ReviewResuscitation plus2026
Reimagining resuscitation ethics: a narrative review and emergent ethical pathways model.
Review in Resuscitation plus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Decision-making surrounding cardiopulmonary resuscitation (CPR) presents persistent ethical challenges in acute and critical care. Existing evidence points to ambiguous do-not-resuscitate pathways, moral distress, family-driven demands, and systemic pressures, yet these influences are often examined separately. This review synthesizes current evidence to clarify the ethical, relational, and organizational dynamics that influence CPR-related decisions. Methods: We conducted a structured narrative review of four databases (Web of Science, PubMed, Scopus, Embase) for studies published between 2020 and 2025. Eligible studies included. Data was analyzed using reflexive thematic analysis. Results: Twenty-two studies were included. Seven interrelated themes emerged: (1) Futility, inappropriate and symbolic CPR; (2) Moral distress, emotional burden and moral residue; (3) Ethical ambiguity and unclear decision pathways; (4) Hierarchy, power and constrained nursing moral agency; (5) Family influence, cultural and religious norms, and truth-telling practices; (6) Systemic, legal and organizational drivers of ethically problematic practice; and (7) Ethical competence, moral sensitivity, advocacy and ethics support. Together, these findings informed the development of an Ethical Pathways Model (EPM) that conceptually depicts how contextual, relational, and individual determinants may converge to shape ethical decision trajectories in resuscitation and how conflicted pathways may contribute to symbolic or non-beneficial CPR and clinician moral distress. Conclusions: Ethical challenges in resuscitation are largely system-produced rather than individual failings. The EPM offers an integrative conceptual framework that may help inform clearer policies, strengthen communication, and guide the development of accessible ethics support to promote more value-concordant resuscitation care and reduce clinician moral distress.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.