Post-traumatic Stress Disorder in Family-witnessed Resuscitation of Emergency Department Patients

Abstract

Introduction Family presence during emergency resuscitations is increasingly common, but the question remains whether the practice results in psychological harm to the witness. We examine whether family members who witness resuscitations have increased post-traumatic stress disorder (PTSD) symptoms at one month following the event. Methods We identified family members of critically ill patients via our emergency department (ED) electronic health record. Patients were selected based on their geographic triage to an ED critical care room. Family members were called a median of one month post-event and administered the Impact of Event Scale-Revised (IES-R), a 22-item validated scale that measures post-traumatic distress symptoms and correlates closely with Diagnostic and Statistical Manual of Mental Disorders-IV criteria for post-traumatic stress disorder (PTSD). Family members were placed into two groups based on whether they stated they had witnessed the resuscitation (FWR group) or not witnessed the resuscitation (FNWR group). Data analyses included chi-square test, independent sample t-test, and linear regression controlling for gender and age. Results A convenience sample of 423 family members responded to the phone interview: 250 FWR and 173 FNWR. The FWR group had significantly higher mean total IES-R scores: 30.4 vs 25.6 (95% confidence interval [CI], −8.73 to −0.75; P<.05). Additionally, the FWR group had significantly higher mean score for the subscales of avoidance (10.6 vs 8.1; 95% CI, −4.25 to −0.94; P<.005) and a trend toward higher score for the subscale of intrusion (13.0 vs 11.4; 95% CI, −3.38 to .028; P = .054). No statistical significant difference was noted between the groups in the subscale of hyperarousal (6.95 vs 6.02; 95% CI, −2.08 to 0.22; P=.121). All findings were consistent after controlling for age, gender, and immediate family member (spouse, parent, children, and grandchildren). Conclusion Our results suggest that family members who witness ED resuscitations may be at increased risk of PTSD symptoms at one month. This is the first study that examines the effects of family visitation for an unsorted population of very sick patients who would typically be seen in the critical care section of a busy ED.

Family presence during patient acute deterioration: A survey of nurses' attitudes and reflection on COVID-19 in an African setting

“…Over 90% of nurses thought that the experience of witnessing the management of an acutely deteriorating patient may cause emotional trauma and stress for the patient's family. It is true that families experiencing the acute deterioration of a loved one may become emotional and require additional support ( 14 ) and are even at risk of developing Post Traumatic Stress Disorder ( 31 ). These situations may place health care practitioners in a difficult position and while consideration for the support of families during this process is vital, there is a lack of objective data supporting these concerns and the risk should not hinder the implementation of good practice( 26 )( 32 ).…”

“…These situations may place health care practitioners in a difficult position and while consideration for the support of families during this process is vital, there is a lack of objective data supporting these concerns and the risk should not hinder the implementation of good practice( 26 )( 32 ). Fundamentally, studies show that family members prefer to be given a choice and strongly believe that it is their right to be present ( 26 , 31 ). Family centred care is not only about physical presence but also about self-determination and allowing the family and patient the right to choose ( 33 ).…”

Impact of family presence during cardiopulmonary resuscitation on team performance and perceived task load: a prospective randomised simulator-based trial

“…In the largest randomised trial conducted so far family members witnessing the resuscitation efforts had significantly less post-traumatic stress disorder (PTSD)-related symptoms8 9 However, a prospective comparison group study reported no impact of witnessing CPR on bereavement-related depression and PTSD symptoms10 while observational studies showed no meaningful effects of family presence11 or even an increase in PTSD-related symptoms 12 13…”

One out of three bystanders of out-of-hospital cardiac arrests shows signs of pathological psychological processing weeks after the incident - results from structured telephone interviews

“…It is controversially discussed whether the risk for post-traumatic stress disorder in relatives is increased or decreased, when they are present during emergency team-led cardiopulmonary resuscitation (CPR) [12][13][14][15][16]. Mathiesen and colleagues interviewed 20 bystanders, who performed CPR, on how they processed this event and found that some struggled in life (feelings of guilt, reduced work capacity, weight loss, flashbacks and nightmares) even years after the event [17].…”