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Modeling Outcomes Using Sequential Organ Failure Assessment (SOFA) Score-Based Ventilator Triage Guidelines During the COVID-19 Pandemic

Published online by Cambridge University Press:  14 February 2022

Pablo Alberto Cuartas*
Affiliation:
Albert Einstein College of Medicine, Bronx, NY, USA
Heitor Tavares Santos
Affiliation:
Division of Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY, USA
Benjamin M Levy
Affiliation:
Albert Einstein College of Medicine, Bronx, NY, USA
Michelle Ng Gong
Affiliation:
Division of Critical Care Medicine, Division of Pulmonary Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
Tia Powell
Affiliation:
Montefiore Einstein Center for Bioethics
Elizabeth Chuang
Affiliation:
Department of Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
*
Corresponding author: Pablo Alberto Cuartas, Email: Pablo.cuartas@einsteinmed.org.

Abstract

Objective:

To model performance of the Sequential Organ Failure Assessment (SOFA) score-based ventilator allocation guidelines during the COVID-19 pandemic.

Methods:

A retrospective cohort study design was used. Study sites included 3 New York City hospitals in a single academic medical center. We included a random sample (205) of adult patients who were intubated (1002) from March 25, 2020, till April 29, 2020. Protocol criteria adapted from the New York State’s 2015 guidelines were applied to determine which patients would have had mechanical ventilation withheld or withdrawn.

Results:

117 (57%) patients would have been identified for ventilator withdrawal or withholding based on the triage guidelines. Of those 117 patients, 28 (24%) survived hospitalization. Overall, 65 (32%) patients survived to discharge.

Conclusion:

Triage protocols aim to maximize survival by redirecting ventilators to those most likely to survive. Over 50% of this sample would have been identified as candidates for ventilator exclusion. Clinical judgment would therefore still be needed in ventilator reallocation, thus re-introducing bias and moral distress. This data suggests limited utility for SOFA score-based ventilator rationing. It raises the question of whether there is sufficient ethical justification to impose a life-ending decision based on a SOFA scoring method on some patients in order to offer potential benefit to a modest number of others.

Type
Brief Report
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

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