Is it always wrong to perform futile CPR?

n engl j med 362;6 nejm.org february 11, 2010 477 care can be hard to define, in some circumstances experienced clinicians can be virtually certain that attempts at resuscitation will fail. In these cases, many argue that hospitals should adopt policies that allow physicians to refuse when families demand futile cardiopulmonary resuscitation (CPR). Several years ago, I cared for a 2-year-old boy who had been born with a large frontal encephalocele. He survived surgical excision but was left neurologically devastated. The clinical team consistently counseled his parents that he would never have any meaningful neurologic development. We recommended redirecting his care toward comfort and palliation. The parents rejected all these suggestions. I came to know the family fairly well through the boy’s multiple admissions to the intensive care unit (ICU) where I am a physician. Despite extensive and continual efforts by everyone involved to support the family and reach an agreement to limit aggressive treatment, the parents continued to insist that everything be done. I vividly recall the evening when, a few minutes after a “code blue” was called over the hospital intercom, I watched this little boy being rolled in through the doors of the ICU. He appeared chalky and lifeless; I remember thinking that he might already be dead. Still, mindful of his father’s unyielding refusal to consider a “do not resuscitate” order, I instructed the staff to attempt resuscitation. We ventilated the boy through his tracheostomy and made multiple unsuccessful attempts to place central venous and intraosseous lines. After perhaps 15 minutes, I asked the team to stop. I pronounced the boy dead. None of us felt good about what had just happened. One of the nurses later told me that it had been so upsetting she had had to fight back the urge to vomit. I went to talk to the parents. They had arrived at the hospital a short time after the code blue was called and were holding their little boy. I fully expected to be on the receiving end of an angry tirade full of accusations about our failure to keep their son alive. Instead, the mood was remarkably quiet and somber, as they began Is It Always Wrong to Perform Futile CPR?