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Family Presence at First Cardiopulmonary Resuscitation and Subsequent Limitations on Care in the Medical Intensive
Rebecca L Krochmal1, John W Blenko1, Majid Afshar1
1Rebecca L. Krochmal was a fellow, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland. John W. Blenko was an associate professor, Department of Anesthesiology, University of Maryland School of Medicine. Majid Afshar is an assistant professor, Division of Pulmonary and Critical Care Medicine, Loyola University School of Medicine, Maywood, IL. Giora Netzer is an associate professor, Division of Pulmonary and Critical Care Medicine, and Department of Epidemiology and Public Health, University of Maryland School of Medicine. Susan C. Roy is director, Department of Pastoral Care, University of Maryland Medical Center. Debra L. Wiegand is an associate professor, Department of Organizational Systems and Adult Health, University of Maryland School of Nursing. Carl B. Shanholtz is a professor of medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine.
Background:
The association of family-witnessed cardiopulmonary resuscitation (CPR) and subsequent advance directives in the medical intensive care unit is unknown.
Objective:
To compare clinical outcomes, including subsequent limitations on care, of family-witnessed vs family-unwitnessed CPR in the inpatient setting.
Methods:
Analysis of demographics and outcomes pertaining to family presence in a retrospective cohort of consecutive patients receiving first CPR in the medical intensive care unit of a tertiary academic medical center.
Results:
In 5 years, 323 patients underwent attempted CPR, of which 49 attempts (15.2%) were witnessed by family. In patients with return of spontaneous circulation, 40.9% of those whose first CPR was witnessed by family later had a do not attempt resuscitation order, which did not differ from patients whose first CPR was unwitnessed by family (31.8%). Family-witnessed CPR in the unit was associated with significantly lower rates of return of spontaneous circulation (44.9%) than was family-unwitnessed CPR (62.0%; P = .02). Of all patients with a first CPR, 42 (13.0%) survived to hospital discharge. Only 1 patient with return of spontaneous circulation after first family-witnessed CPR survived to hospital discharge. In-hospital mortality for all patients requiring subsequent CPR was 97.1%.
Conclusions:
For unclear reasons, family-witnessed CPR in the medical intensive care unit is associated with a similar rate of subsequent CPR efforts and lower rates of return of spontaneous circulation and survival to hospital discharge.
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