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

Fernandez, Rosemarie MD; Compton, Scott PhD; Jones, Kerin A. MD; Velilla, Marc Anthony MD

doi: 10.1097/CCM.0b013e3181a00818
Clinical Investigations

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.

From the Department of Emergency Medicine and Office of Academic and Student Programs (RF), Wayne State University School of Medicine, Detroit, MI; Department of Emergency Medicine (SC), University of Medicine and Dentistry of New Jersey – New Jersey Medical School and Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI; and Department of Emergency Medicine (KAJ, MAV), Wayne State University School of Medicine, Detroit, MI.

Supported, in part, by a grant from The Blue Cross Blue Shield of Michigan Foundation (BCBSM). BCBSM had no involvement in study design, data analysis and interpretation, report writing, or submission decision.

This study was conducted at the Wayne State University School of Medicine.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: fernanre@comcast.net

© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins