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January 11, 1995

When Is CPR Futile?

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.

JAMA. 1995;273(2):156-158. doi:10.1001/jama.1995.03520260078037

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

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