How Common SOFA and Ventilator Time Trial Criteria Would Have Performed During the COVID-19 Pandemic: An Observational Simulated Cohort Study. (9th June 2023)

• Record Type: Journal Article
• Authors: Walsh, B. Corbett; Pradhan, Deepak; Mukherjee, Vikramjit; Uppal, Amit; Nunnally, Mark E.; Berkowitz, Kenneth A.
• Is Part Of: Disaster medicine and public health preparedness. Volume 17(2023)
• Publication Date: 2023-06-09
• Subjects: ethics -- resource allocation -- SARS-CoV-2 -- standard of care -- ventilator; Disaster medicine -- Periodicals; Emergency management -- Planning -- Periodicals; Public health -- Periodicals; 363.34
• DOI: 10.1017/dmp.2022.154
• Languages: English
• ISSNs: 1935-7893

Abstract

Abstract: Objectives: To evaluate how key aspects of New York State Ventilator Allocation Guidelines (NYSVAG)—Sequential Organ Failure Assessment score criteria and ventilator time trials —might perform with respect to the frequency of ventilator reallocation and survival to hospital discharge in a simulated cohort of coronavirus disease (COVID-19) patients. Methods: Single center retrospective observational and simulation cohort study of 884 critically ill COVID-19 patients undergoing ventilator allocation per NYSVAG. Results: In total, 742 patients (83.9%) would have had their ventilator reallocated during the 11-day observation period, 280 (37.7%) of whom would have otherwise survived to hospital discharge if provided with a ventilator. Only 65 (18.1%) of the observed surviving patients would have survived by NYSVAG. Extending ventilator time trials from 2 to 5 days resulted in a 49.2% increase in simulated survival to discharge. Conclusions: In the setting of a protracted respiratory pandemic, implementation of NYSVAG or similar protocols could lead to a high degree of ventilator reallocation, including withdrawal from patients who might otherwise survive. Longer ventilator time trials might lead to improved survival for COVID-19 patients given their protracted respiratory failure. Further studies are needed to understand the survival of patients receiving reallocated ventilators to determine whether implementation of NYSVAG would improve overall survival.