Validation of a Crisis Standards of Care Model for Prioritization of Limited Resources During the Coronavirus Disease 2019 Crisis in an Urban, Safety-Net, Academic Medical Center*

Nadjarian, Albert; LeClair, Jessica; Mahoney, Taylor F.; Awtry, Eric H.; Bhatia, Jasvinder S.; Caruso, Lisa B.; Clay, Alexis; Greer, David M.; Hingorani, Karan S.; Horta, Laila; Ibrahim, Michel A.; Ieong, Michael H.; James, Thea; Kulke, Matthew H.; Lim, Remington; Lowe, Robert; Moses, James; Murphy, Jaime; Nozari, Ala; Patel, Aneesh; Silver, Brent; Theodore, Arthur C.; Wang, Ryan Shufei; Weinstein, Ellen M.; Wilson, Stephen; Cervantes‐Arslanian, Anna M.

doi:10.1097/ccm.0000000000005155

Cited by 3 publications

(7 citation statements)

References 11 publications

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“…CSC are usually designed for a specific situation in a given setting, and synthetic analysis of previous CSC (24) is not helpful for physicians due to the extreme heterogeneity of studied situations. In anticipation of future pandemics, multiple mathematical models have been applied using data derived from previous COVID waves (6)(7)(8)25) but only retrospectively. With the goal of promoting simplicity, we were mainly inspired by CSC used by military physicians.…”

Section: Discussionmentioning

confidence: 99%

“…A task force was rapidly created to develop local guidelines and to define the allocation of ICU resources, with the goal of ensuring appropriate and fair decision-making regarding ICU transfer during the surge. This kind of strategy has previously been described as crisis standards of care (CSC) (6). Numerous CSC have been described (2, 7), and the best model is still heavily debated.…”

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confidence: 99%

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

Pommier

Martino

Delamare

et al. 2022

Critical Care Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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

Pommier

Martino

Delamare

et al. 2022

Critical Care Medicine

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“…Novel coronavirus disease 2019 (COVID-19) involves lung tissue injury and often causes respiratory failure that requires mechanical ventilation (MV) [ 1 , 2 ]. As the pandemic of COVID-19 has significantly depleted medical resources worldwide, the allocation of patients to appropriate places, such as the intensive care unit (ICU), general ward, and home, is needed to prevent unfavorable clinical outcomes due to insufficient treatment [ 3 , 4 ]. However, quick oxygenation deterioration has been reported in patients with COVID-19 compared to other lung diseases.…”

Section: Introductionmentioning

confidence: 99%

Threshold of increase in oxygen demand to predict mechanical ventilation use in novel coronavirus disease 2019: A retrospective cohort study incorporating restricted cubic spline regression

et al. 2022

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Background Rapid deterioration of oxygenation occurs in novel coronavirus disease 2019 (COVID-19), and prediction of mechanical ventilation (MV) is needed for allocation of patients to intensive care unit. Since intubation is usually decided based on varying clinical conditions, such as required oxygen changes, we aimed to elucidate thresholds of increase in oxygen demand to predict MV use within 12 h. Methods A single-center retrospective cohort study using data between January 2020 and January 2021was conducted. Data were retrieved from the hospital data warehouse. Adult patients diagnosed with COVID-19 with a positive polymerase chain reaction (PCR) who needed oxygen during admission were included. Hourly increments in oxygen demand were calculated using two consecutive oxygen values. Covariates were selected from measurements at the closest time points of oxygen data. Prediction of MV use within 12 h by required oxygen changes was evaluated with the area under the receiver operating curves (AUCs). A threshold for increased MV use risk was obtained from restricted cubic spline curves. Results Among 66 eligible patients, 1835 oxygen data were analyzed. The AUC was 0.756 for predicting MV by oxygen demand changes, 0.888 by both amounts and changes in oxygen, and 0.933 by the model adjusted with respiratory rate, PCR quantification cycle (Ct), and days from PCR. The threshold of increments of required oxygen was identified as 0.44 L/min/h and the probability of MV use linearly increased afterward. In subgroup analyses, the threshold was lower (0.25 L/min/h) when tachypnea or frequent respiratory distress existed, whereas it was higher (1.00 L/min/h) when viral load is low (Ct ≥20 or days from PCR >7 days). Conclusions Hourly changes in oxygen demand predicted MV use within 12 h, with a threshold of 0.44 L/min/h. This threshold was lower with an unstable respiratory condition and higher with a low viral load.

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“…This article (12) comes with several limitations. The small number of patients who fell into the major/severe categories in general and the even smaller number assessed for individual comorbidities make the observed mortality rates unreliable.…”

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confidence: 99%

“…In this context, Nadjarian et al (12) bring us their article published in this issue of Critical Care Medicine . Using a retrospective case review, they aimed to assess the validity of 1- and 5-year mortality predictions for several chronic diseases (end-stage renal disease, cirrhosis, malignancy, heart failure, neurodegenerative conditions, and chronic lung disease) based on criteria developed within their institution using multidisciplinary input (Table 1 [12]). The authors reviewed adult cases admitted to the medical, surgical, neurologic, and cardiac ICUs from April 1–15 in 2015 and 2019.…”

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confidence: 99%

Assessing Accuracy and Equity in Crisis Standards of Care*

Peterson

Green

2021

Critical Care Medicine

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Validation of a Crisis Standards of Care Model for Prioritization of Limited Resources During the Coronavirus Disease 2019 Crisis in an Urban, Safety-Net, Academic Medical Center*

Abstract: Supplemental Digital Content is available in the text.

Cited by 3 publications

References 11 publications

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

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

Threshold of increase in oxygen demand to predict mechanical ventilation use in novel coronavirus disease 2019: A retrospective cohort study incorporating restricted cubic spline regression

Assessing Accuracy and Equity in Crisis Standards of Care*

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