Peri-procedural code status discussions before bronchoscopy: a cross-sectional survey of German and Swiss pulmonologists

INTRODUCTION: In-hospital cardiac arrest is associated with poor outcomes, yet peri-procedural code status discussions before bronchoscopy may be inconsistent, particularly in patients with elevated procedural risk. METHODS: We conducted an anonymous online survey of a convenience sample of hospital-based pulmonologists in Germany and Switzerland between April and July 2025. The survey assessed routine practices and attitudes regarding peri-procedural code status discussions, risk stratification, and management of patients with pre-existing No-CPR status. Owing to distribution through multiple channels and secondary forwarding, a precise response rate could not be calculated. RESULTS: A total of 148 pulmonologists participated (mean age 47.8 years; 94.6% board-certified). Discussions regarding CPR preferences were conducted almost always or most of the time before high-risk bronchoscopies by 67.6% of respondents, but were rarely or almost never performed before low-risk procedures by 72.0%. Respondents more frequently reported procedural risk than patient-related factors as a trigger for these discussions. Peri-procedural No-CPR status was considered controversial by 44.9%, and responsibility for these discussions varied among respondents. Only 25% reported formal institutional training. CONCLUSIONS: Substantial variability exists in peri-procedural code status practices before bronchoscopy. Clearer responsibilities and structured guidance are needed to better align care with patient preferences.