Priority Topic: Advanced Cardiac Life Support

Key Feature 8: Attend to family members (ex: with counselling, presence in the code room) during and after resuscitating a patient. 
Skill: Professionalism, Communication
Phase: Treatment

At times, family members may be present during a resuscitation effort. This may be because they happen to be there when the events unfold that lead to resuscitation, or they may learn about the situation and deliberately want to attend. Regardless, it used to be believed that having family members or other loved ones present during a resuscitation was not beneficial and potentially harmful for both the victim and the loved ones. Research now suggests otherwise. The article, "Family presence during resuscitation: A Canadian Critical Care Society position paper" by Oczkowski et al (2015) states,

"Recent evidence suggests that patient outcomes are not affected by the offering of family presence during resuscitation (FPDR), and that psychological outcomes are neutral or improved in family members of adult patients. (...) FPDR should be considered to be an important component of patient and family-centred care."

The article also provides some guidance as to what supports should be in place if family members are to be present during and after resuscitation efforts.

"Departments in which FPDR is to be implemented should designate a skilled, senior member of the health care team (eg, physician, nurse or social worker) to screen for potentially disruptive family members and to act as a chaperone for the family. The chaperone should be able to brief family members, explain events during the resuscitation, provide comfort and escort the family member out if they show signs of distress. If an appropriate chaperone cannot be provided, or there are specific concerns that a family may interfere with resuscitation efforts in a way harmful to the patient or health care providers, family presence should not be offered."

"A postresuscitation debrief with the health care staff can be an important part of the process to help deal with emotions and moral distress, and address any conflicts that may have occurred during the resuscitation."

I used to think that there was risk of harm to family members as bystanders during a resuscitation, as the events may be traumatising for them to witness. I now understand this not to be the case IF there can be a dedicated person ensuring they too are being supported.