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Modeling Outcomes Using Sequential Organ Failure Assessment (SOFA) Score-Based Ventilator Triage Guidelines During the COVID-19 Pandemic.
Cuartas, Pablo Alberto; Tavares Santos, Heitor; Levy, Benjamin M; Gong, Michelle Ng; Powell, Tia; Chuang, Elizabeth.
  • Cuartas PA; Albert Einstein College of Medicine, Bronx, NY, USA.
  • Tavares Santos H; Division of Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY, USA.
  • Levy BM; Albert Einstein College of Medicine, Bronx, NY, USA.
  • Gong MN; Division of Critical Care Medicine, Division of Pulmonary Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
  • Powell T; Montefiore Einstein Center for Bioethics.
  • Chuang E; Department of Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
Disaster Med Public Health Prep ; : 1-11, 2022 Feb 14.
Article in English | MEDLINE | ID: covidwho-1683844
ABSTRACT

OBJECTIVE:

To model performance of sequential organ failure assessment (SOFA) score-based ventilator allocation guidelines during the COVID-19 pandemic.

METHODS:

A retrospective cohort study design was used. Study sites included three New York City hospitals in a single academic medical center. We included a random sample (205) of adult patients intubated (1002) from 3/25/20-4/29/20. Protocol criteria adapted from New York State's 2015 guidelines were applied to determine which patients would have had mechanical ventilation withheld or withdrawn.

RESULTS:

117 (57%) patients would have been identified for ventilator withdrawal or withholding, based on the triage guidelines. Of those 117 patients, 28 (24%) survived hospitalization. Overall, 65 (32%) patients survived to discharge.

CONCLUSIONS:

Triage protocols aim to maximize survival by redirecting ventilators to those most likely to survive. Over half of this sample would have been identified as candidates for ventilator exclusion. Clinical judgment would therefore still be needed in ventilator reallocation, re-introducing bias and moral distress. These data suggest limited utility for SOFA score-based ventilator rationing. This raises the question of whether there is sufficient ethical justification to impose a life-ending decision based on a SOFA scoring method on some patients to offer potential benefit to a modest number of others.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Disaster Med Public Health Prep Journal subject: Public Health Year: 2022 Document Type: Article Affiliation country: Dmp.2022.37

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Disaster Med Public Health Prep Journal subject: Public Health Year: 2022 Document Type: Article Affiliation country: Dmp.2022.37