Triage of Scarce Critical Care Resources in COVID-19 An Implementation Guide for Regional Allocation

Maves, Ryan C; Downar, James; Dichter, Jeffrey R.; Hick, John L.; Devereaux, Asha V.; Geiling, James; Kissoon, Niranjan; Hupert, Nathaniel; Niven, Alexander S.; King, Mary A.; Rubinson, Lewis; Hanfling, Dan; Hodge, James G.; Marshall, Mary Faith; Fischkoff, Katherine; Evans, Laura; Tonelli, Mark R.; Wax, Randy S.; Seda, Gilbert; Parrish, John S.; Truog, Robert D.; Sprung, Charles L.; Christian, Michael D.

doi:10.1016/j.chest.2020.03.063

Cited by 255 publications

(194 citation statements)

References 28 publications

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“…Consistent with recommendations in Canada and the United States, respondents supported triage protocols and multidisciplinary "triage teams" compared to a single "triage o cer" and valued the availability of a bioethicist. 1,2,15 Critical care physicians favored excluding the MRP from these teams,…”

Section: Discussionmentioning

confidence: 99%

Canadian Emergency Medicine and Critical Care Physician Perspectives on Pandemic Triage in COVID-19

Mulla

Bigham

Frolic

et al. 2020

Preprint

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Purpose: Local and regional policies to guide the allocation of scarce critical care resources have been developed, but the views of prospective users are not understood. We sought to investigate the perspectives of Canadian acute care physicians towards triaging scarce critical care resources in the COVID-19 pandemic. Methods: We rapidly deployed a brief survey to Canadian emergency and critical care physicians in April 2020 to investigate current attitudes towards triaging scarce critical care resources and identify subsequent areas for improvement. Descriptive and between-group analyses along with thematic coding were used.Results: The survey was completed by 261 acute care physicians. Feelings of anxiety related to the pandemic were common (65%), as well as fears of psychological distress if required to triage scarce resources (77%). Only 49% of respondents felt confident in making resource allocation decisions. Both critical care and emergency physicians favored multidisciplinary teams over single physicians to allocate scarce critical care resources. Critical care physicians were supportive of decision making by teams not involved in patient care (3.4/5 vs 2.9/5 p=0.04), whereas emergency physicians preferred to maintain their involvement in such decisions (3.4/5 vs 4.0/5 p=0.007). Free text responses identified five themes for subsequent action including the need for further guidance on existing triage policies, ethical support in decision making, medico-legal protection, additional tools for therapeutic communications, and healthcare provider psychological support. Conclusion: There is an urgent need for collaboration between policymakers and frontline physicians to develop critical care resource triage policies that wholly consider the diversity of provider perspectives across practice environments.

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Section: Discussionmentioning

confidence: 99%

Canadian Emergency Medicine and Critical Care Physician Perspectives on Pandemic Triage in COVID-19

Mulla

Bigham

Frolic

et al. 2020

Preprint

Self Cite

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“…These unnecessary cares will impose a signi cant nancial burden on patients and healthcare systems. Rapid triage of patients is also a critical factor, required to manage high patient loads [23]. However, an important downside of routine rapid triage in a pandemic situation is the increased mortality rate due to missing high-risk patients [11].…”

Section: Discussionmentioning

confidence: 99%

Early detection of COVID-19 mortality risk using non-invasive clinical characteristics

Mahdavi

Choubdar

Zabeh

et al. 2020

Preprint

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With no effective treatment currently available and maximum preventive measures already in place, more interventions in the clinical field are needed to decrease COVID-19 patient mortality. Early prediction of mortality risk in COVID-19 patients can decrease mortality by assuring efficient resource allocation and treatment planning. This study conducts an early prediction of COVID-19 prognosis using laboratory, clinical, and demographic data collected from patients in the first day of admission. Three machine learning models were developed to investigate and compare the prediction power of invasive and noninvasive biomarkers. The results suggest that early mortality prediction of patients via non-invasive biomarkers provides significant accuracy and can be used as a triage assisting tool without the need for additional costs or waiting time of laboratory tests.

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“…Thus, data on the prognosis of patients with COVID-19 is needed to update and improve existing protocols. However, these data may be unavailable due to the short period since the onset of the disease [33].…”

Section: Instrumentsmentioning

confidence: 99%

COVID-19: instruments for the allocation of mechanical ventilators—a narrative review

et al. 2020

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After the World Health Organization declared COVID-19 to be a pandemic, the elaboration of comprehensive and preventive public policies became important in order to stop the spread of the disease. However, insufficient or ineffective measures may have placed health professionals and services in the position of having to allocate mechanical ventilators. This study aimed to identify instruments, analyze their structures, and present the main criteria used in the screening protocols, in order to help the development of guidelines and policies for the allocation of mechanical ventilators in the COVID-19 pandemic. The instruments have a low level of scientific evidence, and, in general, are structured by various clinical, non-clinical, and tiebreaker criteria that contain ethical aspects. Few instruments included public participation in their construction or validation. We believe that the elaboration of these guidelines cannot be restricted to specialists as this question involves ethical considerations which make the participation of the population necessary. Finally, we propose seventeen elements that can support the construction of screening protocols in the COVID-19 pandemic.

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Triage of Scarce Critical Care Resources in COVID-19 An Implementation Guide for Regional Allocation

Cited by 255 publications

References 28 publications

Canadian Emergency Medicine and Critical Care Physician Perspectives on Pandemic Triage in COVID-19

Canadian Emergency Medicine and Critical Care Physician Perspectives on Pandemic Triage in COVID-19

Early detection of COVID-19 mortality risk using non-invasive clinical characteristics

COVID-19: instruments for the allocation of mechanical ventilators—a narrative review

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