed to discover whether relatives wanted to be present during the resuscitation of a family member and whether witnessing resuscitation had any adverse psychological effects on bereaved relatives.

Methods

In this pilot study, relatives of patients who required resuscitation were given the option to remain with the patient during resuscitation or were not given this choice and directed to the relatives' room (control group). The unit of randomisation was the patient who required resuscitation and not the relatives. One close relative was paired with each patient. All relatives were accompanied by a chaperone who gave emotional support and provided technical information on the resuscitation. Relatives were followed up 1 month after the resuscitation. We used a questionnaire to ask about the decision to be present or absent during resuscitation. Bereaved relatives also completed five standardised psychological questionnaires to assess anxiety, depression, grief, intrusive imagery, and avoidance behaviour.

Findings

25 patients underwent resuscitation (13 in witnessed resuscitation group, 12 in control group). Three patients in the witnessed group survived, all the control-group patients died. Two relatives in each group were lost to follow-up. Thus, eight relatives who witnessed resuscitation and ten control-group relatives were followed up. There were no reported adverse psychological effects among the relatives who witnessed resuscitation, all of whom were satisfied with their decision to remain with the patient. The clinical team became convinced of the benefits to relatives of allowing them to witness resuscitation if they wished, so the trial was terminated.

Interpretation

In the context of the emergency department, routine exclusion of relatives from the resuscitation room may no longer be appropriate.

Introduction

The families of critically ill or injured patients are routinely excluded from the resuscitation area during active resuscitation. This practice is based on the premise that invasive procedures and aggressive resuscitation would distress the family and that the presence of relatives would compromise the performance of clinical staff.1, 2 This approach has been challenged by the suggestion that relatives could remain with the patient throughout the resuscitation,3, 4 however, most of this work is anecdotal.5, 6, 7

In this preliminary pilot study, we aimed to establish whether the relatives of patients wished to remain with their family member during resuscitation and to assess the psychological effect, if any, of witnessed resuscitation on a bereaved individual. We decided to stop the study early because the randomisation process was at risk of being altered by staff who had become convinced of the benefits of allowing relatives to witness resuscitation.

Section snippets

Study design

Between November, 1995, and February, 1997, the relatives of patients who required resuscitation for cardiac arrest or multiple trauma in the Accident and Emergency Department of Addenbrooke's Hospital, Cambridge, UK, were selected for inclusion in our pilot study. Eligible resuscitations were those in which the patient was accompanied by a relative and one of three specific senior staff members were present.

The unit of randomisation was the patient and not the relatives. Randomisation was by

Results

25 patients were resuscitated. 34 relatives were present, but we included only the person most closely related to the patient in the analysis. The trial profile shows the process of randomisation and follow-up (figure). Both groups of patients had a similar distribution of severe trauma and cardiac arrest due to coronary artery disease (table 1). There were three successful resuscitations (survived to hospital discharge) in the witnessed resuscitation group and none in the control group. Three

Discussion

In this study we found little evidence to support the exclusion of relatives who wish to be present from the resuscitation room. Relatives who remained in the resuscitation room were no more distressed by their experience than controls. Indeed, when assessed 3 months after the resuscitation, there was a trend toward lower degrees of intrusive imagery, post-traumatic avoidance behaviour, and symptoms of grief in the relatives who had witnessed the procedure.

All the relatives included in our

References (14)

There are more references available in the full text version of this article.

Cited by (334)

View all citing articles on Scopus
View full text