Picture this: Your spouse or child has collapsed and isn't breathing. You call 911, and the paramedics rush in and take charge. But you are banished to another room while the medical people try to bring your loved one back to life.
It's about the most stressful scene imaginable. And it's what usually happens.
But now comes the most rigorous study so far on allowing family members to witness CPR — its impact on them, on the medical team, on the CPR itself. The study, in this week's New England Journal of Medicine, was done by a French group, but a U.S. collaborator thinks it sheds light on the long-running debate here.
The study, involving about 500 relatives of patients who got CPR, contains some surprises. Foremost is that watching the resuscitation attempt doesn't have lingering bad effects on relatives who choose to do it — it's actually beneficial for them.
Family members who did not witness CPR were 60 percent more likely to have symptoms of post-traumatic stress disorder later. They also had more anxiety and depression.
Moreover, the resuscitation teams say they didn't experience more stress when relatives were present because relatives didn't interfere with the process. And their presence didn't affect things like the duration of CPR or survival rates. None of them sued, either — a prominent worry in the U.S.
Stephen Borron, a professor of emergency medicine at Texas Tech University and the sole American among the study's authors, thinks it will "raise the level of the conversation" in the U.S. on allowing family members to witness CPR. "It's an issue that's kind of simmered in the background for a long time," Borron tells Shots.
The idea was first proposed back in 1987 — although that proposal was about allowing relatives to watch in-hospital CPR, while the French study involved out-of-hospital resuscitation, usually in patients' homes.
Back in 2002, NEJM published another commentary that advocated giving family members the choice to be present.
Ellen Tsai, a Canadian pediatrician and bioethicist who wrote that piece, recounted a trial of such a policy in a Michigan hospital. Of those who watched, 94 percent later said they would want to do it again. She wrote:
"These procedures are not pleasant to watch. No matter how often people see blood, fluid, needles, defibrillation, intubation, endless alarms, frantic activity, and anxious physicians and nurses on television, watching the procedures on television is not the same as seeing them in person, especially when a loved one is at the center of the activity. Nevertheless, many family members have found that the benefits of being present outweigh the harm."
Borron strongly agrees. When relatives are excluded, they can be left with doubts. "Anytime you close the door on someone and say, 'Just trust me,' there's going to be some suspicion," Borron says.
Some of the benefit to family witnesses, he thinks, may come from a sense of closure.
"My gestalt," Borron says, "is that in a lot of situations where patients have cardiac arrest at home, family members feel they didn't do something they should have — didn't call quick enough or get them to the hospital quick enough, didn't give them their morning meds. There are a million things that go through people's minds."
Witnessing the CPR attempt, he adds, "gives them a sense that they've done their part and that nothing more might have been done to save their loved one."
Borron says he was "a little surprised" by the study's finding that caregivers' stress levels were not increased by having family members witness CPR. One reason might be that French medical personnel are less afraid of being sued.
"It's a sea change to open up resuscitations to patients' families," the Texas specialist says. "I don't think you can necessarily transfer this French study to the American situation. Some additional studies need to be done."
And in any case, Borron thinks there will be pushback from U.S. medical personnel. And that will take some time to sort out.
But some hospitals are moving in that direction. For the past year, the Mid America Heart Institute in Kansas City has been offering patients' relatives the option of being present during in-hospital CPR attempts.
"It gives them comfort and solace to know that their doctor spent 30 minutes trying to do everything they could to save their loved one," Paul Chan, a staff cardiologist there, tells Shots.