It's in the Eyes of the Beholder By Dr. Sonny (Sandeep) S. Kohli, MD FRCPC

Imagine someone you love has just been in a serious car accident and is being transferred to a nearby hospital. If that isn't traumatic enough, now imagine that you arrive at the Emergency Room only to discover that your loved one has had a cardiac arrest and is undergoing emergency efforts to save their life.

Would you want to witness your loved one's resuscitation?

A "Code Blue", as it is called in hospitals, often involves many doctors and nurses rushing to your family member's bedside in the event of a cardiac arrest. They are tense situations to say the least. Chest compressions, electric shocks delivered to the heart (defibrillation), insertion of a breathing tube (intubation), and insertion of special intravenous lines into the body's deeper veins; are just a few of the procedures often performed to save someone's life.

They are not easy to watch or perform, even for health care providers who must do them time and time again.

I am a critical care physician (i.e. I practice in the Intensive Care Unit) and I'm often faced with the dilemma of whether or not a patient's immediate family should be present during resuscitation.

The easy answer from a health care provider's perspective is often an adamant "no way!" We tend to think that a loved one's presence, although good intentioned, does more harm than good.

Nurses at my ICU cited a variety of reasons for this. "It is stressful for us to have the family around when we are performing CPR!" said one nurse who recalls feeling performance anxiety as a frantic mother looked on during the resuscitation of her young son. A respiratory therapist recalls an emotional husband inadvertently getting in the way during his wife's intubation for her pneumonia. "I couldn't secure her airway because he was sobbing at her bedside." It also deserves mention that nurses and doctors are often so absorbed during a Code Blue, that little time is available to attend to a family member's emotional needs.

These are all valid reasons for not allowing family members to be present during resuscitation. But like many interventions in medicine, what clinicians think and what the evidence from controlled studies suggest, is often conflicting.

There is now emerging evidence to support family presence during an arrest. We have been trained to think that witnessing a loved one's resuscitation could result in post-traumatic stress that could haunt a family member for life. But more than 90% of family and staff members who have participated in witnessed arrests said they would do it all over again. Witnessing an arrest may help me with the bereavement process. "Seeing that everything possible was tried, and holding their loved ones after they have died is therapeutic in so many ways", says one Chaplain I spoke to. Also, patients who have survived arrest often remember feeling comforted by a loved one's voice at their bedside.

With this evidence, some leading hospitals now encourage family presence as long as strict guidelines are followed to ensure resuscitation is performed safely and smoothly. Clearly such a strategy is not suitable for everyone. A nurse I know still feels traumatized years after witnessing the arrest and subsequent death of her dad.

My practice has changed as a result of the mounting evidence suggesting a benefit. I now assess each case individually, weighing in the personal preference of the family member and patient, my own biases, and that of the health care team's, before making a decision.

A friend of mine who practices Obstetrics remembers a time when it was considered barbaric to have husbands allowed in the delivery room. Maybe the time has come for this tradition to change as well.