• Journal of critical care · Dec 2021

    Review

    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.

    • Magnolia Cardona, Claudia C Dobler, Eyza Koreshe, Daren K Heyland, Rebecca H Nguyen, Joan P Y Sim, Justin Clark, and Alex Psirides.
    • Institute for Evidence-Based Healthcare, Bond University Gold Coast, Queensland, Australia; Gold Coast University Hospital Evidence-Based Practice Professorial Unit, Southport, Queensland, Australia. Electronic address: mcardona@bond.edu.au.
    • J Crit Care. 2021 Dec 1; 66: 33-43.

    PurposeThis 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.Materials And MethodsReview 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.ResultsEighty 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.ConclusionsThis 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.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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