Ethics
As this study was a systematic review of data from previously
published studies, ethics board approval was neither
required nor sought.
Results
Study selection
A total of 34,297 articles were retrieved in our initial
search and filtered for human studies and clinical trials.
Titles and abstracts of the remaining 1602 articles were
screened in duplication. Twenty-six potentially relevant
articles for FPDR in adults and children were found, with
moderate agreement between reviewers (kappa = 0.420).
Of these studies, three RCTs in adults, covering all of our
predetermined outcomes of interest, met inclusion criteria,
with perfect agreement between reviewers (kappa =
1.0). For pediatric studies, only one RCT, which did not
present data on psychological outcomes for family members,
met our eligibility criteria (Fig. 1).
Study characteristics, results of individual studies, and
risk of bias within studies
Three RCTs compared the systematic offering of FPDR to
usual care (Fig. 2). The largest, by Jabre et al., was a cluster
RCT of 15 prehospital emergency medical units and included
570 families of patients undergoing resuscitation,
judged to be at low risk of bias. No significant differences
in mortality, duration of resuscitation, or resuscitation
interventions were seen. Lower rates of PTSD-related
symptoms and anxiety-related symptoms were seen at