Prioritisation of ICU treatments for critically ill patients in a COVID-19 pandemic with scarce resources

Leclerc, Thomas; Donat, Nicolas; Donat, Alexis; Pasquier, Pierre; Libert, Nicolas; Schaeffer, Elodie; D’Aranda, Erwan; Cotté, Jean; Fontaine, Bruno; Perrigault, Pierre François; Michel, Fabrice; Muller, Laurent; Meaudre, Éric; Veber, Benoît

doi:10.1016/j.accpm.2020.05.008

Cited by 70 publications

(81 citation statements)

References 20 publications

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“…There was a debate in many countries about the prioritization of critical care for patients who will get the most benefit to save the highest number of lives. 20 Thus, it is crucial to determine who would benefit most from intensive care and ventilator support and allocation of scarce resources. 21 However, this concept is both practically and ethically challenging.…”

Section: Discussionmentioning

confidence: 99%

The role of Frailty on Adverse Outcomes Among Older Patients with COVID-19

Kundi

Çetin

Canpolat

et al. 2020

Journal of Infection

103

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Background: Diagnosis and screening of frailty, a condition characterized by an increased vulnerability to adverse outcomes of COVID-19, has emerged as an essential clinical tool which is strongly recommended by healthcare providers concerned with hospitalized elderly population. The data showing the role of frailty in patients infected with COVID-19 is needed. Methods: This was a nationwide cohort study conducted at all hospitals in Turkey. All COVID-19 hospitalized patients (≥ 65 years) were included. Patients who were alive and not discharged up to July 20, 2020, were excluded. The frailty was assessed by using the "Hospital Frailty Risk Score" (HFRS). Patients were classified into three risk groups of frailty based on previously validated cut points as low (< 5 points), intermediate (5-15 points), and high (> 15 points). Additionally, patients who had the HFRS of ≥5 were defined as frail. The primary outcome was in-hospital mortality rates by frailty group.

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Section: Discussionmentioning

confidence: 99%

The role of Frailty on Adverse Outcomes Among Older Patients with COVID-19

Kundi

Çetin

Canpolat

et al. 2020

Journal of Infection

103

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“…A fundamental principle underpinning all pandemic responses is the maximisation of benefit from scarce resources [6]. Resource scarcity and resource saturation are fluid judgements, relying on continual cycles of appraisal, integrating real-time data, and epidemiological projections [8]. Maximising benefit refers not only to enhancing survival in individuals, but also to extending this opportunity to as many patients as possible or most appropriate candidates to benefit from.…”

Section: Ethical Considerationsmentioning

confidence: 99%

“…Currently, identifying patients with the greatest potential to benefit from this resourceintense intervention is limited by the evolving understanding of the natural history of COVID-19 and the ability to prognosticate at an individual patient level. Finally, increased demand for critical care resources, the institution of crisis standards, and limitations on staffing and equipment are forcing the critical care community to confront the ethical boundaries between individual patient benefit, distributive justice, and resource allocation [6][7][8]. Rational decision-making must prevail in order to maximise both individual patient, and societal benefits.…”

Section: Introductionmentioning

confidence: 99%

Provision of ECPR during COVID-19: evidence, equity, and ethical dilemmas

et al. 2020

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The use of extracorporeal cardiopulmonary resuscitation (ECPR) to restore circulation during cardiac arrest is a timecritical, resource-intensive intervention of unproven efficacy. The current COVID-19 pandemic has brought additional complexity and significant barriers to the ongoing provision and implementation of ECPR services. The logistics of patient selection, expedient cannulation, healthcare worker safety, and post-resuscitation care must be weighed against the ethical considerations of providing an intervention of contentious benefit at a time when critical care resources are being overwhelmed by pandemic demand.

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“…The marked declines in presentations of acute coronary and cerebrovascular syndromes are contributed to by impaired healthcare accessibility from over-stretched emergency services and fear of exposure to COVID-19 at medical facilities. 2 These trends similarly impact patients with chronic diseases, threatening to impair long-term control, and perpetuate late detection of complications or deterioration in clinical condition.…”

mentioning

confidence: 99%