Breaking bad news and managing family during an out-of-hospital cardiac arrest

There are approximately 60 000 out-of-hospital cardiac arrests (OHCAs) in England each year (Resuscitation Council UK (RCUK), 2014). Resuscitation is attempted in approximately 30 000 of these patients and current survival-to-discharge statistics show rates of 8.4% (Perkins et al, 2015). The RCUK (2014) reported that 80% of OHCAs occur in the patient's home, with the remaining 20% in a public place. These figures determine that there are approximately 24 000 resuscitation attempts made each year by the emergency services in the family home of patients.

Management of family during a resuscitation attempt and breaking bad news (BBN) of a futile outcome are two well-evidenced topics within the hospital environment. However, there is currently a distinct lack of research around these topics in the out-of-hospital setting. Family presence during resuscitation (FPDR) is a controversial subject that is well-evidenced in the emergency department (ED).

Current research suggests that clinician preference regarding family presence is currently variable and inconclusive (Halm et al, 2005). Some clinicians prefer relatives not to be present during resuscitation owing to clinician anxiety, concerns for the welfare of the family and potential medicolegal issues (Redley and Hood, 1996; Mitchell and Lynch, 1997; Helmer et al, 2000; McClenathan et al, 2002; Porter et al, 2014).