More Voices on Family Presence During CPR

It's absurd how easy this blogging stuff is when you have experienced and articulate people who are willing to voice their thoughts for public consumption. This comes from Andy, an old friend and a current emergency-medicine resident. He was good enough to put this together in spite of the fact that I remain openly and abidingly jealous of his current assignment doing air medical transports.

Matt:

So, here is my less-inspiring, public-educated personal opinion on the subject.

Watching CPR being performed on a loved one can be absolutely devastating. Let's be honest. If you've done CPR on a real, dead human being, you feel the ribs seperating from sternum. Sometimes, you even get the full-on sensory onslaught of bodily fluids and gasses. They don't put this stuff on Sesame Street for a reason. Even so, the American Heart Association has advocated the early presence of family at the bedside for a reason.

Like Mary, I have recently started overseeing full arrests in the emergency department and when I first started, I was very hesistant to bring family members into the resuscitation. In these chaotic situations, I'm all about trying to control all the variables and bringing more people into the room just seemed like a bad idea.

Having seen more cardiac arrests and being more comfortable now, I try and think about what the family is experiencing. By that I mean most of what the general public perceives as real medicine is really nothing more than a patchwork construction of scenes from "ER," "Scrubs," and "Grey's Anatomy." Its a bunch of big-headed people with stereotyped flaws running around electrocuting and assaulting their loved one in distress. Worse yet, lay public seldomly understand that if CPR and ACLS hasn't worked by the time a patient gets to the hospital, the chances are slim to none that they will survive. Truly, what little more can a hospital do with a pulseless patient than hasn't already been done in the field? We push the same medicines and perform the same first-line interventions.

Anyway, that was kind of a tangent. So, to provide my own little anecdote. I was in the department in the other day and I took a radio call from local paramedics that were transporting a young Down's syndrome patient that was found face down in the pool. Mom started CPR and called 911. Needless to say, my stomach turned and I knew this was going to be hard. When the patient arrived, she was very cold and very dead. We warmed her and continued CPR and started giving medicines. The family arrived and I talked with them and gave them a very grim prognosis. They were in shock but I told them I would return with an update. When I got back to the bedside, there was staff everywhere and despite the exponential increase in the amount of care the child was receiving, her condition wasn't improving. At this point I dreaded the thought of bringing her parents to the bedside.

I went out again to give them the update and they were confused and unsure about what to do. I let them know that it was unlikely that we would be able to provide much more for their child. I could tell that nothing registered. They couldn't fathom the condition of their child. So I brought them to the bedside and even I couldn't take it all in. The ER tech, a 160-pound paramedic, was dripping sweat and nearly exhausted from performing CPR on a 30-pound body. Nurses were getting warm blankets and fluids. There were other residents rushing to start lines and administer medicines. I think this is when the parents understood. They saw everything that was being done to save their child. I can't imagine how hard it is to give up hope that your only child will live again, but seeing this amount of effort being amassed without any result had to have helped. After only a few minutes, the patient's mother looked to me and asked us to stop. All she wanted was for us to stop and let her hold her child.

Even for the medically trained, I can see how being secluded from the resuscitation efforts of a full arrest leaves doubt and confusion as to what else could have been done. Rarely have I had to fight family to terminate resuscitation efforts. CPR can be a traumatic event for families to witness. However, it gives an understanding that after a prolonged resuscitation - especially those with very poor prognoses - continued treatment is often futile and potentially "hurtful" for patients. It gives families a very good reason to let go and assist in the decision to continue or terminate efforts.

So, anyway, that's my take.