Core EM - Emergency Medicine Podcast

Episode 205: Family Presence during Resuscitation
We discuss the impact of family presence during resuscitations.
Hosts:
Ellen Duncan, MD, PhD
Brian Gilberti, MD
- 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- Many subspecialists and consultants still request that families step out, often due to outdated concerns.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.
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.
- 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.
- 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- Medical teams should challenge outdated practices and prioritize family-centered care in the emergency department.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.
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