Who gets the ventilator? A multicentre survey of intensivists' opinions of triage during the first wave of the COVID‐19 pandemic

Fjølner, Jesper; Haaland, Øystein Ariandsen; Jung, Christian; Lange, Dylan W. de; Szczeklik, Wojciech; Leaver, Susannah; Guidet, Bertrand; Sviri, Sigal; Heerden, Peter Vernon van; Beil, Michael; Hartog, Christiane S.

doi:10.1111/aas.14094

Cited by 12 publications

(9 citation statements)

References 50 publications

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“…19 Under normal circumstances, even mechanical ventilation, a common treatment option for ARDS, has guidelines that do not apply to patients over a certain age or in critical conditions because of a lack of equipment and manpower in countries such as Italy that had a sudden COVID-19 outbreak. [20][21][22] Moreover, the cautious application of ECMO in patients who are younger and for whom it could be more effective is highly likely. In South Korea, guideline recommendations regarding the indication for initiating ECMO were established by KDCA and doctors in 2020.…”

Section: Discussionmentioning

confidence: 99%

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Extracorporeal Membrane Oxygenation Support and Critically Ill COVID-19 Patient Outcomes: A Population-Based Cohort Study

Kyu Oh,

Song

2023

ASAIO Journal

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We selected critically ill patients with coronavirus disease 2019 (COVID-19) who were receiving extracorporeal membrane oxygenation (ECMO) support and had been transferred to experienced centers. Thus, we aimed to evaluate factors that were associated with receiving ECMO support and factors that were associated with patient mortality. Using data from the National Health Insurance Service and Korea Disease Control and Prevention Agency in South Korea, adult patients admitted to an intensive care unit from October 8, 2020, to December 31, 2021, with a main diagnosis of COVID-19 were included. They were divided into two groups: ECMO group (n = 455) and non-ECMO group (n = 12,648). Receiving ECMO support was less associated with old age [odds ratio (OR), 0.95; 95% confidence interval (CI), 0.94–0.96; p < 0.001], underlying severe disabilities (OR, 0.49; 95% CI, 0.29–0.83; p = 0.008), and booster vaccination status (second: OR, 0.61; 95% CI, 0.39–0.94; p = 0.024; third: OR, 0.40; 95% CI, 0.25–0.65; p < 0.001). In addition, after adjusting for various variables, low mortality in patients with ECMO support was associated with having previously received a second booster vaccination (OR, 0.33; 95% CI, 0.14–0.77; p = 0.010). Vaccination and booster therapy may lower the need for ECMO support and lower mortality among critically ill patients with COVID-19 with ECMO support.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation Support and Critically Ill COVID-19 Patient Outcomes: A Population-Based Cohort Study

Kyu Oh,

Song

2023

ASAIO Journal

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“…In the beginning phase of the pandemic, when intensive care units (ICUs) were rapidly overwhelmed by large numbers of infected patients, difficult decisions must be made on who should be admitted (to be saved) and who should be left on the ward (to die). There were widespread reports that in triage decision-making, chronological age was used against older patients in favour of younger patients (Anderson & Philpot, 2022; Fjølner et al, 2022). It would be unfair to attribute these life-or-death decisions solely to institutional ageism, because pragmatic and utilitarian considerations are inevitably involved in allocating scarce ICU resources.…”

Section: Pandemic Exacerbates Ageismmentioning

confidence: 99%

COVID-19 Pandemic and Positive Ageing

Cheung

2023

Psychology and Developing Societies

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Given the havoc of the worldwide coronavirus disease-2019 (COVID-19) pandemic on the older population, this article outlines a positive ageing framework for understanding and assuaging the havoc. Positive ageing follows the dual ageing ethics of living positively for self (maintaining health and functional independence) and for the betterment of others (other individuals and society at large). However, it suffers from the pandemic because the pandemic exacerbates ageism, impedes vaccine uptake and erodes social networks that have been an important resource and source of human connectedness and support for elders. The suffering thus amplifies the havoc of the pandemic on elders’ physical, psychological and social health. Preventing that suffering and advancing positive ageing, possibly by cultivating social networks and through social reforms to harness the silver demographic dividend of older workers for post-pandemic national recovery, are advisable, considering extant and emerging research evidence.

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“…Decisions to withhold or withdraw life-sustaining treatment (LST) in the intensive care unit (ICU) are considered appropriate if there is no reasonable expectation of beneficial outcome [ 1 ]. However, the evaluation of prognostic information and benefit of critical care for the individual patient varies depending on a number of factors which can be related or unrelated to the individual patient, such as cultural norms and resource constraints [ 2 – 6 ]. Patient-related factors comprise the severity of the acute illness, comorbidities and, notably, old age [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

The role of clinical phenotypes in decisions to limit life-sustaining treatment for very old patients in the ICU

Mousai

Tafoureau

Yovell

et al. 2023

Ann. Intensive Care

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Background Limiting life-sustaining treatment (LST) in the intensive care unit (ICU) by withholding or withdrawing interventional therapies is considered appropriate if there is no expectation of beneficial outcome. Prognostication for very old patients is challenging due to the substantial biological and functional heterogeneity in that group. We have previously identified seven phenotypes in that cohort with distinct patterns of acute and geriatric characteristics. This study investigates the relationship between these phenotypes and decisions to limit LST in the ICU. Methods This study is a post hoc analysis of the prospective observational VIP2 study in patients aged 80 years or older admitted to ICUs in 22 countries. The VIP2 study documented demographic, acute and geriatric characteristics as well as organ support and decisions to limit LST in the ICU. Phenotypes were identified by clustering analysis of admission characteristics. Patients who were assigned to one of seven phenotypes (n = 1268) were analysed with regard to limitations of LST. Results The incidence of decisions to withhold or withdraw LST was 26.5% and 8.1%, respectively. The two phenotypes describing patients with prominent geriatric features and a phenotype representing the oldest old patients with low severity of the critical condition had the largest odds for withholding decisions. The discriminatory performance of logistic regression models in predicting limitations of LST after admission to the ICU was the best after combining phenotype, ventilatory support and country as independent variables. Conclusions Clinical phenotypes on ICU admission predict limitations of LST in the context of cultural norms (country). These findings can guide further research into biases and preferences involved in the decision-making about LST. Trial registration Clinical Trials NCT03370692 registered on 12 December 2017.

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Who gets the ventilator? A multicentre survey of intensivists' opinions of triage during the first wave of the COVID‐19 pandemic

Cited by 12 publications

References 50 publications

Extracorporeal Membrane Oxygenation Support and Critically Ill COVID-19 Patient Outcomes: A Population-Based Cohort Study

Extracorporeal Membrane Oxygenation Support and Critically Ill COVID-19 Patient Outcomes: A Population-Based Cohort Study

COVID-19 Pandemic and Positive Ageing

The role of clinical phenotypes in decisions to limit life-sustaining treatment for very old patients in the ICU

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