Society of Critical Care Medicine Guidelines for the Allocation of Critical Care Resources to Adults During Crisis-Level Shortages

RATIONALE: Efficient distribution of scarce critical care resources is essential to save the most lives in times of crisis. Evidence-based practices and processes enhance clinical decision-making.

OBJECTIVES: The objective of these guidelines was to develop evidence-based, rather than expert-based, recommendations for triaging critically ill patients eligible for ICU admission during times of crisis-level shortages in ICU capacity.

DESIGN: The American College of Critical Care Medicine Board convened a 21-member multidisciplinary panel, comprising doctors in medicine, nursing, and law; advanced practice providers; respiratory therapists; ethicists; and patient/family representatives. The panel included two expert methodologists specialized in developing evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Conflict-of-interest policies were strictly followed during all phases of guidelines development including task force selection and voting.

METHODS: The panel members identified and formulated five fundamental Patient, Intervention, Comparator, and Outcomes questions. The panel conducted a systematic review for each question to identify the best available evidence, analyzed the evidence, and assessed the certainty of the evidence using the GRADE methodology. The GRADE evidence-to-decision framework was used to formulate the recommendations. Good practice statements were included to provide additional guidance.

RESULTS: The panel generated one conditional recommendation and five no recommendation statements.

CONCLUSIONS: Crisis-level shortages significantly disrupt patient care. Despite the role of triage in minimizing adverse outcomes, there is a lack of evidence, as opposed to expert opinion, to guide practice recommendations in the critical clinical scenarios considered by the panel.

Joseph L Nates, Namita Jayaprakash, Kallirroi Laiya Carayannopoulos, Kimia Honarmand, George L Anesi, Lisa Bartlett Davis, Megan E Brunson, Leon L Chen, Michael D Christian, Maryluz Fuentes, John J Gallagher, Christopher G Harrod, Valerie Gutmann Koch, William S Miles, Tsuyoshi Mitarai, Aliza M Narva, Charles L Sprung, Susan Stempek, Janice L Zimmerman, Bryan Boling, Corinna Sicoutris