Author: Kaleb Lachenicht, Director Epic EM and Chief Clinical Officer of ROCKET
Whilst running this afternoon I listened to a summary about a recently published article:
Title: Relatives’ Experiences of Unsuccessful Out-of-Hospital Cardiopulmonary Resuscitation Attempts: A Qualitative Analysis
Authors: Huxley et al.
Published in: BMC Emergency Medicine (2024)
This qualitative study explores the experiences of relatives of non-survivors of out-of-hospital cardiac arrest (OHCA) in the UK. It investigates how family members perceived the resuscitation attempts, their interactions with ambulance clinicians, and the emotional impact of these experiences.
Study Design & Participants:
- Conducted across two UK ambulance services.
- Participants were relatives of OHCA non-survivors.
- Eligible participants were contacted at least three months after the event to allow for emotional processing.
- 14 relatives participated in semi-structured interviews (majority via telephone).
- The deceased individuals were mostly elderly, though some were younger
- All cardiac arrests occurred at home
- 10 resuscitations were terminated at the scene, while 4 were transported to the hospital before the patient died.
Here is a summary of the key findings:
Cardiac arrest is a traumatic event for families
Many relatives described the scene as chaotic and distressing with some of the family members experiencing post-traumatic stress disorder (PTSD)-like symptoms afterward.
We should remember that what is a relatively “normal” day for the EMS provider is a life-changing moment in a family member’s life. The interaction that occurs at the scene of a cardiac arrest will remain with that family member for the rest of their lives.
Families need clear communication from treating clinicians
Families voiced that they wanted real-time, honest updates from the treating providers about what was happening, even when the news was not good.
Many appreciated when paramedics implied the prognosis clearly (telling the family members that things were not looking good and they should consider gathering support/family at the scene/hospital.
A lack of information after death increased distress to family members were unsure as to the next steps or what would happen to the body of thier loved ones after the EMS teams leave.
Families want reassurance that everything possible was done
Relatives felt reassured when witnessing the resuscitation or when paramedics explained their actions, and when they could see that all the actions were taken. There are some nuances here about the perceptions that were interesting to me: some perceived “going through the motions” efforts when clinicians seemed doubtful about success.
Family members mentioned that they were hyper aware of non-verbal cues between team members and would rather have honest communication than have the team “go through the motions”.
Something that didn’t surprise me, but is something that I have not specifically defined as an action point for me post resuscitation, is to think about doing everything possible to minimise distress for the family after we have left. This can be as simple as ensuring all mess is tidied, medical and clinical waste should always be removed from the scene completely, used equipment should not be visible to the family once the resus has been completed. Finding these “evidence of resus” can be very uncomfortable for the family, especially if it means they have to clean up after we are gone.
MOST Surprisingly, many relatives felt resuscitation went on too long
Some felt their loved one had already died and found prolonged efforts distressing, and traumatic as the effect of CPR on the human body is profound. One couple was particularly upset when paramedics continued resuscitation because they had already started CPR, making them feel guilty for initiating it.
This may relate more to the UK-based requirement to continue CPR in some guidelines, for a specific time once EMS have arrived. There seems to be a desire for more patient-centred decisions to be made, rather than just running a resus for a set time due to the guidelines. Families seem to generally understand more than we tend to give them credit for in these end of life situations.
There was a delicate balance between wanting “everything done” and avoiding unnecessary, prolonged attempts – and this is where the magic of the human clinician comes into play. Applying ethical principles or futility, and managing the family expectation as well as the patient as appropriate are all part of why a guideline cannot cover all the required bases no matter how good a guideline it is.
What are the Implications for our own Resuscitation Practice?
This article highlighted some important learning points for me, that I will for sure be applying in the teaching environment going forward. Often a lot of these concepts feel obvious but this is a nice collection of qualitative data to substantiate some of the things we think we already know, and some of the things that are applied because we think they could be reasonable.
The study highlights the need for a more nuanced approach to family involvement in resuscitation, including:
✅ Real-time communication: Keeping families informed rather than isolating them
✅ Understanding family perceptions of resuscitation duration: Acknowledge that some may perceive prolonged or extensive resuscitation as excessive
✅ Emphasizing dignity and patient-centered decision-making: Consider discussing quality of life and expected outcomes
✅ Introducing a structured, family-centered approach: Designating a team member to liaise with relatives during resuscitation
I would love to hear your thoughts on how we can improve communication and decision-making in these moments. How do you handle these complex situations? What can we collectively do to be better for each other and families in these emotional situations?
