This editorial describes the recommendations and ethical approach of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) in response to scarcity of critical care resources in Italy during COVID-19 response.

Italy suffered one of the earliest and most severe COVID-19 outbreaks, resulting in resource scarcity as ICU capacity was overwhelmed in some northern areas of the country. The SIAARTI recommendations aim to prioritize likelihood of survival with intervention and maintenance of quality of life in making allocation decisions when resources are insufficient to treat all patients who may benefit. The recommendations emphasize that this approach is only appropriate once all possible attempts have been made to increase availability of resources or to safely transfer patients to other facilities.

Th SIAARTI recommendations base triage decisions on a patient’s age, comorbidities, and functional status, with the stated goal of saving limited resources for those with much greater probability of survival and life expectancy to maximize benefits for the largest number of people. The explicit inclusion of age among allocation criteria notably distinguishes these recommendations from many others, including those of many US states and other entities, which more frequently rely on measures such as Sequential Organ Failure Assessment (SOFA) score or Clinical Frailty Scale (CFS) score. Such measures are often associated with age but attempt to better account for the heterogeneity of the aging process. However, several ethical frameworks for scarce resource allocation do include age as a factor in distinguishing between patients with similar initial assessment scores.