The Toughest Triage — Allocating Ventilators in a Pandemic

COVID-19 for the Cardiologist

“…Maximizing benefit ideally involves preserving the most lives as well as the most life-years, acknowledging the importance of prognosis. While the practical application of these principles is challenging, there appears to be general agreement across the literature on a number of concepts (160,163,164) Most recommend development of a triage or scoring system that accounts for acute and pre-morbid prognosis in order to allocate scarce resources to those who are most likely to benefit. The scoring system should utilize objective clinical information, in order to minimize the need for clinical judgement and the risk of introducing inconsistency and bias.…”

Treating hypoxemic patients with SARS-COV-2 pneumonia: Back to applied physiology

“…Thus, any therapy and procedures that could prevent intubation and MV, or enhance MV weaning, without further deterioration of the patient's parlous state would be welcome. The present approach seems rational in a situation where we are facing terrible challenges in the provision of ICU beds and ventilators (9). All procedures seem justified as long as they do not obscure clinical detection of the need for MV and does not increase the transmission dynamics of COVID-19 by aerosol-generating procedures (in absence of protective equipment for healthcare professionals).…”

Critical Care During the Coronavirus Crisis: Challenges and Considerations for the Cardiothoracic and Vascular Anesthesia Community

“…1; 22-25 Mechanical ventilators are an essential part of the hardware line for the critical care surge response to COVID-19 and as such may have to be triaged during the crisis phase of the pandemic. 26 The Center for Disease Control has recently issued guidance for the allocation of ventilators across a health care region. [27][28] The first recommendation is to assess the ventilator demand based on data-tracking and subsequent modeling to predict the number of patients that will likely require ventilation.…”

“…The third recommendation is to consider equitable access across the health region, including factors such vulnerable populations, high-risk populations, and referral centers. [24][25][26][27][28] The fourth consideration is to develop and apply an ethical framework to maximize patient salvage with transparent and consistent criteria, given the limited resources. [24][25][26][27][28] The concept of sharing a single ventilator for multiple patients has also been proposed as a solution to increase ventilator capacity during this coronavirus crisis.…”

“…[24][25][26][27][28] The fourth consideration is to develop and apply an ethical framework to maximize patient salvage with transparent and consistent criteria, given the limited resources. [24][25][26][27][28] The concept of sharing a single ventilator for multiple patients has also been proposed as a solution to increase ventilator capacity during this coronavirus crisis. [30][31] A device for sharing a ventilator in this fashion has recently received emergency approval from the Food and Drug Administration in the United States.…”