Existing Crisis Standards of Care Triage Protocols May Not Significantly Differentiate Between Patients With Coronavirus Disease 2019 Who Require Intensive Care

Abstract

Objectives: To determine how several existing crisis standards of care triage protocols would have distinguished between patients with coronavirus disease 2019 requiring intensive care. Design: Retrospective cohort study. Setting: Single urban academic medical center. Patients: One-hundred twenty patients with coronavirus disease 2019 who required intensive care and mechanical ventilation. Interventions: None. Measurements and Main Results: The characteristics of each patient at the time of ICU triage were used to determine how patients would have been prioritized using four crisis standards of care protocols. The vast majority of patients in the cohort would have been in the highest priority group using a triage protocol focusing on Sequential Organ Failure Assessment alone. Prioritization based on Sequential Organ Failure Assessment and 1-year life expectancy would have resulted in only slightly more differentiation between patients. Prioritization based on Sequential Organ Failure Assessment and 5-year life expectancy would have added significant additional differentiation depending on how priority groups were defined. Conclusions: There is considerable controversy regarding the use of criteria other than prognosis for short-term survival in initial allocation of critical care resources under crisis standards of care triage protocols. To the extent that initial triage protocols would not create sufficient differentiation between patients, effectively resulting in a first-come, first-served initial allocation of resources, it is important to focus on how resources would be reallocated in the event of ongoing scarcity.