Family Presence at First Cardiopulmonary Resuscitation and Subsequent Limitations on Care in the Medical Intensive Care Unit Journal Article

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Authors: Krochmal, R. L.; Blenko, J. W.; Afshar, M; Netzer, G; Roy, S. C.; Wiegand, D. L.; Shanholtz, C. B.
Article Title: Family Presence at First Cardiopulmonary Resuscitation and Subsequent Limitations on Care in the Medical Intensive Care Unit
Abstract: 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.
Journal Title: American Journal of Critical Care : An Official Publication, American Association of Critical-Care Nurses
Volume: 26
Issue: 3
ISSN: 1937-710X; 1062-3264
Publisher: American Association of Critical-Care Nurses  
Journal Place: United States
Date Published: 2017
Start Page: 221
End Page: 228
Language: eng
DOI/URL:

10.4037/ajcc2017510
Notes: LR: 20170502; CI: (c)2017; JID: 9211547; ppublish