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 "Hospitals that have been hesitant to set policies that allow
families to be in the room during resuscitation should be encouraged
that this didn't lead to worse outcomes or errors," said Dr. Zachary
Goldberger, the study’s lead author from the University of
Washington Harborview Medical Center in Seattle.
"This is an important opportunity to enhance our end-of-life care
for patients who are hospitalized,” he told Reuters Health.
The study examined cardiac arrest outcomes for 41,568 patients
treated at 252 U.S. hospitals from January 2007 through September
2010. Of those, 80 hospitals that treated 13,470 patients had
policies allowing families to observe resuscitation.
Overall, about 58 percent of patients had so-called spontaneous
circulation restored, with a pulse returning for at least 20 minutes
during the cardiac arrest, and roughly 18 percent survived until
being discharged from the hospital, the authors reported in
Circulation: Cardiovascular Quality and Outcomes.
Hospital policies on family presence during resuscitation had no
impact on whether patients survived to leave the hospital. And,
after adjusting for hospital characteristics and differences in the
patients, the policies also had no effect on restoring circulation.
The study is limited by its lack of data linking results for
individual patients to whether their family members were present
during resuscitation, Goldberger said. The study also lacks specific
details about the policies in place at individual hospitals, making
it hard to draw conclusions about which provisions might have the
biggest impact on outcomes.
"The study doesn't show that family presence can effect outcomes,
and more research is needed to fully understand the implications of
this," Goldberger said.
Resuscitation procedures can be quite violent, and more research is
needed on how watching them might impact families and patients who
survive the incident, said Lisa Salberg, founder and chief executive
of the Hypertrophic Cardiomyopathy Association, a patient advocacy
group.
"I think you are opening a Pandora's box with this," said Salberg,
who wasn't involved in the study. "Some families may want to see
more and rather than sequester them it may make sense to let them
in, but you are doing very aggressive things to their loved one –
you are pounding on their chest and putting in IVs and maybe opening
their chest – people may not want to see that."
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On the other hand, when there's time to explain the procedures to
families and prepare them for what they may see, allowing them to
stay may provide a certain amount of comfort and closure, said Dr.
Steven Simpson, head of critical care at the University of Kansas
Hospital in Kansas City.
At his last job, where a family presence policy was in place, it
often provided closure for families without distracting doctors from
the task at hand, said Simpson, who wasn't involved in the study.
Many times, when families saw exactly what was involved in
resuscitation, they asked doctors to stop, bringing an early halt to
a process that can often go on for 45 to 60 minutes, he said.
In the emergency department at his Kansas hospital, families are
allowed to observe and, often, nurses are assigned to stay with them
to make sure they understand what they're seeing and help them cope
with the way procedures may unfold, Simpson said. It's an
opportunity for family members to close the loop.
"If I see my loved one go down and there is a code blue and they
usher me out and make me wait in the waiting room, and the next
thing I know my loved one is dead, that leaves a gap that is hard to
fill, like if you get a call out of the blue one afternoon that your
son or daughter was killed in a car crash," said Simpson. "I have
never had a family member say I wish I hadn't been there, and I have
had numerous people say thanks."
SOURCE: http://bit.ly/1HAB89r
Circulation: Cardiovascular Quality and Outcomes, online March 24,
2015.
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