This article reports on guidelines released by Northwell Health, one of New York state’s largest hospital systems, outlining institutional processes for allocating ventilators toward patients most likely to benefit should the need arise due to resource scarcity.
According to the article, the guidelines recommend that medical teams reevaluate intubated patients on ventilators if an adequate supply of ventilators is not available to treat all patients:
- Patients with advanced illnesses (also including patients who have been readmitted to a hospital more than 3 times in the past 6 months) should be reevaluated after 3 days if they show no clinical improvement.
- Patients with prior advanced health problems should be reevaluated after 7 days if they show no clinical improvement.
- Otherwise healthy patients should be evaluated after 7 days.
- If a patient does not improve, clinical teams should consult palliative care specialists and the hospital clinical triage team to discuss whether extubation is appropriate.
- In general, patient and resource evaluation and documentation should occur daily due to frequent fluctuations in patient needs and available resources.
The memo also advises that patients who are likely to die regardless of medical assistance should not be offered interventions such as CPR and intubation and that patients who are not intubated or who are extubated will receive palliative care to manage or prevent pain and other symptoms.
According to the article, the Northwell guidelines may be updated to match standards currently being developed in New York state. New York released ventilator allocation guidelines focused on influenza pandemic situations in 2015 (available here). Those state guidelines incorporate evidence-based clinical data and ethical guidance with the primary goal of saving the most lives when there is a limited supply of available ventilators. The 2015 guidelines include periodic clinical assessment at 48 and 120 hours using SOFA (Sequential Organ Failure Assessment) score as the primary indicator of prognosis, improvement or deterioration, and likelihood of survival and focus explicitly on a patient’s short-term likelihood of surviving the acute medical episode (as opposed to long-term survival).