{"id":3874,"date":"2020-06-14T12:10:18","date_gmt":"2020-06-14T11:10:18","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3874"},"modified":"2020-06-15T10:47:07","modified_gmt":"2020-06-15T09:47:07","slug":"pandemic-priority-decisions-and-triage-from-good-to-ugly","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/06\/14\/pandemic-priority-decisions-and-triage-from-good-to-ugly\/","title":{"rendered":"Pandemic priority decisions and triage, from good to ugly"},"content":{"rendered":"

By Hans Flaatten, Michael Beil, and Susannah Leaver.<\/p>\n

The present COVID-19 pandemic has fuelled discussions regarding the prospects and limitations of treatment in critically ill patients. This commentary <\/a>describes a framework for understanding pandemic triage ranging from \u201cbusiness as usual\u201d (\u201cgood\u201d) to the extreme depletion of all resources (\u201cugly\u201d). This is illustrated with different stages based on the combination of patient numbers and available resources in intensive care. These variables move simultaneously in opposite directions. We describe triage changing from being patient centered (egalitarian) to society oriented (utilitarian). Further, we challenge societies and government to develop triage rules based upon what would be acceptable from their perspective, rather than transferring this responsibility to the medical profession.<\/p>\n

The COVID-19 pandemic has opened a \u201cPandora\u2019s Box\u201d with regard to triage decisions and has demonstrated how strange and unpleasant the content can be. Also, in some countries in Europe we have glimpsed a look into this \u201cbox\u201d<\/a>. Criteria for ICU admission at the peak have been far from usual practice in European ICUs, with some apparently using age as a single criterion for ICU admission. This differs from common practice but is also understandable. The old have \u201clived their life\u201d compared to young individuals who may have more than half their expected lifespan before them.<\/p>\n

Within the European Society of Intensive Care Medicine (ESICM) we have for some years had a research group focusing on the outcomes of the very old ICU patients (\u226580 years). Through several large prospective cohort studies throughout Europe (the VIP-studies)<\/a>, we investigated which factors are important to understand survival in this patient group. The aim is to create ICU admission criteria in patients ><\/u>80 years old based on their chances of survival as well as the quality of life in those who survived. There is still a lot to learn, but our understanding increases with each study, based on enthusiasm and interest for the topic. We have consistently demonstrated that pre-existing frailty is an important predictor of survival, and that other geriatric issues such as cognitive impairment, reduced activities of daily living and comorbidities seem to offer little additional value for prognostication.<\/p>\n

When this pandemic started our research-group was interested to follow how the elderly patients faired, since it was postulated early on that old age was a \u201crisk factor\u201d. However, data showing that age was indeed an independent risk factor was less well documented. We therefore commenced a study (COVIP) of elderly COVID-19 patients (\u226570 years) in Europe and some Mediterranean countries, again collecting data on frailty and markers of severity of the disease. This study is now nearing completion. The study group have had a weekly \u201czoom-meeting\u201d to discuss this and ethical issues surrounding triage of COVID-19 patients. It quickly became apparent that we did not have a unified view on triage within Europe, and some otherwise very sophisticated countries even lacked guidelines! It seems that most countries not severely hit by the COVID-wave managed triage differently from those that \u201cdrowned\u201d.<\/p>\n

 <\/p>\n

Paper title: <\/strong>The good, the bad and the ugly: pandemic priority decisions and triage<\/a><\/p>\n

Blog post authors and affiliations<\/strong>:\u00a0<\/span><\/p>\n

Hans Flaatten, Department of Anaesthesia and intensive care, Haukeland University Hospital, Bergen, Norway<\/p>\n

Michael Beil, General Intensive Care Unit, Haddassah Medical Center, Jerusalem, Israel<\/p>\n

Susannah Leaver, Intensive Care and Respiratory Medicine, St George’s NHS Foundation Trust, London UK<\/p>\n

Competing interests<\/strong>: None<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

By Hans Flaatten, Michael Beil, and Susannah Leaver. The present COVID-19 pandemic has fuelled discussions regarding the prospects and limitations of treatment in critically ill patients. This commentary describes a framework for understanding pandemic triage ranging from \u201cbusiness as usual\u201d (\u201cgood\u201d) to the extreme depletion of all resources (\u201cugly\u201d). This is illustrated with different stages […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":354,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8070],"tags":[],"class_list":["post-3874","post","type-post","status-publish","format-standard","hentry","category-pandemic"],"yoast_head":"\nPandemic priority decisions and triage, from good to ugly - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/06\/14\/pandemic-priority-decisions-and-triage-from-good-to-ugly\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Pandemic priority decisions and triage, from good to ugly - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Hans Flaatten, Michael Beil, and Susannah Leaver. The present COVID-19 pandemic has fuelled discussions regarding the prospects and limitations of treatment in critically ill patients. This commentary describes a framework for understanding pandemic triage ranging from \u201cbusiness as usual\u201d (\u201cgood\u201d) to the extreme depletion of all resources (\u201cugly\u201d). 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