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

https://doi.org/10.1016/j.jacc.2020.05.006Get rights and content
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Highlights

  • Difficult decisions about triage and allocation have arisen in the COVID-19 pandemic.

  • In a crisis, autonomy may become subordinate to maximize the number of lives saved.

  • Fairness involves equal access to scarce resources, ignoring factors unrelated to prognosis and maximizing benefit.

  • Transparent communication and palliative care are central to providing the best possible care to patients.

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.

Key Words

COVID-19
end of life
ethics
palliative care
resource allocation

Abbreviations and Acronyms

COVID-19
coronavirus disease-19
CPR
cardiopulmonary resuscitation
DNAR
do not attempt resuscitation
ICU
intensive care unit
PPE
personal protective equipment

Cited by (0)

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.

Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.