Relatives in the resuscitation room: a review of benefits and risks

Headnote

Abstract

In the rare circumstance when a child is resuscitated there is great debate over whether to allow parents and relatives to remain present. Research reveals both positive and negative family responses to witnessing a resuscitation attempt and the rights and needs of the child/young person must be considered. Staff are generally positive about the benefits of witnessed resuscitation but report a lack of knowledge and skills in supporting the presence of relatives. Scenarios used in resuscitation training need to include the presence of family members and local policies should be developed based on the available evidence.

Headnote

Key words

* Children: death

* Resuscitation

* Ethics

It is now widely accepted in children's services that a child can be accompanied at all times by a parent, other family member or carer. However, in the rare circumstance when a child is resuscitated there is great debate over whether to allow parents and relatives to remain present. The presence of relatives in the resuscitation room is an emotive issue steeped in legal, ethical and moral dilemmas and requires difficult decision making by all involved. This article considers possible advantages and disadvantages of witnessed resuscitation from the perspectives of each group involved and makes some recommendations for practice.

Most published research considers witnessed resuscitation of adults in general accident and emergency (A&E) departments, and many papers originate from other countries (Hanson and Strawser 1992, Osuagwu 1993, Meyers et al 1998). While the main principles in the discussion are comparable, the findings of these studies are not necessarily applicable to children and young people in the UK. The discussion in this article addresses witnessed resuscitation of children/young people following cardiac or respiratory arrest in the A&E environment.

Resuscitation

Anderson (1994) describes cardio pulmonary resuscitation (CPR) as 'the basic emergency procedure for life support, consisting of artificial respiration and manual external cardiac massage.' Respiratory and cardiac arrests in children are rare (Advanced Life Support Group 2003) and with good management they are usually preventable (Lee 1996). When a respiratory arrest in a child progresses to cardiac arrest the outcome is not usually favourable (Advanced Life Support Group 2003).

Television hospital dramas and soaps have exposed the general public to the phenomenon of CPR. According to Van der...