Catastrophic COVID-19 Delta Variant Surge in French West Indies: Report of an ICU Triage Policy*

Abstract

OBJECTIVES: Here, we report the management of a catastrophic COVID-19 Delta variant surge, which overloaded ICU capacity, using crisis standards of care (CSC) based on a multiapproach protocol. DESIGN: Retrospective observational study. SETTING: University Hospital of Guadeloupe. PATIENTS: This study retrospectively included all patients who were hospitalized for COVID-19 pneumonia between August 11, 2021, and September 10, 2021, and were eligible for ICU admission. Intervention: Based on age, comorbidities, and disease severity, patients were assigned to three groups: Green (ICU admission as soon as possible), Orange (ICU admission after the admission of all patients in the Green group), and Red (no ICU admission). MEASUREMENTS AND MAIN RESULTS: Among the 328 patients eligible for ICU admission, 100 (30%) were assigned to the Green group, 116 (35%) to the Orange group, and 112 (34%) to the Red group. No patient in the Green group died while waiting for an ICU bed, whereas 14 patients (12%) in the Orange group died while waiting for an ICU bed. The 90-day mortality rates were 24%, 37%, and 78% in the Green, Orange, and Red groups, respectively. A total of 130 patients were transferred to the ICU, including 79 from the Green group, 51 from the Orange group, and none from the Red group. Multivariate analysis revealed that among patients admitted to the ICU, death was independently associated with a longer time between ICU referral and ICU admission, the Sequential Organ Failure Assessment score, and the number of comorbidities, but not with triage group. CONCLUSIONS: CSC based on a multiapproach protocol allowed admission of all patients with a good prognosis. Higher mortality was associated with late admission, rather than triage group.

Putting ICU triage guidelines into practice: A simulation study using observations and interviews

“…The coronavirus disease 2019 (COVID-19) pandemic has, since its start in early 2020, overwhelmed healthcare systems all over the world [1][2][3][4]. Many patients with severe COVID-19 needed to be admitted to the intensive care unit (ICU): a hospital ward that can provide immediate life-saving care to patients who have, or are at risk of, life-threatening organ dysfunction, and which is staffed by specialized healthcare professionals.…”

Crisis Triage in the Era of COVID-19: Old Tools, New Approaches, and Unanswered Questions*

“…Emergency preparedness data are particularly scarce in resource-limited settings, including rural areas in resource-rich countries, low- and middle-income countries, and geographically isolated islands. Onto this stage, Pommier et al (11) present in this issue of Critical Care Medicine the results of real-world implementation of a novel CSC strategy on the island of Guadeloupe, a French protectorate in the Caribbean, during the height of the 2021 Delta variant surge (August 11–September 10). The investigators conducted a retrospective observational study at the University Hospital of Guadeloupe evaluating their COVID-19–specific ICU triage protocol.…”

“…In this case, the system described for access to an ICU bed applied only to patients with COVID-19, and there were significant numbers of non-COVID-19 patients competing for the same beds. The authors noted that CSC also were applied to non-COVID-19 patients, but ICU admission criteria were different (11). To leave these patients out of the allocation equation weakens the overall premise of the study.…”

“…Additionally, differences in 90-day mortality between groups were striking: 24%, 37%, and 78% among those in the green, orange, and red groups, respectively. Multivariate analysis revealed that among patients admitted to the ICU, mortality was independently associated not with the triage group assignment, but with a longer time between ICU referral and admission, Sequential Organ Failure Assessment score, and number of comorbidities (11).…”