2026 American Academy of Neurology Abstract Website

Objective:

To investigate provider attitudes towards CPR and medical futility, and to compare perceptions of futile CPR versus other procedures.

Background:

Cardiopulmonary resuscitation (CPR) has historically been offered by default to all hospitalized patients, regardless of prognosis, unless a do-not-resuscitate (DNR) order is explicitly documented. Ethical concerns regarding autonomy and non-maleficence arise when CPR is performed on patients with devastating injuries. Prior studies show significant heterogeneity in physician attitudes towards medical futility.

Design/Methods:

An electronic survey was distributed to critical care providers at a tertiary academic medical center. Questions focused on experiences with futile CPR and procedures, perceptions of their frequency, their opinion on refusing futile care, and views on unilateral DNR orders.

Results:

43 (12.5%) responses were obtained, including 21 attendings (48.8%), 5 fellows (11.6%), and 17 residents (39.5%) across neurology (41.9%), pulmonary critical care (32.5%), medicine (11.6%), surgery (11.6%), and neurosurgery (2.3%). All providers reported participating in futile care, 81.3% had performed futile CPR and 69.7% futile procedures. 46.5% believe futile CPR is performed 'often' or 'very frequently' versus 11.6% that believe futile procedures/surgeries are performed frequently. Refusal of futile procedures and CPR were supported by 97% and 86%, respectively. 53% believe providers should be permitted to place a DNR order without the consent of the patient or surrogate. Critical care physicians showed the strongest support for unilateral DNRs (78.6%) compared with neurologists (44%) and surgeons (20%). Fear of litigation (90.7%) was frequently cited as a reason for delivering futile care, as was perceived benefit to the patients’ families (90.7%) to know all efforts were made to care for the patient.

Conclusions:

CPR is viewed as futile more often than procedures and surgeries. While most providers agree that they should not perform CPR when deemed futile, fewer providers support placing DNR orders without the consent of the patient or surrogate.