Admission triage tool for adult intensive care unit admission in Hong Kong during the COVID-19 outbreak.

Intensive care is expensive, and the numbers of intensive care unit (ICU) beds and trained specialist medical staff able to provide services in Hong Kong are limited. The most recent increase in coronavirus disease 2019 (COVID-19) infections over July to August 2020 resulted in more than 100 new cases per day for a prolonged period. The increased numbers of critically ill patients requiring ICU admission posed a capacity challenge to ICUs across the territory, and it may be reasonably anticipated that should a substantially larger outbreak occur, ICU services will be overwhelmed. Therefore, a transparent and fair prioritisation process for decisions regarding patient ICU admission is urgently required. This triage tool is built on the foundation of the existing guidelines and framework for admission, discharge, and triage that inform routine clinical practice in Hospital Authority ICUs, with the aim of achieving the greatest benefit for the greatest number of patients from the available ICU resources. This COVID-19 Crisis Triage Tool is expected to provide structured guidance to frontline doctors on how to make triage decisions should ICU resources become overwhelmed by patients requiring ICU care, particularly during the current COVID-19 pandemic. The triage tool takes the form of a detailed decision aid algorithm based on a combination of established prognostic scores, and it should increase objectivity and transparency in triage decision making and enhance decision-making consistency between doctors within and across ICUs in Hong Kong. However, it remains an aid rather than a complete substitute for the carefully considered judgement of an experienced intensive care clinician.

The impacts on bystander and dispatcher-assisted cardiopulmonary resuscitation during COVID-19 pandemic

Purpose: The impact of emerging infections disease pandemic such as COVID-19 on bystander CPR performance is not well known. Materials-and-methods: This was an observational database prospectively collected from National Registry for DACPR (dispatcher-assisted CPR), a continuous quality control for OHCA by audio records analyses of EMS calls. The performance of DACPR before and after the COVID-19 epidemic was compared among four individual EMS systems (three metropolitan and one suburban). The bystander chest compressions (BCC) rate prior to the call, successful delivery of BCC after dispatcher-assisted, and the continuity of CC until hand-over by the paramedics after arrival (HCC) as the categorical indicators, and the operational time interval corresponding to call-to-compression were evaluated and analyzed using Pearson's chi-squared test, Independent t-test, and Kruskal–Wallis test with SPSS Version 22. Results: In a total of 3263 eligible patients from four EMS systems, for patients already receiving BCC prior to the call, though showing a tendency of decrease, there were no significant differences after the epidemics (A: 3.6% vs. 5.7%, p = 0.13;B: 4.5% vs. 6.1%, p = 0.46;C: 6.0% vs. 6.6%, p = 0.71;D: 6.8% vs. 10.7%, p = 0.59;Total: 4.9% vs. 6.4%, p = 0.11). For dispatcher-assisted BCC delivery, a metropolitan (B) significantly decreased and the suburban (D) significantly increased (A: 55.0% vs. 56.1%, p = 0.72;B: 41.8% vs. 52.3%, p = 0.03;C: 60.6% vs. 56.5%, p = 0.19;D: 83.0% vs. 60.2%, p < 0.01;Total: 56.8% vs. 55.6%, p = 0.53). For continuity of HCC, a metropolitan(C) and the suburban (D) both significantly increased as well as the total cases (A: 43.9% vs. 46.4%, p = 0.43;B: 28.5% vs. 31.0%, p = 0.56;C: 54.0% vs. 40.0%, p < 0.01;D: 77.4% vs. 59.3%, p = 0.02;Total: 47.4%vs.41.3%, p < 0.01). For call-to-compression interval, all regions showed a tendency to be faster without significance (A: 185 vs. 189 s, p = 0.8;B: 141 vs. 156 s, p = 0.19;C: 173 vs. 182 s, p = 0.12;D: 156 vs. 171 s, p = 0.27;Total: 164 vs. 172 s, p = 0.19). Conclusions: The impacts of COVID-19 pandemic showed a tendency to decrease BCC prior to dispatcher-assisted, and were significantly varied for dispatcher-assisted BCC among different EMS systems, however the timely BCC would not be delayed. Continuity of BCC even significantly increased under the national continuous auditing.