The presence of a family witness impacts physician performance during simulated medical codes

Abstract

Objective: To determine whether the presence and behavior of a family witness to cardiopulmonary resuscitation (CPR) impacts critical actions performed by physicians.

Design: This was a randomized comparison study of physicians' performance during a simulated cardiac arrest with three different family witness states.

Setting: This study was conducted at the Wayne State University Eugene Applebaum College of Pharmacy and Health Science's Center for Healthcare Simulation.

Subjects: Second-year and third-year emergency medicine (EM) residents from the Wayne State University Department of Emergency Medicine-affiliated residency programs and Michigan State University-affiliated EM residency programs.

Intervention: Thirty teams comprised of one second-year and one third-year EM resident were randomly assigned to one of the three groups: 1) no family witness; 2) a nonobstructive "quiet" family witness; and 3) a family witness displaying an overt grief reaction.

Measurements and main results: Each pair was assessed for time to critical actions (e.g., minutes to CPR and drug administration) and for resuscitation-based performance outcomes (e.g., number of shocks) during a simulated cardiac arrest. The time to critical events was similar across groups with respect to initiating CPR, attempting to intubate the patient, and pronouncing the death of the patient. However, the time to deliver the first defibrillation shock was longer for the overt reaction witness group (2.57 minutes) as compared with the quiet (1.77 minutes) and no family witness (1.67 minutes) groups. Additionally, fewer total shocks were delivered in the overt reaction witness groups (4.0 minutes) vs. the quiet (6.5 minutes) and no family witness groups (6.0 minutes).

Conclusion: The presence of a family witness may have a significant impact on physicians' ability to perform critical actions during simulated medical resuscitations. Further study is necessary to see if this effect crosses over into real clinical practice and if training ameliorates this effect.