Photo Credit: Drazen Zigic

Clear guidelines and flexibility regarding family presence at code events in the ICU are essential as patients, families, and care settings vary widely.

Code events requiring cardiopulmonary resuscitation and often adult cardiac life support interventions occur commonly in the ICU. Either by accident or choice, the afflicted patient’s families and loved ones often attend these events. Professionals, patients, and families are divided regarding the benefits and detriments of family presence at these events.

The presence of family may bring closure to the patient’s illness, alleviating feelings of guilt or mistrust and understanding that everything possible has been done for them. Transparency of care leads to greater trust among families in the care team, which may have important implications for future care. Some families have cultural or ethical beliefs, almost mandating their presence at end of life. This is part of our ethical duty to perform medical care in ways consistent with the spiritual and cultural requirements of our patients and families.

However, family presence can create emotional and physical stress on the care team. Code situations are high-stakes endeavors in which undivided attention and adequate physical spacing are crucial. Most people are unfamiliar with the extreme stress and physical trauma involved with chest compressions, defibrillation, and other almost violent interventions and are at high risk for psychological and emotional trauma. Discussing these issues with families when setting a code status is important. Finally, codes typically involve several healthcare professionals working in a small area adjacent to the patient.

In my experience, some family members wish to be present. Some do not wish to be present and should not be coerced. The current literature and anecdotal experience both suggest the importance of adequate professional staffing in these occurrences. Specifically, the presence of a trained dedicated professional staff, not personally involved in the code effort, to answer questions and physically direct members is vital in assuring acceptable outcomes among families and the care team.

Both clear Unit guidelines and case-by-case flexibility in these matters are important, as patients, families, and care settings will vary widely. It is hoped that the prominence of patient-centered care and concern for patients’ and families’ health and well-being will result in the best outcomes achievable in stressful circumstances.