Title: CPR in the COVID-19 Era — An Ethical Framework
Publication Date: 06 May 2020
Key Takeaways: The authors feel that it is important that clinicians acknowledge resource constraints when discussing goals of care and DNR status with patients. It may be appropriate to withhold CPR in certain circumstances: 1) if ventilators or critical care beds are not available or patient is not eligible to them due to fair triage process or 2) if the patient’s condition is deteriorating significantly despite provision of critical care, or 3) the institution determines that staffing shortages are so severe that the deployment of a typical code team would jeopardize outcomes for other patients.
Ventilator Rationing Literature:
Title: Crisis Standard of Care Recommendations for Triaging Critical Resources During the COVID-19 Pandemic
Publisher: Society of Critical Care Medicine
Publication Date: Not provided
Key Takeaway: The Society of Critical Care Medicine proposes recommendations for allocatoin of resources during Covid-19 pandemic at three levels of institutional capacity; conventional, contingency and crisis.
Title: Universal Do-Not-Resuscitate Orders, Social Worth, and Life-Years: Opposing Discriminatory Approaches to the Allocation of Resources During the COVID-19 Pandemic and Other Health System Catastrophes
Publisher: American College of Physicians
Publication Date: April 24, 2020
Key Takeaway: This article reviews several proposed approaches for decision-making during a time of limited resources and applies standards of ethical decision-making. No guidelines given.
Title: Ventilator Allocation Guidelines
Publisher: New York State Department of Health
Publication Date: November 2015
Key Takeaway: This 2015 document is an update of a 2005 New York State guidance on use of ventilators if/when shortages occur. This was developed for the H1N1 Pandemic Influenza.
Title: Too Many Patients…A Framework to Guide Statewide Allocation of Scarce Mechanical Ventilation During Disasters
Publication Date: April 2019
Key Takeaway: The authors propose a strategy for ventilator allocation in epidemics of novel respiratory pathogens that uses a scoring system comprised of 4 elements: 1) likelihood of short-term survival based on a sequential organ failure assessment (SOFA) score and 2) likelihood of long-term survival (based on presence of comorbid conditions).
Title: COVID-19 Ethics Resource Center
Publisher: American Medical Association Journal of Ethics
Publication: Continuously updated
● A collection of AMA resources and writings meant to promote ethical reflection around challenges including rationing of limited health care resources, restriction of individual movement and liberties, and the professional duty to treat in the face of personal danger.
Title: Ethics in the Time of Coronavirus: Recommendations in the COVID-19 Pandemic
Publication: Journal of the American College of Surgeons, April 1, 2020
Key Takeaway: Recommendations for several of the most pressing ethical challenges of the novel coronavirus (COVID-19) pandemic:
Title: Too many patients…A framework to guide statewide allocation of scarce mechanical ventilation during disasters.
Publication: Chest, April, 2019
Key Takeaway: How to ration ventilators: This is a multi-year Johns Hopkins study (following Katrina) involving doctors and laymen to create a scoring system using Sequential Organ Failure Assessment (SOFA), severity of comorbidities, and age to determine who gets a ventilator.
National Academies Rapid Expert Consultation on the Crisis Standards of Care
Advance Care Planning and DNR