Scarce-Resource Allocation and Patient Triage During the COVID-19 Pandemic: JACC Review Topic of the Week

Abstract

The COVID-19 pandemic and its sequelae have created scenarios of scarce medical resources, leading to the prospect that health care systems have faced or will face difficult decisions about triage, allocation, and reallocation. These decisions should be guided by ethical principles and values, should not be made before crisis standards have been declared by authorities, and, in most cases, will not be made by bedside clinicians. Do not attempt resuscitation and withholding and withdrawing decisions should be made according to standard determination of medical appropriateness and futility, but there are unique considerations during a pandemic. Transparent and clear communication is crucial, coupled with dedication to provide the best possible care to patients, including palliative care. As medical knowledge about COVID-19 grows, more will be known about prognostic factors that can guide these difficult decisions.

Keywords: COVID-19; end of life; ethics; palliative care; resource allocation.

Graphical abstract

Central Illustration

Framework for Understanding Standards of Care Implications During Pandemic Conditions Conventional and contingency standards of care do not involve decisions about allocation or reallocation of resources. Under crisis standard of care, as declared by regional authorities, in most circumstances triage teams will make decisions. However, cardiovascular clinicians at the bedside play a crucial role in providing care, conducting advance care planning, explaining the process of allocation and triage, and determining the appropriateness or futility of medical interventions, including resuscitative measures.