A catalogue of tools and variables from crisis and routine care to support decision-making about allocation of intensive care beds and ventilator treatment during pandemics: Scoping review

• Published in: Journal of critical care 2021-12, Vol.66, p.33-43
• Main Authors: Cardona, Magnolia, Dobler, Claudia C., Koreshe, Eyza, Heyland, Daren K., Nguyen, Rebecca H., Sim, Joan P.Y., Clark, Justin, Psirides, Alex
• Format: Article
• Language: English
• Subjects: COVID-19; COVID-19 pandemic; Decision making; Healthcare rationing; Intensive care; Mortality; Pandemics; Review; Triage; Ventilation; Ventilator
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2021.08.001

This scoping review sought to identify objective factors to assist clinicians and policy-makers in making consistent, objective and ethically sound decisions about resource allocation when healthcare rationing is inevitable. Review of guidelines and tools used in ICUs, hospital wards and emergency departments on how to best allocate intensive care beds and ventilators either during routine care or developed during previous epidemics, and association with patient outcomes during and after hospitalisation. Eighty publications from 20 countries reporting accuracy or validity of prognostic tools/algorithms, or significant correlation between prognostic variables and clinical outcomes met our eligibility criteria: twelve pandemic guidelines/triage protocols/consensus statements, twenty-two pandemic algorithms, and 46 prognostic tools/variables from non-crisis situations. Prognostic indicators presented here can be combined to create locally-relevant triage algorithms for clinicians and policy makers deciding about allocation of ICU beds and ventilators during a pandemic. No consensus was found on the ethical issues to incorporate in the decision to admit or triage out of intensive care. This review provides a unique reference intended as a discussion starter for clinicians and policy makers to consider formalising an objective a locally-relevant triage consensus document that enhances confidence in decision-making during healthcare rationing of critical care and ventilator resources. •Many health services have been overwhelmed by the COVID-19 pandemic•Clinicians may require guidance to make the difficult decisions on allocation of ICU beds and ventilators.•This review offers objective clinical guidance beyond preparedness, resource allocation, equity and social justice principles.•There is no consensus on the ethical issues associated with ICU triage decisions.