Offering the opportunity for family to be present during cardiopulmonary resuscitation: 1-year assessment
- 4.8k Downloads
To evaluate the psychological consequences among family members given the option to be present during the CPR of a relative, compared with those not routinely offered the option.
Prospective, cluster-randomized, controlled trial involving 15 prehospital emergency medical services units in France, comparing systematic offer for a relative to witness CPR with the traditional practice among 570 family members. Main outcome measure was 1-year assessment included proportion suffering post-traumatic stress disorder (PTSD), anxiety and depression symptoms, and/or complicated grief.
Among the 570 family members [intention to treat (ITT) population], 408 (72 %) were evaluated at 1 year. In the ITT population (N = 570), family members had PTSD-related symptoms significantly more frequently in the control group than in the intervention group [adjusted odds ratio, 1.8; 95 % confidence interval (CI) 1.1–3.0; P = 0.02] as did family members to whom physicians did not propose witnessing CPR [adjusted odds ratio, 1.7; 95 % CI 1.1–2.6; P = 0.02]. In the observed cases population (N = 408), the proportion of family members experiencing a major depressive episode was significantly higher in the control group (31 vs. 23 %; P = 0.02) and among family members to whom physicians did not propose the opportunity to witness CPR (31 vs. 24 %; P = 0.03). The presence of complicated grief was significantly greater in the control group (36 vs. 21 %; P = 0.005) and among family members to whom physicians did not propose the opportunity to witness resuscitation (37 vs. 23 %; P = 0.003).
At 1 year after the event, psychological benefits persist for those family members offered the possibility to witness the CPR of a relative in cardiac arrest.
KeywordsCardiac arrest Family presence Post-traumatic stress disorder Complicated grief
Supported by the Programme Hospitalier de Recherche Clinique 2008 of the French Ministry of Health and by the Research Delegation of the Assistance Publique – Hopitaux de Paris (Aurélie Guimfack and Christine Lanau). We are indebted to Martine Tanke, who monitored the ongoing results of the trial; to the physicians, nurses, and ambulance attendants of each center for their valuable cooperation with the study; to Malika Chafai for her secretarial assistance. This study was funded solely by the Programme Hospitalier de Recherche Clinique 2008 of the French Ministry of Health.
Conflicts of interest
No author has a conflict of interest with regard to this study.
- 1.Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, Annane D, Bleichner G, Bollaert PE, Darmon M, Fassier T, Galliot R, Garrouste-Orgeas M, Goulenok C, Goldgran-Toledano D, Hayon J, Jourdain M, Kaidomar M, Laplace C, Larche J, Liotier J, Papazian L, Poisson C, Reignier J, Saidi F, Schlemmer B (2005) Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 171:987–994PubMedCrossRefGoogle Scholar
- 6.Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C, Barnoud D, Bleichner G, Bruel C, Choukroun G, Curtis JR, Fieux F, Galliot R, Garrouste-Orgeas M, Georges H, Goldgran-Toledano D, Jourdain M, Loubert G, Reignier J, Saidi F, Souweine B, Vincent F, Barnes NK, Pochard F, Schlemmer B, Azoulay E (2007) A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 356:469–478PubMedCrossRefGoogle Scholar
- 12.Jabre P, Belpomme V, Azoulay E, Jacob L, Bertrand L, Lapostolle F, Tazarourte K, Bouilleau G, Pinaud V, Broche C, Normand D, Baubet T, Ricard-Hibon A, Istria J, Beltramini A, Alheritiere A, Assez N, Nace L, Vivien B, Turi L, Launay S, Desmaizieres M, Borron SW, Vicaut E, Adnet F (2013) Family presence during cardiopulmonary resuscitation. N Engl J Med 368:1008–1018PubMedCrossRefGoogle Scholar
- 18.Sheehan DV, Lecrubier Y, Harnett-Sheehan K, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar G (1998) The Mini International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview. J Clin Psychiatry 59(Suppl 20):22–33Google Scholar
- 19.Pochard F, Azoulay E, Chevret S, Lemaire F, Hubert P, Canoui P, Grassin M, Zittoun R, le Gall JR, Dhainaut JF, Schlemmer B (2001) Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity. Crit Care Med 29:1893–1897PubMedCrossRefGoogle Scholar
- 20.Bourgeois ML (2004) Les deuils traumatiques. Stress et Trauma 4:241–248Google Scholar
- 24.Belpomme V, Adnet F, Mazariegos I, Beardmore M, Duchateau FX, Mantz J, Ricard-Hibon A (2013) Family-witnessed resuscitation: nationwide survey of 337 out-of-hospital emergency teams in France. Emerg Med J 30:1038–1042Google Scholar
- 26.Antonelli M, Bonten M, Chastre J, Citerio G, Conti G, Curtis JR, De Backer D, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Rocco P, Timsit JF, Wernerman J, Zhang H (2012) Year in review in intensive care medicine 2011: I. Nephrology, epidemiology, nutrition and therapeutics, neurology, ethical and legal issues, experimentals. Intensive Care Med 38:192–209PubMedCentralPubMedCrossRefGoogle Scholar
- 29.Meert KL, Donaldson AE, Newth CJ, Harrison R, Berger J, Zimmerman J, Anand KJ, Carcillo J, Dean JM, Willson DF, Nicholson C, Shear K (2010) Complicated grief and associated risk factors among parents following a child’s death in the pediatric intensive care unit. Archiv Pediatr Adolesc Med 164:1045–1051CrossRefGoogle Scholar