Vanessa Belpomme

Family Presence during Cardiopulmonary Resuscitation

BACKGROUND The effect of family presence during cardiopulmonary resuscitation (CPR) on the family members themselves and the medical team remains controversial. METHODS We enrolled 570 relatives of patients who were in cardiac arrest and were given CPR by 15 prehospital emergency medical service units. The units were randomly assigned either to systematically offer the family member the opportunity to observe CPR (intervention group) or to follow standard practice regarding family presence (control group). The primary end point was the proportion of relatives with post-traumatic stress disorder (PTSD)-related symptoms on day 90. Secondary end points included the presence of anxiety and depression symptoms and the effect of family presence on medical efforts at resuscitation, the well-being of the health care team, and the occurrence of medicolegal claims. RESULTS In the intervention group, 211 of 266 relatives (79%) witnessed CPR, as compared with 131 of 304 relatives (43%) in the control group. In the intention-to-treat analysis, the frequency of PTSD-related symptoms was significantly higher in the control group than in the intervention group (adjusted odds ratio, 1.7; 95% confidence interval [CI], 1.2 to 2.5; P=0.004) and among family members who did not witness CPR than among those who did (adjusted odds ratio, 1.6; 95% CI, 1.1 to 2.5; P=0.02). Relatives who did not witness CPR had symptoms of anxiety and depression more frequently than those who did witness CPR. Family-witnessed CPR did not affect resuscitation characteristics, patient survival, or the level of emotional stress in the medical team and did not result in medicolegal claims. CONCLUSIONS Family presence during CPR was associated with positive results on psychological variables and did not interfere with medical efforts, increase stress in the health care team, or result in medicolegal conflicts. (Funded by Programme Hospitalier de Recherche Clinique 2008 of the French Ministry of Health; ClinicalTrials.gov number, NCT01009606.).

Family Presence During Cardiopulmonary Resuscitation

Patricia Jabre, M.D., Ph.D., Vanessa Belpomme, M.D., Elie Azoulay, M.D., Ph.D., Line Jacob, M.D., Lionel Bertrand, M.D., Frederic Lapostolle, M.D., Ph.D., Karim Tazarourte, M.D., Ph.D., Guillem Bouilleau, M.D., Virginie Pinaud, M.D., Claire Broche, M.D., Domitille Normand, M.S., Thierry Baubet, M.D., Ph.D., Agnes Ricard-Hibon, M.D., Ph.D., Jacques Istria, M.D., Alexandra Beltramini, M.D., Armelle Alheritiere, M.D., Nathalie Assez, M.D., Lionel Nace, M.D., Benoit Vivien, M.D., Ph.D., Laurent Turi, M.D., Stephane Launay, M.D., Michel Desmaizieres, M.D., Stephen W. Borron, M.D., Eric Vicaut, M.D., Ph.D., and Frederic Adnet, M.D., Ph.D.

Epidemiology of adverse effects of prehospital sedation analgesia.

The aim of this study was to introduce a continuous monitoring of side effects related to sedation-analgesia in the field. A document was completed by physicians on board the ambulances for all prehospital interventions and checked daily by the medical staff. A total of 3605 interventions were evaluated over a 12-month period. Six hundred four patients undertook analgesia and/or sedation: group 1 (spontaneously breathing patients) n = 289 and group 2 (intubated-ventilated patients) n = 315. Sixty-four percent of patients received intravenous opioids in group 1. The anesthetic technique used for intubation was the rapid sequence induction in 70% of patients. Side effects were observed in 5.5% in group 1 (nausea: 2%, hypotension: 1%, hypoxemia: 1%) and 22% of patients in group 2 (hypotension-arrhythmia: 12%, cardiac arrest: 2%, difficult intubation: 5%, hypoxemia: 1%, pulmonary aspiration: 1%, laryngospasm/bronchospasm: 2%). No death was related to these medications. A close monitoring of side effects related to sedation-analgesia must be included in a quality program to improve patient safety in the field.

Family witnessed resuscitation: nationwide survey of 337 prehospital emergency teams in France

Objective To assess the practices and opinions of prehospital emergency medical services (EMS) with regard to family witnessed resuscitation (FWR) and to analyse the differences between physicians’ and nurses’ responses. Design An anonymous questionnaire (30 yes/no questions on demographics and FWR) was sent to all prehospital emergency staff (physicians, nurses and support staff) working for the 377 Mobile Intensive Care Units in France. Results Of the 2689 responses received 2664 were analysed. Mean respondent age was 38±8 years, the male to female ratio was 1:2. 87% of respondents had already performed FWR and 38% had offered relatives the option to be present during resuscitation. Most respondents (90%) felt that FWR might cause psychological trauma to the family; 70% thought that FWR might impact on the duration of resuscitation and 68% on EMS team concentration. In the 28% of cases when relatives had asked to be present, 59% of respondents had acquiesced but only 27% were willing to invite relatives to be routinely present. Conclusions Prehospital EMS teams in France seems to support FWR but are not yet ready to offer it systematically to relatives. Following our survey, written guidelines are currently in development in our department. These guidelines could be the first step of a national strategy for developing FWR in France. We await results from other studies of family members’ opinions to compare prehospital practitioners’ and family members’ views to further develop our practice.

Fetal monitoring in the prehospital setting.

BACKGROUND Prehospital emergency care providers have very little information regarding fetal perfusion adequacy in the field. OBJECTIVE This study was conducted to evaluate the feasibility of the use of fetal monitoring in the prehospital setting. METHODS A mobile cardiotocometer was used for all consecutive pregnant women managed by our physician-staffed Emergency Medical Services unit. The visualization of interpretable tracings (both fetal heart rate and tocography) at the different stages of prehospital management was evaluated. Any change in a patients management was also recorded. RESULTS There were 145 patients enrolled during 119 inter-hospital transfers and 26 primary prehospital interventions. Interpretable tracings were obtained for 81% of the patients during the initial examination. This rate decreased to 66% during handling and transfer procedures. For 17 patients (12%), the monitoring led to a change in the patients management. CONCLUSION This study shows that cardiotocography can be easily performed in the prehospital setting, and is usually feasible. Moreover, the study demonstrates a positive impact of fetal heart rate monitoring on prehospital management.