Early ReportPsychological effect of witnessed resuscitation on bereaved relatives
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
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