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When Is CPR Futile?
Ann Alpers, JD;
Bernard Lo, MD
JAMA. 1995;273(2):156-158.
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| Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings. |
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The root sense of "futility," with its immutable failure and inherent frustration, derives from ancient mythology. According to Ovid, the daughters of Danaus were condemned to draw water in leaky buckets from which the liquid would inevitably spill.1 If cardiopulmonary resuscitation (CPR) is literally futile, a do-not-attempt-resuscitation (DNAR) order is appropriate, even without the agreement of the patient or surrogate. An example in which CPR would be as futile as transporting water in a leaky bucket is a 72-year-old man with progressive septic shock, renal failure, obtundation, and respiratory failure despite 7 days of intensive care. Maximal treatment for the underlying condition has already failed, and there is no plausible pathophysiological mechanism by which CPR would restore adequate circulation.2,3 However, many situations are not as clear-cut, and physicians may disagree with their colleagues and their patients over whether the leak is so severe that it would be pointless
. . . [Full Text PDF of this Article]
Author Affiliations
From the Program in Medical Ethics (Drs Alpers and Lo), and the Robert Wood Johnson Clinical Scholars Program (Dr Lo), the Center for AIDS Prevention Studies, and the Division of General Internal Medicine, University of California, San Francisco.
Footnotes
Reprint requests to Program in Medical Ethics, Center for AIDS Prevention Studies, Division of General Internal Medicine, University of California, 521 Parnassus Ave, Room C 126, San Francisco, CA 94143-0903 (Dr Lo).
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