Using systematic reviews to guide decision making about family-witnessed resuscitation.

Family-witnessed resuscitation (FWR) allows family members to be present while emergency cardiac life support measures are applied. This article describes the use of systematic reviews to inform best clinical policy on FWR. The authors searched Medline and CINAHL for relevant systematic reviews and retrieved four. The reviews were then tested for rigor and validity using the open source Critical Appraisal Skills Programme from the Institute of Health Science, University of Oxford. The reviews were assessed to be of acceptable quality and therefore good sources of evidence to guide practice and policy development. Two reviews examined FWR of adult patients, one examined FWR of children and adults, and one examined FWR of children. Together, the four reviews covered 83 studies that describe the perspectives of more than 15,000 health care providers; 2,000 family members; and 2,000 patients. The systematic reviews provide clear evidence that both patients and family members want the option to be present during FWR. In contrast, there is significant variability among health care providers, with those in favor ranging from 7% to 96%. This wide range is related to (worldwide) geography and to provider status (e.g., Registered Nurse and Medical Doctor). Generally, patients, family, and providers agreed on the benefits of FWR. Barriers to FWR include perceptions of possible performance anxiety and family interruption of care. The authors conclude that institutional settings need to develop a rational policy on FWR, have family support personnel present during FWR, and develop training programs for students and staff on family presence.