Published online October 1, 2007
PEDIATRICS Vol. 120 No. 4 October 2007, pp. 842-854 (doi:10.1542/peds.2006-3706)
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STATE-OF-THE-ART REVIEW ARTICLE

Parent Presence During Complex Invasive Procedures and Cardiopulmonary Resuscitation: A Systematic Review of the Literature

R. Scott Dingeman, MDa,b, Elizabeth A. Mitchell, BSc, Elaine C. Meyer, RN, PhDd,e and Martha A.Q. Curley, RN, PhD, FAANc,f

a Department of Anesthesiology, Perioperative and Pain Medicine
c Cardiovascular and Critical Care Nursing Program
d Institute for Professionalism and Ethical Practice, Division of Critical Care Medicine, Children's Hospital Boston, Boston, Massachusetts
b Departments of Anesthesiology
e Psychiatry, Harvard Medical School, Boston, Massachusetts
f University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania

ABSTRACT

We conducted a systematic review of the literature on parent presence during complex invasive pediatric procedures and/or resuscitation. We identified 15 studies that met our inclusion criteria. All studies were summarized chronologically according to level of evidence. The studies all demonstrated that parents prefer to have the choice about whether they remain at their child's side during complex invasive procedures and resuscitation, but they also revealed that apprehensions and controversy abound among clinicians regarding this practice. Despite the endorsements of the American Academy of Pediatrics and the Society of Critical Care Medicine and the recommendations of the American Heart Association, few pediatric institutions have drafted guidelines, conducted clinical education, or committed sufficient staff resources to fully support this practice. We present this review not only to illustrate the various perspectives of parents/guardians, clinicians, and pediatric patients themselves that have been reported to date but also to encourage more research so that the practice can be performed safely and benefit parents, their children, and clinicians alike.

Key Words: parent • acute care • procedures • resuscitation • invasive

Abbreviations: CPR—cardiopulmonary resuscitation • AAP—American Academy of Pediatrics • ACEP—American College of Emergency Physicians • RCT—randomized, controlled trials • ED—emergency department

Accepted May 17, 2007.


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