A framework for critical care triage during a major surge in critical illness

During the COVID-19 pandemic, many jurisdictions experienced surges in demand for critical care that strained or overwhelmed their healthcare system’s ability to respond. A major surge necessitates a deviation from usual practices, including difficult decisions about how to allocate critical care re...

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Bibliographic Details
Published in:Canadian journal of anesthesia 2022-06, Vol.69 (6), p.774-781
Main Authors: Downar, James, Smith, Maxwell J., Godkin, Dianne, Frolic, Andrea, Bean, Sally, Bensimon, Cecile, Bernard, Carrie, Huska, Mary, Kekewich, Mike, Ondrusek, Nancy, Upshur, Ross, Zlotnik-Shaul, Randi, Gibson, Jennifer
Format: Article
Language:English
Subjects:
Anesthesiology
Bioethics
Cardiology
Coronaviruses
COVID-19
Critical Care
Critical Care Medicine
Critical Illness - therapy
Decision making
Feedback
Health sciences
Hospitals
Human rights
Humans
Illnesses
Intensive
Medicine
Medicine & Public Health
Pain Medicine
Pandemics
Pandemics - prevention & control
Pediatrics
Pneumology/Respiratory System
Public health
SARS-CoV-2
Special
Special Article
Triage
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Summary:During the COVID-19 pandemic, many jurisdictions experienced surges in demand for critical care that strained or overwhelmed their healthcare system’s ability to respond. A major surge necessitates a deviation from usual practices, including difficult decisions about how to allocate critical care resources. We present a framework to guide these decisions in the hope of saving the most lives as ethically as possible, while concurrently respecting, protecting, and fulfilling legal and human rights obligations. It was developed in Ontario in 2020–2021 through an iterative consultation process with diverse participants, but was adopted in other jurisdictions with some modifications. The framework features three levels of triage depending on the degree of the surge, and a system for prioritizing patients based on their short-term mortality risk following the onset of critical illness. It also includes processes aimed at promoting consistency and fairness across a region where many hospitals are expected to apply the same framework. No triage framework should ever be considered “final,” and there is a need for further research to examine ethical issues related to critical care triage and to increase the extent and quality of evidence to inform critical care triage.
ISSN:0832-610X
1496-8975
DOI:10.1007/s12630-022-02231-2