Improving Ventilator Rationing Through Collaboration With Experts on Resource Allocation

Pathak, Parag A.; Sönmez, Tayfun; Ünver, M. Utku

doi:10.1001/jamanetworkopen.2020.12838

Cited by 9 publications

(7 citation statements)

References 6 publications

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“…However, the accuracy of such scoring systems in predicting survivability is being debated, and it has been suggested that other factors might need to be considered when making the decision of to whom a ventilator should be allocated, and more importantly, of who to remove from such treatment. 30 Our findings suggest that laypersons might share similar or even more difficult dilemmas. For example, it seems that the participants in our study were unable to discriminate between the chances for survivability of an older person who was cognitively intact and a young person with cognitive deterioration.…”

Section: Discussionmentioning

confidence: 67%

Laypersons’ Priority-Setting Preferences for Allocating a COVID-19 Patient to a Ventilator: Does a Diagnosis of Alzheimer’s Disease Matter?

Werner¹,

Landau²

2020

CIA

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Purpose The current study aimed 1) to assess laypersons’ priority-setting preferences for allocating ventilators to COVID-19 patients with and without AD while differentiating between a young and an old person with the disease, and 2) to examine the factors associated with these preferences. Methods A cross-sectional online survey was conducted among a sample of 309 Israeli Jewish persons aged 40 and above. Results Overall, almost three quarters (71%) of the participants chose the 80-year-old patient with a diagnosis of AD to be the last to be provided with a ventilator. The preferences of the remaining quarter were divided between the 80-year-old person who was cognitively intact and the 55-year-old person with AD. Education and subjective knowledge about AD were significantly associated with participants’ preferences. Conclusion Our results suggest that cognitive status might not be a strong discriminating factor for laypersons’ preferences for allocating ventilators during the COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 67%

Laypersons’ Priority-Setting Preferences for Allocating a COVID-19 Patient to a Ventilator: Does a Diagnosis of Alzheimer’s Disease Matter?

Werner¹,

Landau²

2020

CIA

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“…In such reserve systems, valuable resources are reserved for specific categories of individuals (eg, those from disadvantaged zip codes) and triage decisions are deployed within but not between categories. 39 , 40 This approach has been successfully used for human organ donation and public school voucher programs. 41 Another proposal incorporates measures of social disadvantage into allocation guidelines.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of the Sequential Organ Failure Assessment Score for In-Hospital Mortality by Race and Relevance to Crisis Standards of Care

et al. 2021

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IMPORTANCE Crisis Standards of Care (CSC) are guidelines for rationing health care resources during public health emergencies. The CSC adopted by US states ration intensive care unit (ICU) admission using the Sequential Organ Failure Assessment (SOFA) score, which is used to compare expected in-hospital mortality among eligible patients. However, it is unknown if Black and White patients with equivalent SOFA scores have equivalent in-hospital mortality.OBJECTIVE To investigate whether reliance on SOFA is associated with bias against Black patients in CSC. DESIGN, SETTING, AND PARTICIPANTSThis cohort study was conducted using data from the eICU Collaborative Research Database of patients admitted to 233 US ICUs in 2014 to 2015. Included individuals were Black and White adult patients in the ICU, who were followed up to hospital discharge. Data were analyzed from May 2020 through April 2021.EXPOSURE SOFA scores at ICU admission. MAIN OUTCOMES AND MEASURESHierarchical logistic regression with hospital fixed effects was used to measure the interaction between race and SOFA as a factor associated with in-hospital mortality, as well as the odds of death among Black and White patients with equivalent priority for resource allocation according to the SOFA-based ranking rules of 3 statewide CSC (denoted A, B, and C) under shortage conditions that were severe (ie, only patients with the highest priority would be eligible for allocation), intermediate (ie, patients in the highest 2 tiers would be eligible for allocation), or low (ie, only patients with the lowest priority would be at risk of exclusion). RESULTS Among 111 885 ICU encounters representing 95 549 patients, there were 16 688 encounters with Black patients (14.9%) and 51 464 (46.0%) encounters with women and the mean (SD) age was 63.3 (16.9) years. The median (interquartile range) SOFA score was not statistically significantly different between Black and White patients (4 [2-6] for both groups; P = .19), but mortality was lower among Black individuals compared with White individuals with equivalent SOFA scores (odds ratio [OR], 0.98; 95% CI, 0.97-0.99; P < .001). This was associated with lower mortality among Black patients compared with White patients prioritized for resource allocation in 3 CSC under shortage conditions that were severe

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“…However, the accuracy of such scoring systems in predicting survivability is debated, and it has been suggested that other factors should be considered when deciding to whom a ventilator should be allocated, and more importantly, who should be removed from such treatment. 38 …”

Section: Discussionmentioning

confidence: 99%

“…First, clear triaging protocols should be developed to assure that all ethical principles are considered (even if not finally implemented), especially for patients with AD or other type of dementia. 38 These protocols should include objective measures to assess survivability. Second, to ease the moral and clinical difficulties of triaging in general and especially for persons with AD, we suggest decisions should be made by a team or a committee.…”

Section: Discussionmentioning

confidence: 99%

Examining hospital staff members' preferences for allocating a ventilator to a COVID-19 patient with and without Alzheimer's disease

Idilbi

AboJabel

2021

Geriatric Nursing

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Improving Ventilator Rationing Through Collaboration With Experts on Resource Allocation

Cited by 9 publications

References 6 publications

Laypersons’ Priority-Setting Preferences for Allocating a COVID-19 Patient to a Ventilator: Does a Diagnosis of Alzheimer’s Disease Matter?

Laypersons’ Priority-Setting Preferences for Allocating a COVID-19 Patient to a Ventilator: Does a Diagnosis of Alzheimer’s Disease Matter?

Accuracy of the Sequential Organ Failure Assessment Score for In-Hospital Mortality by Race and Relevance to Crisis Standards of Care

Examining hospital staff members' preferences for allocating a ventilator to a COVID-19 patient with and without Alzheimer's disease

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