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Family-witnessed resuscitation in the emergency department in a low-income country

11 January 2024
Volume 33 · Issue 1


Cardiac arrest is often a sudden and traumatic event. Family-witnessed resuscitation was first recommended by the American Heart Association over two decades ago. Since then several global professional bodies have identified a range of potential benefits for relatives; however, it remains contentious. For nurses working in emergency departments (EDs) in low-income countries, the evidence for, and experience of, family-witnessed resuscitation is limited. This article critically appraises the literature relating to the perceptions of medical professionals and critically ill patients and their families about communication, family presence and their involvement during resuscitation in the ED. Three themes relating to family-witnessed resuscitation in the ED were identified by a focused literature search. These were: leadership and communication, limitation of policies and guidelines and relatives' views. The recommendations from this review will be used to develop emergency and trauma nursing practice guidelines in Zambia, a low-income country in sub-Saharan Africa.

The emergency department (ED) is a fast-paced, complex area of nursing practice, in which nurses need to have the knowledge and skills to recognise and respond to the burden of critical illness and the high volume of patients (Mitchell et al, 2020). Cardiac arrest is a sudden, life-threatening situation, where speed of intervention is crucial. Patients may arrive in the ED already in cardiorespiratory or peri-arrest while others may deteriorate during admission. Family-witnessed resuscitation was identified as appropriate over 30 years ago (Doyle et al, 1987), and recommended by the American Heart Association in 2000. Since then international organisations have increasingly advocated the use of this practice (Bossaert et al, 2015; British Medical Association et al, 2016; Resuscitation Council UK, 2021; Yeung et al, 2021). However, it is a cause for concern that, in many settings, this has not become established practice with health professionals still stating reservations (Grimes, 2020). For emergency nurses working in low-income countries (LICs), such as Zambia, an additional challenge is the limited availability of evidence to support this intervention. Therefore, this article critically appraises the literature relating to the different professional perspectives regarding the family's presence during resuscitation in the ED.

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