Medline ® Abstract for Reference 67
of 'Palliative care: Issues in the intensive care unit in adults'
Psychological effect of witnessed resuscitation on bereaved relatives.
Robinson SM, Mackenzie-Ross S, Campbell Hewson GL, Egleston CV, Prevost AT
Lancet. 1998 Aug;352(9128):614-7.
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.
Emergency Department, Addenbrooke's NHS Trust, Cambridge, UK.