This forthcoming article (currently in pre-proof) discusses scarce resource allocation planning for a public health emergency with a specific focus on extracorporeal membrane oxygenation (ECMO), used to treat severe respiratory failure.
The authors note that ECMO has only recently been considered as part of proactive disaster preparedness planning, which is crucial to avoid ad hoc decision-making during an emergency in which critical resources become scarce. ECMO can be an appropriate and potentially life-saving therapy for coronavirus-associated pneumonia, as well as other conditions, but its availability is inconsistent and lacking in regional coordination.
The authors recommend planning and coordination efforts that ensure:
- Clinical decision support tools are available in advance and adaptable to the circumstances
- All participating hospitals are aware of the situation
- Specialty resources are directed to those most likely to benefit
- Expert clinicians are involved in decision-making.
The authors recommend that in the event of scarcity, ECMO resources should be allocated to prioritize patients with conditions that have historically better outcomes and shorter expected duration of support. Allocation decisions should be made using a framework determined in advance with broad input from subject experts, ethics committees, health systems, and the community. The authors offer specific recommendations based on experiences coordinating resources across five ECMO centers in Minnesota.