Overcoming Barriers to Family Inclusion in Resuscitation

Show Notes

Overview

• Historical Context: The conversation around allowing family members in the room during resuscitation events began gaining attention in 1987. Since then, the practice has been increasingly encouraged.
• Current Practices in Pediatrics:
  • Family presence during pediatric resuscitations remains inconsistent, with healthcare provider acceptance ranging from 15% to 85%.
  • Many subspecialists and consultants still request that families step out, often due to outdated concerns.
• Common Concerns & Myths:
  • Interference in resuscitation → Studies show minimal disruption.
  • Legal risks → No increased litigation risk has been demonstrated.
  • Family trauma → Research suggests that presence may help with grieving and reduce PTSD symptoms.

Evidence from the Literature

New England Journal of Medicine study on Family Presence During Cardiopulmonary Resuscitation (Jabre et al., 2013):

• In a randomized controlled trial of 570 relatives, PTSD-related symptoms were significantly higher in family members who were not offered the opportunity to be present during resuscitation.
  • 79% of relatives in the intervention group witnessed CPR compared to 43% in the control group.
  • Family members who did not witness CPR had a higher likelihood of PTSD symptoms (adjusted OR 1.7, p=0.004).
  • Anxiety and depression symptoms were also higher in those who did not witness CPR.
• Impact on Medical Teams:
  • The study found no evidence that family presence affected resuscitation success rates, medical team stress levels, or led to legal consequences.
  • Health professionals’ concerns over interference were largely unfounded.

Guideline Support & Barriers to Implementation

• Professional recommendations from pediatric societies support family presence during resuscitations.
• Barriers include:
  • Lack of institutional policies ensuring family inclusion.
  • Lack of formal training for providers on how to support families during these critical moments.

Final Takeaways

• Encouraging institutional policy changes and training providers is key to implementing family presence during codes.
• Medical teams should challenge outdated practices and prioritize family-centered care in the emergency department.
• Family-witnessed resuscitation does not increase stress, legal risk, or compromise medical care—but it can significantly improve bereavement outcomes.