Episode 15 - Paediatrics: Part 2 - Family Presence During Cardiac Arrest

In the second part of the series on paediatrics, we discuss the implications of family presence during paediatric cardiac arrest. The second interlude segment will be presented by Dr Kerf Tan.
Theme: Paediatrics. 


Participants: 
Dr Kerf Tan (emergency physician), Dr Karl Pobre (paediatric emergency physician and paediatrician), Mariez Gorgi, Shreyas Iyer, Harry Hong, and Samoda Wilegoda


Discussion:
Dainty, K., Atkins, D., Breckwoldt, J., Maconochie, I., Schexnayder, S., & Skrifvars, M. et al. (2021). Family presence during resuscitation in paediatric and neonatal cardiac arrest: A systematic review. Resuscitation, 162, 20-34. https://doi.org/10.1016/j.resuscitation.2021.01.017.


Presenter: Mariez Gorgi (emergency medicine advanced trainee).


Summary:
  • This systematic review set out to determine the impact of family presence during resuscitation (specifically in cardiac arrest) on patient outcomes, family-centered outcomes and healthcare-provider outcomes.
  • A total of 38 papers were included in the review; consisting of observational studies, qualitative interviews or surveys, spanning from 1999 to 2019 in 11 different countries.
  • No papers explored the impact of family presence on patient outcome.
  • Most parents wished to be offered the opportunity to be present in the resuscitation in order to provide comfort to their child, as well as assisting in accepting the outcome and knowing that everything that could be done had been done for their child. 
  • The opinion of healthcare providers was more widely varied, citing the concern of psychological trauma to the parents, interference with management of the patient and stress on the treating team (performance-related anxiety). 
  • However, the more experienced a healthcare worker with having family presence in a resuscitation, the more agreeable they were to this. 
  • However, the evidence provided in all papers was of very low quality, and there is an urgent need for better quality data surrounding this topic. 
  • Important things to consider with family presence is to flag that you may need them to leave the room during the resuscitation, and having a dedicated support person for the family present. 
  • Hot and cold debriefs involving all relevant staff (paramedics, nursing staff, allied health, doctors) are also incredibly important following a resuscitation such as this. 
 
Take-Home Points: 
  • It would be great to have better studies looking into family presence in resuscitation (looking into outcomes for the patients themselves as well as better qualitative data looking into what happens to families and healthcare workers afterwards). 
  • If there is family around, they should be asked whether they want to be present in the resuscitation. 
  • There should be a resource allocated to families to prevent their presence taking away from the resuscitation itself. 
  • If you are struggling following a resuscitation, seek support. 

Resources (to support doctor well-being) - 
  • Applications: Shift (Black Dog Institute app for healthcare workers), Calm, Headspace, Feeling Good, Smiling Minds, Insight Timer.  
  • JMO support line (NSW): 1300 566 321.
  • Employee Assistance Program (free confidential service for all NSW Health employees) - 1300  687 327. 
  • Doctors for doctors: www.drs4drs.com.au.
  • Beyond Blue: 1300 224 636.
  • Lifeline: 13 11 14. 
  • Suicide call-back service: 1300 659 467. 

Credits:
This episode is produced with help of HETI's Emergency Medicine Training Network 5.


Music/Sound Effects
  • Breathe by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.
  • Emotional Piano Improvisation by Alexander Nakarada | https://www.serpentsoundstudios.com, Music promoted by https://www.free-stock-music.com, Attribution 4.0 International (CC BY 4.0), https://creativecommons.org/licenses/by/4.0/.
  • Inspiration by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. 
  • Sound effects from https://www.free-stock-music.com. 

Thank you for listening!


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See you next time,
Caroline, Kit, Pramod, Samoda, and Shreyas.

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