Dr Sue Robinson explains why relatives should go into the resus room

Research indicates that first hand experience may help relatives come to terms with death more easily, and reduce the emotional stress of bereavement.

Established medical practice is for family members to be excluded from the clinical area during resuscitation.

Richard Hannaford explains the research

The ban was thought necessary to save relatives from the distress of seeing aggressive resuscitation techniques, such as restarting the heart by electric shock.

It was thought the presence of relatives might also compromise the performance of medical staff.

Ban is misguided

Dr Robinson explains resuscitation techniques to a relative

However, a new study by Dr Susan Robinson and colleagues from Cambridge, suggests the ban may be misguided.

In this pilot study, some relatives of patients who required resuscitation were given the option to remain with the patient during resuscitation, while others were directed to the relatives' room.

All relatives were accompanied by a chaperone who provided emotional support and technical information on the resuscitation.

Emotional impact

The researchers assessed the emotional and psychological impact on the relatives of 18 patients who had died after failed resuscitation for heart attack or multiple trauma, such as a road accident.

They either interviewed the relatives, or asked them to complete a questionnaire three months after the event, and again six months later.

Eight relatives witnessed resuscitation, 10 did not.

Dr Robinson and her colleagues found there was a trend towards lower levels of anxiety, depression, intrusive imagery (such as mental flashbacks of the event), and even grief among relatives who had witnessed resuscitation.

The investigators also say that having a relative present benefited clinical staff because it placed the patient in a proper family context.

In addition, three patients whose relatives were allowed to witness successful attempts at resuscitation were happy that their loved ones had been close, and none believed their confidentiality or dignity had been compromised.

Reality less distressing

Writing in the Lancet, the team states: "One particular concern expressed by staff was that relatives would suffer mental anguish as a result of seeing a loved one undergo aggressive resuscitation.

"These worries were not shared by the relatives themselves who found the reality of the resuscitation room less distressing than anything they might have imagined if they had been in the relatives' room.

"The decision to have a relative present during resuscitation has benefited our staff.

"The patient is placed into context as an important and valued member of a family, which allows the team to care for the family as a whole.

"In the emergency department there is rarely an opportunity to develop any relationship with the family before delivering the unexpected news of the death of a relative.

"The time spent with the family during resuscitation creates a rapport between the chaperone, the team leader, and the relative, which makes the communication about a death easier for the staff.

"We recommend that relatives should be offered the choice to remain with the patient during resuscitation."

The Cambridge team believes a larger study is now needed to research their findings further.

Universal practice soon

A relative comforts the patient

Peter Driscoll, senior lecturer in emergency medicine at Hope Hospital, Salford, said it was likely that allowing relatives into the resuscitation room would soon be universal practice.

Mr Driscoll said the Hope already gave relatives the option of attending resuscitation attempts or remaining in the relatives' room.

In practice many people first opted to remain in the relatives' room, but then decided they wanted first hand experience of resuscitation attempts.

At all times they were accompanied by a "relatives" nurse, who provided constant feedback about what was going on.

"The nightmare situation is to have a relative in the resuscitation room who is not accompanied by anybody, and who hears and sees things they do not understand," Mr Driscoll said.