Bystanders and Close Ones in Unsuccessful Resuscitation: An Overlooked Population in Out-of-Hospital Cardiac Arrest

Bystanders, lay rescuers, and close ones involved in out-of-hospital cardiac arrest resuscitation attempts that end in death represent an often-overlooked population within emergency care. As community-centered resuscitation systems increasingly promote dispatcher-assisted cardiopulmonary resuscitation (CPR), community first responder programs, and public CPR training, more individuals are becoming directly involved in resuscitation attempts, many of which are unsuccessful. Such experiences can be associated with emotional distress, intrusive memories, guilt, and post-traumatic stress symptoms. The impact may differ according to the person’s relationship with the patient and their involvement in the resuscitation. This perspective paper discusses the psychological impact of unsuccessful resuscitation and considers the role of emergency nurses in providing support across dispatch, prehospital, and hospital settings. Approaches such as supportive follow-up contact and referral for psychological support, as distinct from formal psychological debriefing protocols, could help address some of these needs, although current evidence on their effectiveness remains preliminary. Greater recognition of people involved in unsuccessful resuscitation and their support needs may represent a further step in the development of community-centered resuscitation systems.